Alcohol Overdose: Causes, Risk, Signs and How to Prevent It

Alcohol overdose, also known as alcohol poisoning, happens when a person consumes a toxic amount of alcohol, leading to severe impairment of bodily functions. 

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), more than 178,000 alcohol-related deaths occur annually in the United States, with approximately 120,000 male deaths and 59,000 female deaths. The numbers showed a significant increase during the COVID-19 pandemic, rising from 78,927 deaths in 2019 to 99,017 in 2020, peaking at 108,791 in 2021, before slightly decreasing to 105,415 in 2022. The main causes include liver diseases, cardiovascular diseases, various cancers, and alcohol use disorder, with alcohol also playing a role in 17.4% of opioid overdose deaths.

The primary cause of alcohol overdose is consuming large amounts of alcohol in a short period. Binge drinking, where individuals drink excessively over a few hours, significantly increases the risk of overdose.

Risk factors of alcohol poisoning include binge drinking, mixing alcohol with other substances, drinking on an empty stomach, consuming high-alcohol content beverages, body size and composition, age, gender, tolerance levels, and pre-existing health conditions.

Signs of alcohol overdose include confusion, vomiting, seizures, slow or irregular breathing, and a blue-tinged or pale skin tone. In severe cases, the person becomes unconscious and unresponsive.

The effects of alcohol overdose are fatal if not treated promptly. Alcohol overdose leads to severe dehydration, brain damage, hypothermia, irregular heartbeats, and respiratory failure.

Treatment for alcohol overdose involves administering oxygen, intravenous fluids, and medications to manage symptoms. In severe cases, the patient requires intubation and mechanical ventilation.

Preventive measures for alcohol overdose include drinking in moderation, avoiding binge drinking, and knowing your limits. It’s essential to stay hydrated, eat before and while drinking, and never mix alcohol with other substances.

What is an Alcohol Overdose?

Alcohol overdose, also known as alcohol poisoning, happens when an individual consumes a huge amount of alcohol in a short period, leading to severe impairment of bodily functions. It is considered a medical emergency and needs immediate attention. 

As the Minnesota Department of Health put it, alcohol poisoning, or alcohol overdose, occurs when a person consumes alcohol faster than their liver processes it. Once the liver is overwhelmed, it no longer metabolizes alcohol as it should.  The symptoms of an alcohol overdose include severe confusion, vomiting, seizures, slow and irregular breathing, hypothermia, unconsciousness, and, in extreme cases, death.

According to the CDC, there are 2,200 alcohol poisoning deaths each year in the US. These alarming numbers reflect the urgent need for increased awareness and education on the dangers of excessive alcohol consumption, as well as stronger support systems to prevent such tragedies.

What Causes an Alcohol Overdose?

An alcohol overdose, or alcohol poisoning, is caused by an excessive consumption of alcohol within a short time, which results in an increased Blood Alcohol Concentration and, subsequently, liver damage. 

The body only processes a certain amount of alcohol per hour, typically about one standard drink. The liver uses an enzyme called alcohol dehydrogenase to convert alcohol into acetaldehyde, a toxic chemical and known carcinogen. Another enzyme quickly converts acetaldehyde into acetate, which is eventually turned into water and carbon dioxide for the body to eliminate.

However, the liver only processes a limited amount of alcohol at a time. Consuming more alcohol than the liver handle raises the individual’s Blood Alcohol Concentration, BAC, leading to a buildup of acetaldehyde. 

High BAC levels overwhelm the body’s ability to function correctly, leading to symptoms of alcohol poisoning. These symptoms include confusion, vomiting, seizures, slow or irregular breathing, hypothermia, and unconsciousness. Without prompt medical treatment, alcohol overdose causes permanent brain damage or death. Blood Alcohol Concentration (BAC) is a measure of the amount of alcohol present in a person’s bloodstream and is expressed in percentages. 

What Blood Alcohol Content (BAC) Is Alcohol Poisoning?

Alcohol poisoning typically occurs at blood alcohol levels of 0.35% (350 mg/dL), though levels above 0.25% (250 mg/dL) put patients at high risk for coma.

According to Dasgupta, A.’s 2015 study, ‘ Alcohol and its biomarkers: Clinical aspects and laboratory determination.’, the effects progress from mild impairment at 0.08% (legal limit) to severe effects:

• 0.02-0.05%: Relaxation and positive mood
• 0.08%: Minor impairment
• 0.10-0.15%: Significant sensory/cognitive impairment
• 0.20%: Severe impairment, visual problems
• 0.30%: Vomiting, alcohol intoxication symptoms
• 0.40%: Stupor, coma, respiratory depression
• ≥0.50%: Potentially lethal

What Increases the Risk of Alcohol Poisoning?

Factors that increase the risk of alcohol poisoning include binge drinking, mixing alcohol with other substances, and age. Each contributes to the body’s inability to metabolize alcohol efficiently and safely.

Here are the risk factors of alcohol poisoning in detail below:

• Binge Drinking: Drinking plenty of alcohol in a short period significantly raises blood alcohol concentration (BAC). This rapid intake overwhelms the liver’s ability to process alcohol, leading to toxic levels in the bloodstream. Binge drinking is a huge risk factor for alcohol poisoning, especially among young adults and college students.
• Mixing Alcohol with Other Substances: Taking alcohol with drugs, especially depressants like opioids, benzodiazepines, or sedatives, amplifies the effects of alcohol. This combination severely depresss respiratory and cardiovascular functions, increasing the risk of poisoning and fatal outcomes.
• Drinking on an Empty Stomach: When alcohol is consumed without food, it is absorbed more quickly into the bloodstream. Food slows down the absorption process, giving the liver more time to metabolize alcohol. Drinking alcohol on an empty stomach leads to a faster and higher spike in BAC, heightening the risk of alcohol poisoning.
• High-Alcohol Content Beverages: Drinks with a high concentration of alcohol, such as spirits and liquors, result in a larger amount of alcohol entering the bloodstream rapidly. This quick influx leads to dangerously high BAC levels, increasing the likelihood of poisoning.
• Body Size and Composition: Individuals with smaller body sizes and lower body water content are more susceptible to alcohol poisoning. Women generally have less body water than men, leading to higher BAC levels even with the same amount of alcohol consumption.
• Age: Age influences the risk of alcohol overdose due to differences in metabolism and tolerance. Younger individuals, particularly adolescents and young adults have lower alcohol tolerance and engage in binge drinking behaviors, increasing the risk of overdose. Older adults metabolize alcohol more slowly and have existing health conditions or take medications that interact negatively with alcohol, heightening the risk.
• Gender: Gender affects the risk of alcohol overdose because women have lower body water content and different alcohol metabolism rates than men. These physiological differences result in higher blood alcohol concentrations in women, even when consuming the same amount of alcohol as men. 
• Tolerance Levels: People with low alcohol tolerance are at a higher risk of alcohol poisoning. Their bodies are less accustomed to processing large amounts of alcohol, making them more vulnerable to its toxic effects.
• Pre-existing Health Conditions: Certain medical conditions, such as liver disease, diabetes, or metabolic disorders, impair the body’s ability to metabolize alcohol effectively. Individuals with these conditions face a higher risk of alcohol poisoning because their bodies cannot process alcohol as efficiently as healthy individuals.

Who is Most at Risk for Alcohol Poisoning?

Individuals most at risk for alcohol poisoning include young adults, women, and people mixing alcohol with drugs and other substances, especially those who engage in binge drinking. This group consumes large quantities of alcohol in short periods, overwhelming their bodies’ ability to metabolize it safely.

According to the Minnesota Department of Health, one of the greatest risk factors for alcohol poisoning is binge drinking. It contributed to 429 deaths in Minnesota in 2021. Binge drinking refers to the consumption of four or more drinks for females or five or more drinks for males on an occasion.

Women, due to physiological differences, tend to have higher blood alcohol concentrations. Bodies of individuals with pre-existing health conditions such as liver disease or metabolic disorders also find it difficult to metabolize the alcohol and dispose of it properly. 

Additionally, people mixing alcohol with other substances, including prescription medications or recreational drugs, face a significantly increased risk of alcohol poisoning. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol was involved in at least 7.1% of emergency department visits and 17.4% of deaths from opioid overdoses in 2020.

What are the Critical Signs and Symptoms of Alcohol Overdose?

The critical symptoms of alcohol overdose include mental confusion, difficulty remaining conscious, vomiting, seizures, trouble breathing, slow heart rate, clammy skin, dulled responses (such as no gag reflex, which prevents choking), and extremely low body temperature.

The critical symptoms of an alcohol overdose include:

• Confusion: The individual exhibits disorientation and an inability to comprehend their surroundings or situation.
• Vomiting: Frequent and uncontrollable vomiting occurs as the body attempts to expel the excess alcohol.
• Seizures: Alcohol overdose triggers seizures, indicating severe neurological distress. 

According to Sandeep, P.’s 2013 study, ‘Clinical profile of patients with nascent alcohol-related seizures.’, In the study of 100 male patients with alcohol-related seizures (ARS), 88% had generalized seizures while 12% showed partial seizures. Patients with cortical atrophy (27%) had significantly longer alcohol use history (23.62 years) and a higher risk of seizure clustering. Those experiencing seizures within 6 hours of drinking had shorter drinking histories, with one case revealing underlying idiopathic generalized epilepsy, highlighting the importance of EEG and neuroimaging in proper diagnosis and treatment.

• Slow or irregular breathing: Breathing becomes dangerously slow or erratic, posing a significant risk to life.
• Hypothermia (low body temperature): The body temperature drops to dangerously low levels, leading to hypothermia.
• Blue-tinged or pale skin: The skin appears bluish or pale, signaling inadequate oxygenation and circulation.
• Unconsciousness: The person loses consciousness, becoming unresponsive to external stimuli. According to Kivimäki, M.’s 2020 study, ‘Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia.’, a study of 131,415 adults found that individuals who reported losing consciousness due to alcohol had a two-fold increased risk of dementia compared to moderate drinkers who had not lost consciousness. Of the 96,591 participants, 10.4% reported losing consciousness due to alcohol consumption in the past 12 months.
• Unresponsiveness: There is a complete lack of response to verbal or physical cues, indicating a medical emergency.

How To Help Someone With Alcohol Poisoning?

To help someone with alcohol poisoning, immediately call emergency services (911), keep them awake and sitting upright, monitor their breathing patterns closely, and stay with them until medical help arrives. Never leave a person with suspected alcohol poisoning alone, as their condition worsens rapidly and becomes life-threatening.

Here are the following steps to take when someone has alcohol poisoning:

• Call Emergency Services: Immediately dial 911 or your local emergency number. Describe the symptoms and provide any relevant information about the person’s condition and the amount of alcohol consumed.
• Keep the Person Awake and Sitting Up: If the person is conscious, try to keep them awake and in a sitting position to prevent choking on vomit. Engage them in conversation to maintain their alertness.
• Turn Them on Their Side: If the person is unconscious or semi-conscious, place them in the recovery position (on their side) with their head turned to one side. The side position helps keep the airway clear and reduces the risk of choking on vomit.

• Monitor Breathing and Heart Rate: Regularly check their breathing and pulse. If breathing becomes slow, irregular, or stops, perform CPR if you are trained, and continue monitoring until emergency personnel arrive.
• Do Not Leave Them Alone: Stay with the person until help arrives. Constantly monitor their condition and be prepared to provide additional information to emergency responders.
• Do Not Give Them Food, Drink, or Medication: Avoid giving the person food, water, coffee, or any other substance, as these worsen their condition. Do not attempt to induce vomiting.
• Provide Relevant Information: When emergency personnel arrive, inform them about the person’s symptoms, the amount of alcohol consumed, any other substances taken, and any known medical conditions.

The World Health Organization states that around the world, 3 million deaths every year result from the harmful use of alcohol, which represents 5.3% of all deaths. Prompt action and continuous monitoring significantly increase the chances of survival and recovery for someone experiencing alcohol poisoning.

How is an Alcohol Overdose Treated?

Treatment for alcohol poisoning involves observation, monitoring, glucose administration, administering medications, fluid hydration via IV, and frequent assessment of breathing. 

The ways alcohol overdose is treated are detailed below:

• Observation: Medical staff observe the patient closely to assess their condition and detect any changes.
• Monitoring: Continuous monitoring of vital signs occurs to ensure the patient’s safety and well-being.
• Glucose Administration: Glucose is administered to address potential hypoglycemia resulting from alcohol consumption.
• Administering Medications: Medications are given to manage symptoms and complications associated with alcohol overdose.
• Fluid Hydration via IV: Intravenous fluids provide rehydration, maintain blood pressure, and support liver function. According to Perez, S. R.’s 2013 study, ‘Intravenous 0.9% sodium chloride therapy does not reduce the length of stay of alcohol-intoxicated patients in the emergency department: a randomized controlled trial.’, intravenous 0.9% sodium chloride (normal saline) is frequently used to treat patients with acute alcohol intoxication, though studies show it doesn’t reduce emergency department length of stay.
• Oxygen Therapy: Oxygen therapy occurs for patients experiencing respiratory distress to improve oxygen levels.
• Mechanical Ventilation: In severe cases, mechanical ventilation assists with breathing when the patient has stopped breathing or has a depressed respiratory rate. According to de Wit, M.’s 2010 study, ‘Alcohol-use disorders in the critically ill patient.’, alcohol use disorders (AUDs) significantly increase the need for mechanical ventilation in hospitalized medical patients, with a 49% higher likelihood of requiring this intervention compared to those without AUDs.
• Activated Charcoal: Activated charcoal binds the remaining alcohol in the stomach, preventing further absorption into the bloodstream.
• Continuous Monitoring: Continuous monitoring tracks the patient’s progress and addresses complications like hypothermia or irregular heartbeats.
• Gastric Lavage: Gastric lavage is performed to remove alcohol from the stomach in cases of coma or unresponsiveness. According to Atluri, P.’s 2021 study, ‘Toxic Alcohol Ingestion: A Case Report and Review of Management Pathways.’, gastric lavage for toxic alcohol removal must be initiated within 30-60 minutes post-ingestion to be effective. Beyond this window, the procedure becomes ineffective as the alcohol has already been absorbed systemically.

How To Treat Alcohol Poisoning At Home?

To treat alcohol poisoning at home you need medical knowledge. Otherwise, alcohol poisoning cannot be treated safely at home and requires immediate emergency medical care. If you suspect alcohol poisoning, call emergency services immediately (911 in the US). While waiting for help, monitor the person’s breathing, consciousness, and vital signs. If they’re unconscious, place them in the recovery position on their side to prevent choking. Do not attempt home remedies like coffee or cold showers, as these worsen their condition. Never leave the person alone and stay with them until medical help arrives, as alcohol poisoning be fatal without proper treatment.

How Long Does Alcohol Poisoning Last?

Alcohol poisoning lasts for several hours after drinking stops. According to Jung, Y. C.’s 2014 study, ‘Alcohol: intoxication and poisoning – diagnosis, and treatment.’, alcohol poisoning symptoms typically persist from several hours to over 24 hours, with duration primarily determined by blood alcohol concentration and the liver’s metabolic rate. The timeline varies based on the volume of alcohol consumed, drinking patterns, and individual factors like body weight, gender, and metabolic health. Complications extend this duration, particularly in cases where the patient has underlying chronic alcohol use issues or requires medical intervention for associated conditions. The severity and length of intoxication directly correlate with how quickly alcohol and its metabolites accumulate in the bloodstream compared to the liver’s ability to process them.

What is the Long-Term Outlook for an Alcohol Overdose?

The long-term outlook for an individual who has experienced an alcohol overdose depends on several factors, including the severity of the overdose, the speed and effectiveness of medical treatment received, and the person’s overall health and drinking habits.

Repeated episodes of alcohol overdose lead to more severe health issues, including persistent brain damage, neurological impairments, and liver disease. 

Chronic misuse of alcohol that leads to repeated overdoses significantly increases the risk of developing lasting conditions such as alcoholic hepatitis, fibrosis, or cirrhosis of the liver, which are life-threatening.

Can an Alcohol Overdose Lead to Death?

Yes, alcohol overdose leads to death. Severe alcohol poisoning causes respiratory failure, choking, heart arrhythmias, and coma, all of which are fatal without immediate medical intervention. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Alcohol-Related Disease Impact (ARDI) application estimates over 178,000 alcohol-attributable deaths annually in the U.S. This includes approximately 120,000 male deaths and 59,000 female deaths. Excessive alcohol use is identified as one of the leading preventable causes of death in the United States.

How To Prevent an Alcohol Overdose?

To prevent an alcohol overdose, drink in moderation, avoid binge drinking, and know your limits. Additionally, never mix alcohol with other drugs, and ensure you eat before and while drinking to slow alcohol absorption.

Can Alcohol Overdose Occur from Drinking Beer Only?

Yes, alcohol overdose occurs from drinking beer if consumed in large quantities over a short period. Any alcoholic beverage leads to an overdose if enough is consumed quickly.

Does Eating While Drinking Prevent Alcohol Overdose?

Yes, eating while drinking slows the absorption of alcohol and reduces the risk of overdose, but it does not eliminate the risk. The California Department of Alcoholic Beverage Control explains that food slows the rate of alcohol intoxication by causing the pyloric valve at the stomach’s bottom to close during digestion. This action prevents alcohol from entering the small intestine, where most of it is absorbed.

Can Alcohol Overdose Happen the First Time You Drink?

Yes, alcohol overdose happens the first time someone drinks, especially if they consume a large amount quickly. Lack of tolerance and experience with alcohol increases the risk.

Is It Safe to Let Someone Sleep Off Alcohol Poisoning?

No, it is not safe to let someone “sleep off” alcohol poisoning, as the National Institute on Alcohol Abuse and Alcoholism explains, If someone shows signs of alcohol overdose, they need immediate medical attention to prevent potentially fatal complications.

What Should You Do if You See Someone Who Has Alcohol Poisoning?

If you see someone who has alcohol poisoning, it is important to call emergency services immediately and keep the person awake and sitting up. Describing the symptoms to emergency responders ensures timely and appropriate medical intervention.

Turn the person on their side if they are unconscious to prevent choking and monitor their breathing and heart rate. Do not leave them alone until help arrives. Providing relevant information to emergency personnel about the person’s condition and alcohol consumption is lifesaving.

Can Chronic Alcohol Consumption Lead To Memory Loss?

Yes, chronic alcohol consumption leads to memory loss. The brain, particularly the hippocampus which controls memory and learning, suffers significant damage from prolonged alcohol use. When someone drinks heavily for extended periods, it damages neurons in the hippocampus, leading to cognitive decline and serious conditions like Alcohol-Related Brain Damage (ARBD) and Wernicke-Korsakoff Syndrome (WKS). These disorders result in severe memory loss and other cognitive problems.