Alcohol Intoxication

What to do now

1. Call 911 or your local emergency number if the person shows any danger sign: will not wake up, breathing fewer than 8 times a minute or with gaps of 10 seconds or more, blue, gray or very pale skin, cold and clammy skin, a seizure, or repeated vomiting while not fully awake.
2. Do not leave them alone. BAC can keep rising for 30 to 90 minutes after the last drink as alcohol in the stomach is absorbed.
3. Place them in the recovery position: on their side, top knee bent, head tilted slightly back so vomit can drain and the airway stays open.
4. Keep them warm with a blanket; alcohol causes heat loss.
5. If they are awake, keep them sitting up, give small sips of water if they can swallow safely.
6. Tell responders what and how much they drank, and any drugs or medicines taken.

What not to do

• Do not let them "sleep it off" alone or on their back.
• Do not give coffee, cold showers or more alcohol. They do not speed sobering and can cause harm.
• Do not try to make them vomit.
• Do not let them drive, swim or walk home alone.

How alcohol affects the body

Alcohol is absorbed from the stomach and small intestine within minutes and reaches the brain quickly. It depresses the central nervous system, slowing reaction times, coordination and judgment, and at high levels the brain centers that control breathing and gag reflexes. The liver clears roughly one standard drink per hour, and nothing can speed this up.

A standard drink in the US contains 14 g of pure alcohol: about 12 oz (355 ml) of 5% beer, 5 oz (150 ml) of 12% wine, or 1.5 oz (44 ml) of 40% spirits.

Stages of alcohol intoxication

Effects vary between people, but typical effects by BAC are:

People with tolerance from regular drinking may appear less impaired at the same BAC, but the dangers to breathing remain.

Risk factors for severe intoxication

• Binge drinking: 4 or more drinks for women or 5 or more for men in about 2 hours. Drinking games and shots raise BAC fast.
• Empty stomach.
• Smaller body size and female sex: less body water to dilute alcohol.
• Young age: teens and children are especially sensitive and prone to low blood sugar.
• Mixing with drugs: opioids, benzodiazepines, sleeping pills and some antihistamines multiply the sedative effect. Energy drinks mask drowsiness and encourage more drinking.
• High-strength or homemade alcohol.

Complications

• Choking on vomit (aspiration), the most common cause of death in alcohol poisoning.
• Breathing failure and coma. See alcohol poisoning.
• Low blood sugar (hypoglycemia): especially in children and people with diabetes.
• Hypothermia from heat loss, especially outdoors.
• Injuries: falls, head injuries, burns, car crashes and drowning.
• Dehydration, irregular heart rhythms ("holiday heart") and seizures.
• Risky behavior, including unprotected sex and violence.

Diagnosis and hospital treatment

In the ER, clinicians check breathing, oxygen levels, blood sugar, temperature and alertness, and look for head injury and other drugs. Tests may include a breath or blood alcohol level, blood glucose, electrolytes, and sometimes a CT scan of the head.

Treatment is supportive:

• protecting the airway, sometimes with a breathing tube
• oxygen and close monitoring
• IV fluids and glucose
• thiamine (vitamin B1) for people who drink heavily, to prevent Wernicke encephalopathy
• warming for hypothermia
• treating injuries and other substances

There is no antidote that reverses alcohol. Most people recover fully within hours as the liver clears it.

Hangover and the next day

Headache, nausea, thirst, tiredness and low mood the next day reflect dehydration, poor sleep, inflammation and alcohol byproducts. Fluids, food and rest help. Be cautious with painkillers: acetaminophen (paracetamol) after heavy drinking adds strain to the liver, and ibuprofen or aspirin can irritate the stomach. If you use one, follow the label dose. Morning shaking, sweating and anxiety that improve with a drink point to alcohol withdrawal and dependence.

Preventing harmful intoxication

• Eat before and while drinking.
• Alternate alcoholic drinks with water.
• Know standard drink sizes and count your drinks.
• Avoid drinking games and mixing alcohol with drugs.
• Plan a safe way home and look out for friends.
• US Dietary Guidelines advise, for adults who choose to drink, no more than 2 drinks a day for men and 1 for women.

Frequently asked questions

What are the signs of alcohol intoxication?

Early signs include talkativeness, reduced inhibitions and impaired judgment. As BAC rises, people develop slurred speech, poor balance, slowed reactions, flushed skin, vomiting and memory gaps. Confusion, inability to stay awake, slow breathing and seizures are signs of alcohol poisoning and need 911.

How long does alcohol intoxication last?

The liver clears about one standard drink per hour. After a heavy night, alcohol can still be in your blood the next morning, impairing driving. Coffee, cold showers and exercise do not speed this up. Only time lowers blood alcohol.

What is the difference between alcohol intoxication and alcohol poisoning?

Intoxication describes any level of impairment from alcohol. Alcohol poisoning is the dangerous extreme, when blood alcohol is high enough to suppress breathing, heart rate, temperature control and the gag reflex. It can cause coma and death and is a medical emergency.

How do you help someone who is very drunk?

Stay with them, keep them on their side in the recovery position, keep them warm, and check their breathing regularly. Do not give coffee, cold showers or let them sleep on their back. Call 911 if they cannot be woken, breathe slowly or irregularly, or have a seizure.

Can you die from alcohol intoxication?

Yes. Very high blood alcohol can stop breathing or cause choking on vomit. In the US, alcohol poisoning causes several deaths every day. Mixing alcohol with opioids or sedatives greatly increases this risk. Prompt emergency care saves lives.