Alcohol poisoning
Alcohol poisoning is not just a heavy night out. It is the point at which there is so much ethanol in the blood that it shuts down the parts of the brain…
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Alcohol poisoning is not just a heavy night out. It is the point at which there is so much ethanol in the blood that it shuts down the parts of the brain running breathing, heart rhythm and the gag reflex. The liver clears roughly one drink an hour, and nothing speeds that up — not coffee, not food, not a cold shower. Everything poured in faster than that piles up in the bloodstream, which is why a person often gets worse after they have put the glass down.
When being drunk turns into being poisoned
Alcohol keeps crossing into the blood from the stomach and gut for another 30 to 90 minutes after the last mouthful. Someone who falls asleep at a party carries on getting drunker while asleep: the level rises, breathing slows, and rousing them becomes harder and harder. Hence the most common mistake of all, leaving them to sleep it off. Not everyone wakes up.
The dividing line is not how much went in but how the person answers back. Someone who can be shaken awake, who swears, pushes your hand away and rolls onto their side unaided, is drunk. Someone who does not react to a loud voice or to pain, and who breathes slowly or with gaps, is poisoned.
Signs that mean calling an ambulance
Do not wait for things to look truly awful. Call emergency services — 112 across Europe — if any one of these is present:
- you cannot wake them: no response to voice, to shaking or to pain;
- slow breathing (fewer than eight breaths a minute), shallow breathing, or gaps longer than ten seconds;
- a seizure or twitching has occurred;
- vomiting in someone who cannot sit up or hold their head;
- skin that is cold, clammy, pale or bluish; on darker skin this shows up better on the lips, gums and nail beds;
- the body feels cold to the touch even in a warm room;
- they do not recognise where they are or who is with them;
- loss of bladder or bowel control.
Call as well when things still look manageable but something makes them worse: the drinker is a child or a teenager; the drink came from an unknown source; sleeping tablets, sedatives, painkillers or antidepressants were taken alongside it; the person fell and may have hit their head. Do not drive them anywhere yourself — their state changes on the way, and inside a car there is nothing you can do about it.
What to do while help is on the way
There is only one job: keep them from choking and keep them from getting cold.
- do not leave them alone, not even for a minute;
- if they are unconscious but breathing, turn them onto their side with the head also turned and tilted slightly down, and bend the upper leg so they stay put — vomit then runs out rather than down into the lungs;
- if they are awake, sit them up so they do not drop off flat on their back;
- cover them with a coat or blanket and bring them in out of the cold;
- count their breaths and make sure the rate is not falling;
- give water only to someone fully alert who is swallowing confidently, and only in small sips;
- have the facts ready for the crew: what was drunk and how much, what medicines the person takes, whether there is diabetes, epilepsy, heart disease or liver disease.
What not to do:
- make them vomit — with a dulled level of consciousness the stomach contents go into the lungs, and that is one of the main ways alcohol poisoning kills;
- pour coffee or energy drinks into them — caffeine removes no alcohol at all, it only masks the drowsiness and creates a false sense that things are improving;
- put them under a cold shower or out into the cold — the skin vessels are already wide open, heat is lost fast, and you add the risk of a fall or of passing out in the water;
- give more alcohol to steady them, lay them flat on their back and walk away, or hand them tablets at random.
What is actually dangerous here
- Inhaling vomit. The reflex is suppressed and the person is on their back, so stomach contents travel into the airway. What follows is suffocation or a severe pneumonia.
- Breathing stopping. At high levels the breathing centre no longer responds to carbon dioxide building up.
- Blood sugar falling. Alcohol blocks the liver from making glucose. It happens soonest in children, in thin or undernourished people and in anyone who drank without eating. It brings seizures and loss of consciousness, and from the outside it looks like an ordinary heavy binge.
- Hypothermia. Widened vessels give off heat while the sense of cold disappears. Falling asleep outdoors can kill even when the temperature is above freezing.
- Heart rhythm disturbance. A single episode of heavy drinking can set this off in someone young and healthy.
- A missed head injury. Bleeding under the coverings of the brain after a fall looks exactly the same: sluggishness, vomiting, confusion. If there was a blow to the head, say so.
When it is not ordinary drink
The most treacherous situation of all is adulterated alcohol. Methanol is almost indistinguishable from ethyl alcohol by taste or smell and is incomparably more toxic. Its hallmark is the delay: for the first 6 to 24 hours the person simply seems drunk, or even appears to be sobering up, and only afterwards come the fog and veil across the vision, loss of sight, severe abdominal pain and deep noisy breathing. At that point the clock runs in hours: treatment works while the poison has not yet turned into the products that destroy the optic nerve and the kidneys. A similar delay follows poisoning with fluids containing ethylene glycol or isopropanol. If the drink was bought informally or came out of an unlabelled container, tell the crew straight away rather than waiting for a deterioration.
Two further reasons not to wait. Children: drink, lotions, perfume and hand sanitiser drop a child's blood sugar at quantities an adult would laugh at. And combinations: alcohol together with sleeping tablets, sedatives, opioid painkillers, muscle relaxants and some antihistamines suppresses breathing more than any of them would on its own. On top of that, with certain antibiotics and antifungals even a small amount of alcohol triggers a dramatic reaction with flushing, vomiting and a drop in blood pressure.
What happens in hospital
There is no antidote to ethanol, and a drip does not sober anyone up faster: fluids replace water and salts but barely change the rate at which alcohol breaks down. Admission serves a different purpose, which is to keep the person alive until the body finishes the job. Staff watch the breathing, give oxygen or take over ventilation if needed, run in glucose when the sugar is low, warm the person up, replace fluid, and add vitamin B1 for anyone who has been drinking for years and eating badly. Where an adulterated product is suspected, extra blood tests are taken and specific measures are used, up to filtering the blood by machine. If there was a head injury, a scan is done. Home drips advertised for sobering up replace none of this, and in a serious poisoning they are dangerous in themselves.
How to keep it from getting that far
- alternate alcoholic drinks with water and never start on an empty stomach;
- spirits downed in one go and drinking games against the clock are the commonest route to poisoning among young people;
- check in advance whether your regular medication mixes with alcohol;
- skip drinking after a sleepless night, an illness, hard physical work or dehydration;
- buy alcohol where someone is accountable for it — that is the only defence against adulterated spirits;
- agree within your group that anyone who passes out is not left to sleep but put on their side and watched;
- if severe episodes keep repeating, the issue is no longer one particular night and is worth discussing with a doctor.
Online consultation
An online appointment is not a substitute for emergency care: with any of the signs listed above, call the emergency number. Where the decision is less obvious, though, a doctor by video or by message can help — judging how dangerous the situation is right now, explaining what to watch for in someone who has stayed at home after a rough night, going through how alcohol interacts with your medicines, advising which tests are worth doing after an episode of poisoning, and pointing you to the right specialist if those episodes keep happening.
This material is for information only and does not replace medical advice.
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