Alcohol Poisoning

By Laurence Degelsmith, MD
January 11, 2008

Acute alcohol intoxication can kill you.

This is especially true in young adults and teenagers who are not used to drinking and often find themselves at parties where alcohol is abundant and maturity is not. I would estimate from my experience as an emergency physician that well over half of all non-weather related motor vehicle accidents can be attributed to alcohol.

Drunk driving is a very serious problem, especially among teenagers and young adults. I can recall at least two dozen teenagers that I have treated in the emergency department or the ambulance during the last 12 months that were very lucky to survive their accidents. In just about every accident, most of which were rollovers, not only was the young driver intoxicated, but the passengers had been drinking as well. I always dread having to tell parents that their child was killed. Alcohol-related trauma is a topic in and of itself, but I would like to keep the focus of this article on the medical issues related to acute alcohol intoxication.

Who gets alcohol poisoning?

Acute alcohol poisoning occurs when someone drinks a large amount of alcohol over a short period of time. The risk of developing toxicity from alcohol depends on how much alcohol is ingested, what type of alcohol is ingested and how quickly it is absorbed into the body. The absorption rate is usually dependant on how much food is in the stomach, which can delay the absorption of alcohol. Acute alcohol poisoning is usually seen in individuals who are not used to drinking and can cause severe sickness and even death.

An average person can metabolize about one drink every hour. This means one beer, one glass of wine or one shot of hard alcohol can be imbibed, absorbed and metabolized by the liver without causing any major effects. Any amount more than that is likely to cause signs of intoxication. Drinking only a few drinks per hour is likely to cause intoxication and probably a bad hangover, but unlikely to cause acute alcohol poisoning.

We usually see acute poisoning in the individual who drinks half a bottle of hard alcohol at one time, usually on a bet or to show off to friends. Sometimes we see it in the teenager who drinks several glasses of punch at a party not realizing there was grain alcohol in the punch. Essentially, alcohol poisoning occurs when a person drinks much more than their body can metabolize and the effects of the alcohol overwhelm the body.

Signs of alcohol poisoning

Alcohol has a depressant effect on the nervous system throughout the body. It can affect the nerves that control breathing, heart activity, swallowing (and the gag reflex which prevents the aspiration of vomit into the lungs) and of course general alertness and consciousness. Alcohol also dilates blood vessels, which can cause a loss of heat from the body and the possibility of hypothermia, especially in cold weather.

Early signs of alcohol poisoning include vomiting, irregular breathing, confusion or decreased levels of consciousness, as evidenced by slow responsiveness, falling down and even passing out. The vomiting can become severe to the point of significant dehydration and low blood sugar. The combination of vomiting and a decreased gag reflex can also cause choking and aspiration of the vomitus into the lungs, which kills many people. Severe untreated alcohol poisoning is characterized by seizures, coma and possible respiratory and cardiac arrest. In other words, death.

Can doctors reverse alcohol poisoning?

When we see a patient with acute alcohol poisoning, we monitor their blood sugar, respiratory status, ability to maintain a gag reflex (which prevents aspiration) and hydration status. Occasionally, a patient is so intoxicated that we must put a tube down their throat to breath for them. I had to do this to a 15-year-old last year who drank too much at a party. Why the 15-year-old was drinking, in a state where the legal drinking age is 21, is another question altogether.

Just last weekend we had a 14-year-old and a 15-year-old brought in by ambulance who were both very intoxicated and couldn’t even stand up on their own. Almost every other week I see kids this age brought in for severe intoxication. Luckily, most of them just require intravenous fluids and medication to stop the continuous vomiting often caused by the alcohol.

A few, however, get pretty sick and might require more aggressive measures in the emergency department including intubation to support breathing and prevent aspiration into their lungs.

Unfortunately, medications such as activated charcoal and narcan, which are used for other types of overdoses, don’t work for alcohol. Pumping the stomach rarely works unless the patient recently drank a large amount that might still be in their stomach. Coffee or lots of water might help delay intoxication, but won’t reverse the effects of severe alcohol poisoning. Only time can reverse the effects of alcohol poisoning. Medical personnel can provide supportive measures to prevent and treat respiratory arrest, severe dehydration, hypoglycemia and hypothermia. Severe permanent brain injury is, however, possible from severe alcohol poisoning despite medical intervention.

Acute alcohol binging

There are a few other points to consider regarding acute alcohol binging. A person who falls asleep (or passes out) after recently drinking a significant amount of alcohol can be in real danger because the alcohol level in the body can continue to rise even while asleep, from the absorption of alcohol still in the stomach. It is therefore imperative to closely observe a person who passes out after just drinking a lot because he or she can stop breathing or vomit and not be awake enough to clear the vomit from his or her mouth, and will therefore choke to death. An additional fact to be aware of is that many over the counter and prescription medications can increase the depressant effects of alcohol. Some of these medications include sedatives, antihistamines, muscle relaxants and narcotics. Someone who is taking one of these medications won’t need to drink as much to experience symptoms of intoxication from alcohol and suffer from possible alcohol poisoning.

If you find yourself with a friend or acquaintance who might be at risk of alcohol poisoning because they recently drank a large amount and they are starting to become sleepy, it is very important to stay with them. If their breathing becomes irregular or they cannot be woken up they need medical attention immediately. If they start to vomit, lay them on their side and try to make sure that they clear the vomit from their mouth. Call 911 or get them to the hospital as soon as possible if they are not arousable.

Acute alcohol poisoning is a common and serious problem that can be prevented by the simple measure of drinking in moderation. One to two drinks per hour should be enough to enjoy the evening and not end up on a ventilator in the intensive care unit.

Chronic alcoholics

We see a fair number of alcohol-related medical complaints in the emergency department each week. By my estimation, about half of the patients who present to the emergency department intoxicated are chronic alcoholics. We rarely worry about the chronic alcoholic from an acute medical standpoint since their bodies are used to the toxic effects of the alcohol. These patients, once evaluated for signs of trauma or acute medical conditions, are usually allowed to sleep off their acute intoxicated state and are discharged once they can walk without falling down.

Many chronic alcoholics actually present to us with alcohol levels up to seven times the 0.08 legal limit for driving. A chronic alcoholic can drink all day and easily reach a level of 0.3 to 0.5, which means that three to five percent of their blood volume is alcohol. That much alcohol would probably kill most people who are not used to drinking every day, but it barely affects the alcoholic, who drinks heavily and daily.

Often, chronic alcoholics fall and hit their head, which can lead to life-threatening bleeding around the brain. They are prone to developing seizures due to low blood sugar levels, metabolic disorders or alcohol withdrawal. This is why we must evaluate every intoxicated patient, even the ones we see on a regular basis

Author’s note: This article encompasses general guidelines taken from several published sources as well as my ten years of personal experience as an emergency physician. There will often be exceptions to the above guidelines because the risk vs. benefit ratio of using any medication will be different for each patient.

Laurence Degelsmith graduated from Horace Greeley High School in 1985, has an undergraduate degree from Washington University in Saint Louis, attended New York Medical College and did his residency in emergency medicine at the University of Michigan. He is an emergency department physician at Northern Westchester Hospital in Mt. Kisco and a member of the Chappaqua Volunteer Ambulance Corps.