Alcohol Poisoning

Overview

Alcohol poisoning is a serious and potentially life-threatening condition that occurs when a large amount of alcohol is consumed in a short period of time, causing blood alcohol levels to rise to dangerous heights. The body can process alcohol only at a certain rate. When that rate is exceeded, alcohol builds up in the blood and places increasing pressure on the brain, nervous system, and vital organs.

Alcohol suppresses the central nervous system. In small amounts, this suppression is felt as relaxation and a loosening of inhibitions. At very high levels, however, essential life functions such as breathing, heart rate, and consciousness become compromised. At that point, a medical emergency is underway.

Alcohol poisoning can happen to anyone; not just those thought of as heavy drinkers. In young and inexperienced drinkers, in those who drink quickly on an empty stomach, and in people with a low body weight, even a smaller amount of alcohol can lead to serious poisoning. Alcohol poisoning is a medical emergency and requires calling for help without delay.

Symptoms

The symptoms of alcohol poisoning become more severe as blood alcohol levels rise. Some may be confused with ordinary intoxication, but the following signs indicate serious poisoning.

• Mental confusion and extreme drowsiness. The person may slip into a state that is very difficult to rouse, may be unable to respond to questions, or may become completely unresponsive to their surroundings.
• Vomiting. Vomiting is particularly dangerous in alcohol poisoning. As consciousness is suppressed, the gag reflex weakens and the person may choke on their own vomit.
• Seizures. When blood alcohol levels reach dangerous heights, seizures can occur.
• Slow or irregular breathing. Fewer than eight breaths per minute, or a pause of more than ten seconds between breaths, is a serious warning sign. Respiratory arrest can lead to death.
• Blue or purple tinge to the lips or fingernails. This can be a sign of insufficient oxygen intake.
• Drop in body temperature. Severe cooling of the body (hypothermia) is common in alcohol poisoning. The person may appear cold and pale.
• Loss of coordination. Inability to stand, falling, and loss of muscle control may be seen.
• Loss of consciousness. The person may lose consciousness entirely and become impossible to rouse.

One of the dangerous aspects of alcohol poisoning is that symptoms can continue to worsen even after drinking has stopped. Even after the stomach is empty, alcohol continues to be absorbed from the intestines, so blood alcohol levels can keep rising for some time.

When to Call Emergency Services

Do not wait if alcohol poisoning is suspected. Call emergency services immediately if any of the following are present:

• If the person cannot be roused or is unconscious, call for help right away.
• If breathing is slow, shallow, or irregular (or has stopped) call emergency services immediately.
• If the person is having a seizure, urgent help is essential.
• If there is a blue or pale tinge to the skin and the person feels cold, call for help.
• If the person is vomiting and is unconscious, urgent intervention is needed due to the risk of choking.

Do not leave the person alone while waiting for help to arrive. If they are unconscious, turn them onto their side; this position reduces the risk of choking if they vomit.

Causes and Risk Factors

The primary cause of alcohol poisoning is consuming too much alcohol too quickly. However, the same amount of alcohol does not have the same effect on everyone. Certain factors increase the risk.

• Speed of drinking. The liver can process approximately one standard drink per hour. When alcohol is consumed much faster than this, it accumulates in the blood.
• Drinking on an empty stomach. When alcohol is consumed without food, absorption happens much more rapidly and blood alcohol levels rise more quickly.
• Body weight and composition. In people with a lower body weight and a higher proportion of body fat, the same amount of alcohol leads to a higher blood alcohol level.
• Age. Young people (particularly adolescents) are more sensitive to the effects of alcohol. Inexperience also sets the stage for drinking too much too quickly.
• Sex. Women metabolize alcohol more slowly than men, and the same amount of alcohol reaches a higher blood level in women.
• Medication and substance use. Sleep medications, sedatives, and some pain relievers dramatically increase the suppressive effect on the central nervous system when taken alongside alcohol.
• Tolerance to alcohol. Regular drinkers develop tolerance and need more alcohol to feel an effect. This is not protective, however; blood alcohol levels can still reach dangerous heights.
• Type and strength of alcohol. Consuming high-strength drinks quickly raises blood alcohol levels much faster.

Diagnosis

Alcohol poisoning is assessed in the emergency department using clinical findings and tests.

• Physical examination. Level of consciousness, breathing rate and depth, pulse, body temperature, and coordination are all evaluated.
• Blood alcohol level measurement. A blood test directly measures the amount of alcohol in the blood. This measurement is important both for assessing the severity of the poisoning and for guiding treatment decisions.
• Blood and urine tests. Blood sugar levels, electrolyte balance, and kidney and liver function are assessed. A dangerous drop in blood sugar is a common complication of alcohol poisoning.
• Investigation for other substances. Whether other substances or medications are involved is investigated. This information is important for directing treatment.

Treatment

There is no specific antidote for alcohol poisoning. Treatment is supportive in nature and aimed at protecting vital functions.

• Respiratory support. If breathing is compromised, oxygen is given. In severe cases, mechanical ventilation may be needed.
• Fluid and electrolyte replacement. Intravenous fluids are given to correct dehydration and restore electrolyte balance.
• Correcting blood sugar. Alcohol interferes with the liver's ability to produce sugar. When blood sugar drops, glucose is administered intravenously.
• Maintaining body temperature. If hypothermia has developed, warming measures are taken.
• Close monitoring. The patient is closely monitored for breathing, pulse, consciousness, and blood values. If symptoms worsen, intervention is immediate.
• Stomach pumping. In some situations (particularly when a very large amount of alcohol was consumed very recently and the person is conscious) stomach pumping may be performed. This decision is made by the treating doctor.

There is no scientific evidence that any of the common beliefs about alcohol poisoning (giving coffee, putting the person in cold water, or making them walk around) actually lower blood alcohol levels. These approaches waste valuable time and can make the situation worse.

Prevention

Alcohol poisoning is largely a preventable condition.

• Drink slowly. Avoid consuming more than one standard drink per hour to avoid exceeding the rate at which the liver can process alcohol.
• Eat food. Eating before and during drinking slows absorption and prevents blood alcohol levels from rising too quickly.
• Drink water. Drinking water between alcoholic drinks slows absorption and reduces dehydration.
• Be careful with high-strength drinks. Drinks with a high alcohol content raise blood alcohol levels much more rapidly.
• Be careful if you take medications. Medications that act on the nervous system can interact dangerously with alcohol. Do not drink without first consulting your doctor.
• Watch out for others. If you notice someone you are with drinking excessively, step in. Do not hesitate to call for help if alcohol poisoning is suspected.

Preparing for Your Appointment

Alcohol poisoning typically results in an emergency department visit. However, being prepared is useful when attending a follow-up appointment after discharge, or when accompanying someone who has experienced alcohol poisoning.

What you can do:

• Share how much alcohol was consumed and over what period of time.
• Mention any other medications or substances that were used.
• Share whether anything similar has happened before.
• List any known health conditions and medications being taken.

Questions you can ask your doctor:

• Has any lasting damage been done to my organs?
• What symptoms should I watch for after discharge?
• Can I get support regarding my alcohol use?
• What can I do to make sure this does not happen again?

Your doctor may ask:

• How much alcohol was consumed and over what period of time?
• Were any other substances or medications involved?
• Has anything like this happened before?
• Are there any known health conditions or medications being taken?
• Is there a regular pattern of alcohol use?