**3. Epidemiology**

218 Complementary Pediatrics

Ethanol is absorbed in the stomach or small bowel. Approximately 25% is absorbed directly from the stomach into the bloodstream; the remainder is absorbed by the small bowel. Ethanol cannot be stored; 90% up to 98% of it is broken down in the liver by oxidation. The other 2% to10% is removed directly via urine, breathed out through the lungs or excreted in sweat. Ethanol reaches its peak-blood-concentration within one hour, particularly when

Oxidation of ethanol takes place in two ways. Most of it is done by enzymes known as alcohol dehydrogenase (ADH), which produces acetaldehyde, and aldehyde dehydrogenase (ALDH), which transforms acetaldehyde into acetate, a non-toxic metabolite. In this process, hydrogen is transferred from nicotinamide adenine dinucleotide (NAD+) to become NADH (figure 1). Acetate is further metabolized through the citric-acid cycle and leaves the body as carbon dioxide and water. A small amount is processed via an alternative pathway, known as the 'microsomal ethanol-oxidizing system', using cytochrome P-450. In young people, this system is hardly used, as it is mainly activated in regular drinkers or when the level of

Different subtypes of ALDH exist within the human body. Mitochondrial ALDH-2 has the biggest affinity with alcohol. About 50 per cent of East-Asian people have a genetic variation which causes their ALDH enzyme not to work very well, resulting in accumulation of toxic

The kinetics of alcohol has several metabolic consequences. Due to a changed NAD+/NADH ratio, which inhibits gluconeogenesis, the glucose metabolism can be affected. If existing glycogen deposits have been used, this might lead to hypoglycaemia. Young persons with low glycogen levels are particularly at risk. In other situations alcohol may favor, rather than

In oxidation, several acid metabolites are being formed, such as lactate and hydroxyacid, which causes metabolic acidosis. In metabolic acidosis, renal potassium loss can cause hypokalaemia, which could be increased by vomiting. These metabolic alterations also favor liver damage. In practice, hypoglycaemia rarely occurs and acidosis is often mild (2) (see

inhibit, gluconeogenesis and may therefore cause hyperglycaemia (2).

**2. Physiology** 

ingested on an empty stomach.

alcohol is very high (1).

Fig. 1. Oxidation of Ethanol

also Acute Care chapter).

acetaldehyde.

Of all the substances, alcohol is –by far- the most popular product. Almost all secondary school students try out alcoholic beverages at least once before they leave school between the age of 16 and 18. The percentage of students who abstain in their secondary school period is constant at around 10% (ref). Between 50% and 60% of all students consume alcohol every month.

Over the past years, this percentage has been rather stable. Since 2003, the youngest students (12 – 14 years) show an increase in lifetime prevalence of alcohol use and previous month alcohol use, especially among girls. Girls also seem to become an increasing cause of concern on other scales. Since 2003, young girls (<15 years) engage in binge drinking more often and have the same frequency of drunkenness as young boys (3;4).

Monitoring alcohol related hospital admissions in the Netherlands is part of the Dutch Pediatric Surveillance System (NSCK). This unique and effective signaling system collects information on several predetermined diseases, disorders or symptoms in Dutch general and academic hospitals. Nearly all the Dutch pediatricians participate (92%). Adolescent alcohol use was included in 2007, and ever since it has been one of the leading topics of the system.

When a patient under the age of 18 is admitted because of alcohol related problems, the pediatrician in charge reports the case. Questionnaires are distributed to the pediatricians by mail or they can download them from the website. The questionnaire consists of four parts, exploring (1) previous alcohol use circumstances and hospital treatment, (2) patient characteristics, (3) alcohol use patterns, and (4) control variables.
