Refers to various unpleasant physiological and psychological effects following the consumption of alcohol, such as wine, beer and distilled spirits.

The socioeconomic implications of an alcohol hangover include workplace absenteeism, impaired job performance, reduced productivity, poor academic achievement, and dangerous daily activities such as driving a car or operating heavy machinery.

After being ingested, ethanol in alcoholic beverages is first converted to acetaldehyde by the enzyme alcohol dehydrogenase and then to acetic acid by oxidation and egestion

It can last for several hours or for more than 24 hours.

Fifteen percent of men and women who have consumed alcohol experience hangovers at least monthly.

In a study of college students, 25% had experienced a hangover in the previous week and 29% reported losing school time for hangover recovery.

Factors involved in hangover include: acetaldehyde accumulation, changes in the immune system and glucose metabolism, dehydration, metabolic acidosis, disturbed prostaglandin synthesis, increased cardiac output, vasodilation, sleep deprivation and malnutrition.

There are specific effects to individual beverages or congeners that play an important role in hangover.

Hangover symptoms typically occur after the intoxicating effects of alcohol wears off, generally the morning after a night of heavy alcohol intake.

Hangover symptoms include: general malaise, thirst, headache, feeling dizzy or faint, tiredness, loss of appetite, nausea, stomach ache, tachycardia, changes in sleep pattern and gastrointestinal distress, drowsiness and impaired cognitive function.

Prevention: Avoiding alcohol or drinking in moderation are the most effective ways to avoid a hangover.

Hangovers associated with workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement.

Hangover symptoms develop when blood alcohol concentration falls considerably and peak when it returns to almost zero.

Complex organic molecules found in alcoholic beverages known as congeners may produce hangover effects because some, such as methanol, are metabolized to the notably toxic substances formaldehyde and formic acid.

The accumulation of acetaldehyde, the first metabolite of alcohol, accounts for alcohol’s flush reaction.

With exposure to alcohol there is a conversion of nicotinamide adenine dinucleotide (NAD+) to its reduced form NADH in a redox reaction making normal bodily functions more difficult.

Acetaldehyde increases the susceptibility to oxidative stress.

Alcohol induced redox changes include increased triglyceride production, increased amino acid catabolism, inhibition of the citric acid cycle, lactic acidosis, ketoacidosis, hyperuricemia, disturbance in cortisol and androgen metabolism and increased fibrogenesis.

No significant correlation between hangover severity and the concentrations of various hormones, electrolytes, free fatty acids, triglycerides, lactate, ketone bodies, cortisol, and glucose in blood and urine samples exist.

Alcohol induces the CYP2E1 enzyme, which metabolizes ethanol and other substances into more reactive toxins.

During binge drinking the enzyme CYP2E1 is activated and plays a role in creating a harmful condition known as oxidative stress which can lead to cell death.

Acetaldehyde, the first by-product of ethanol, is between 10 and 30 times more toxic than alcohol itself.

Acetaldehyde can remain elevated for many hours after initial ethanol consumption.

Certain genetic factors can amplify the negative effects of acetaldehyde: some people, predominantly East Asians, have a mutation in their alcohol dehydrogenase gene that makes this enzyme unusually fast at converting ethanol to acetaldehyde.

About half of all East Asians convert acetaldehyde to acetic acid more slowly causing a higher buildup of acetaldehyde than normally seen in other groups.

Such individuals that experience the alcohol flush or less likely to become alcoholics.

Clear liquors have a lower concentration of congeners.

Congeners include:amines, amides, acetones, acetaldehydes, polyphenols, methanol, histamines, fusel oil, esters, furfural, and tannins.

Congeners in alcoholic drinks are added as flavoring or as a by-product of fermentation and the wine aging process.

Congeners may potentially aggravate hangover.

Dark liquors have a higher concentration while clear liquors have a lower concentration of congeners.

Bourbon has a total congener content 37 times higher than that found in vodka.

Darker liquors, which have higher congeners, produce worse hangovers.

Methanol is a potent congener that is naturally formed in small quantities during fermentation, and can produce some toxic compounds, such as formaldehyde and formic acid, which may play a role in the severity of hangover.

Ethanol, however, slows the conversion of methanol into its toxic metabolites so that most of the methanol can be excreted harmlessly in the breath and urine without forming its toxic metabolites.

This is the explanation of the temporary postponement of symptoms reported in the common remedy of drinking more alcohol to relieve hangover symptoms.

Methanol metabolism is effectively inhibited by consumption of alcohol.

Methanol accumulates during drinking and only begins to be metabolized once ethanol has been cleared.

Correlations between methanol concentrations and the presence of hangover symptoms that have been found.

The metabolic processes required for alcohol elimination also depletes essential vitamins and electrolytes.

Alcohol is a diuretic, causing excretion of electrolytes through urination.

Ethanol’s dehydrating effect by causing increased urine production which could cause thirst, dry mouth, dizziness and may lead to an electrolyte imbalance.

Drinking, can result in a lack of key B and C vitamins, as well as potassium, magnesium, and zinc may cause fatigue, aching and other hangover-like symptoms.

Electrolyte changes play only a minor role in hangover and are caused by dehydration effects.

Drinking water may help relieve dehydration but is unlikely rehydration significantly reduces the presence and severity of alcohol hangover.

Alcohol intake on the stomach lining can account for nausea, as it stimulates the production of hydrochloric acid in the stomach.

Alcohol hangover is associated with a decrease in blood glucose concentration.

The relationship between blood glucose concentration and hangover severity is unclear.

Several cytokines have been found to be significantly increased in the blood after alcohol consumption including: interleukin 12 (IL-12), interferon gamma (IFNγ) and interleukin 10 (IL-10).

The immune system is involved with hangover and it is suggested symptoms can probably be reduced by administration of a cyclooxygenase inhibitor such as aspirin or ibuprofen.

Person-related factors are known to influence its severity include: personality, genetics, health status, age, sex, associated activities during drinking such as smoking, the use of other drugs, physical activity such as dancing, as well as sleep quality and duration.

There are genetic alleles associated with aldehyde dehydrogenase (ALDH) and alcohol flush reactions in Asians.

These genetic factors influence alcohol tolerance and the development of hangover.

Drinkers with genotypes known to lead to acetaldehyde accumulation are more susceptible to hangover effects.

Approximately 25% of heavy drinkers do not experience hangover, an indication that genetic variation plays a role in individual differences of hangover severity.

It is suspected hangovers get worse with age, caused likely by declining supplies of alcohol dehydrogenase, the enzyme involved in metabolizing alcohol.

Drinking patterns change across ages, with heavy drinking episodes resulting in hangover decreases as age increases.

Women are more prone to hangover than men, explained by differences in the pharmacokinetics of alcohol, as women attain a higher blood alcohol concentration (BAC) than men at the same number of drinks.

Acetaldehyde is absorbed from cigarette smoking during alcohol consumption is regarded as a contributor to alcohol hangover symptoms.

No evidence suggests that any conventional or complementary intervention is effective for preventing or treating alcohol hangover.

The most effective way to avoid the symptoms of hangover is to avoid drinking.

Rehydration before going to bed or during hangover may relieve dehydration-associated symptoms such as thirst, dizziness, dry mouth, and headache.

There is no evidence that non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen provide a benefit and there are concerns that taking alcohol and aspirin together may increase the risk of stomach bleeding and liver damage.

An estimated 9.23% of the U.S. labor force work experiences a hangover.

About 23% of drinkers do not report any hangover after drinking to intoxication.

The average annual opportunity cost due to hangovers are estimated as $2000 per working adult.

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