ConditionMental health & sleep
Alcohol Poisoning
Alcohol poisoning is a life-threatening overdose that happens when a large amount of alcohol is drunk in a short time, shutting down areas of the brain that control breathing, heart rate and temperature. Warning signs include confusion, vomiting, seizures, slow or irregular breathing, pale or blue skin, low body temperature and being unable to wake up. Do not let the person "sleep it off". Call 911 or your local emergency number and keep them on their side.
Also called: Acute alcohol intoxication, alcohol overdose, ethanol poisoning, severe alcohol intoxication
At a glance
- What it is
- A dangerous overdose of alcohol that suppresses breathing, heart rate and temperature control.
- Usual cause
- Binge drinking, especially drinking games, shots or chugging; also children swallowing alcohol products.
- Danger signs
- Confusion, vomiting while drowsy, seizures, slow or irregular breathing, blue or pale skin, low temperature, unresponsive.
- What to do
- Call 911, keep them on their side, stay with them, do not give coffee or a cold shower.
- Treatment
- Hospital monitoring, airway and breathing support, IV fluids, glucose and warming.
When to get help
Call 911 or go to the ER
- Cannot be woken, or wakes only briefly
- Breathing slower than 8 breaths a minute, or gaps of 10 seconds or more between breaths
- Seizures
- Blue, gray or pale skin, or cold, clammy skin
- Vomiting while drowsy or unconscious
- A child who has swallowed any alcohol, mouthwash, hand sanitizer or perfume and is drowsy, unsteady or vomiting
See a doctor within a day or two
- Very confused, unable to stand or walk, or repeated vomiting after drinking
- A child who has swallowed an alcohol-containing product but seems well: call Poison Control at 1-800-222-1222 (US)
What to do right now
If you think someone has alcohol poisoning:
- Call 911 or your local emergency number. Do not wait for all the signs. Many states have Good Samaritan laws that protect people who call for help.
- Stay with them. Never leave someone who is very drunk to sleep it off alone.
- Put them in the recovery position: on their side, top knee bent, head tilted slightly back so vomit can drain and they do not choke.
- Keep them awake and sitting up if they are conscious; offer small sips of water only if they can swallow.
- Keep them warm with a blanket.
- Tell responders what and how much they drank, and any other drugs or medicines.
- If they stop breathing, start CPR if you are trained.
Dangerous myths
Do not:
- give coffee: it does not sober anyone up and can worsen dehydration
- put them in a cold shower: it can cause dangerous cooling or a fall
- make them walk it off
- make them vomit, which risks choking
- give more alcohol or other drugs
Blood alcohol keeps rising for 30 to 90 minutes after the last drink, as alcohol is still being absorbed from the stomach, so someone can get worse even after they stop drinking.
Why alcohol poisoning is dangerous
Alcohol depresses the central nervous system. At high blood levels it suppresses:
- breathing, which can slow or stop
- the gag reflex, so vomit can be inhaled into the lungs (aspiration), causing choking or pneumonia
- heart rhythm and blood pressure
- temperature regulation, causing hypothermia
- blood sugar, causing hypoglycemia, especially in children and people who have not eaten
Severe dehydration from vomiting can damage the kidneys and brain. In the US, alcohol poisoning kills several thousand people a year, most of them middle-aged adults, not only young binge drinkers.
Symptoms and stages
| Blood alcohol (approx.) | Typical effects |
|---|---|
| 0.08% to 0.15% | Impaired judgment, coordination and reaction time; legal limit for driving in most of the US is 0.08% |
| 0.16% to 0.30% | Vomiting, slurred speech, confusion, blackouts, staggering |
| 0.31% to 0.45% | Stupor, loss of consciousness, risk of life-threatening suppression of breathing and heart |
| Above 0.45% | High risk of death |
Tolerance varies: people who drink heavily may appear less affected at a given level, while children, small adults and people who rarely drink can be in danger at lower levels.
Who is at risk
- Binge drinking: 5 or more drinks for men or 4 or more for women in about 2 hours; drinking games and shots are especially risky
- Children who swallow alcohol, mouthwash, hand sanitizer, vanilla extract or perfume
- Mixing alcohol with opioids, benzodiazepines, sleeping pills or other sedatives, which multiplies the effect on breathing
- Drinking on an empty stomach
- Smaller body size
- Caffeinated alcoholic drinks, which mask drowsiness and lead to more drinking
Hospital treatment
There is no antidote that reverses alcohol. Treatment supports the body while the liver breaks the alcohol down (roughly one standard drink per hour):
- protecting the airway and giving oxygen; a breathing tube and ventilator if breathing is inadequate
- IV fluids for dehydration and low blood pressure
- glucose for low blood sugar
- thiamine (vitamin B1) to prevent Wernicke encephalopathy in people who drink heavily
- warming for hypothermia
- monitoring heart rhythm, blood alcohol and other drugs
- treating seizures, injuries or aspiration pneumonia
Other toxic alcohols such as methanol (in some homemade or counterfeit spirits and antifreeze) or ethylene glycol need specific antidotes and sometimes dialysis.
After an episode
A hospital visit for alcohol poisoning is a chance to look at drinking patterns. Repeated binge drinking can be a sign of alcohol use disorder. Brief counseling, follow-up with a primary care doctor or the SAMHSA National Helpline (1-800-662-4357, US) can help.
Prevention
- Pace drinks: no more than one standard drink per hour.
- Eat before and while drinking, and alternate with water.
- Avoid drinking games and shots.
- Never mix alcohol with sedatives, opioids or sleeping pills.
- Look out for friends, and make a plan to get home safely.
- Store alcohol and alcohol-containing products out of children's reach.
Frequently asked questions
What are the signs of alcohol poisoning?
Signs include confusion, vomiting, seizures, slow or irregular breathing, pale or blue skin, low body temperature and being unable to wake up or stay awake. A person does not need to have every sign. If you suspect alcohol poisoning, call 911 right away.
What should you do if someone has alcohol poisoning?
Call 911, stay with them, and place them on their side in the recovery position so they cannot choke on vomit. Keep them warm and awake if possible. Do not give coffee, cold showers or more alcohol, and do not leave them to sleep it off.
Can you sleep off alcohol poisoning?
No. Blood alcohol can keep rising after drinking stops, and a sleeping person can stop breathing or choke on vomit. Someone who is very drunk and hard to wake needs emergency help, not sleep.
How much alcohol causes alcohol poisoning?
There is no fixed amount. It depends on body size, how fast you drink, whether you have eaten, tolerance and other drugs. Drinking large amounts quickly, such as during drinking games, is the most common cause. For children, even a small amount can be dangerous.
How long does alcohol poisoning last?
The liver clears roughly one standard drink per hour, so very high blood alcohol levels can take many hours to fall. Most people treated in hospital recover within 12 to 24 hours, but complications such as aspiration pneumonia or injury can extend recovery.
Sources
This guide was written from current patient and clinical guidance, including:
- NIAAA: Understanding the dangers of alcohol overdose
- CDC: Alcohol poisoning deaths; Binge drinking
- MedlinePlus: Alcohol use and safe drinking; Ethanol poisoning
- SAMHSA: Underage drinking resources
- Poison Control (America's Poison Centers): Alcohol