Background: It is well known that ethanol can cause significant morbidity and mortality, and much of
the related toxic effects can be explained by its metabolic profile.
Objective: This work performs a complete review of the metabolism of ethanol focusing on both major and minor
Method: An exhaustive literature search was carried out using textual and structural queries for ethanol and related
known metabolizing enzymes and metabolites.
Results: The main pathway of metabolism is catalyzed by cytosolic alcohol dehydrogenase, which exhibits multiple isoenzymes and genetic
polymorphisms with clinical and forensic implications. Another two oxidative routes, the highly inducible CYP2E1 system and
peroxisomal catalase may acquire relevance under specific circumstances. In addition to oxidative metabolism, ethanol also originates
minor metabolites such as ethyl glucuronide, ethyl sulfate, ethyl phosphate, ethyl nitrite, phosphatidylethanol and fatty acid ethyl esters.
These metabolites represent alternative biomarkers since they can be detected several hours or days after ethanol exposure.
Conclusion: It is expected that knowing the metabolomics of ethanol may provide additional insights to better understand the toxicological
effects and the variability of dose response.