Alcohol Poisoning — How to Recognise It and What to Do Right Now

This Is a Medical Emergency. Read This First.

If you are reading this because someone near you may have alcohol poisoning right now: call emergency services (999 in the UK, 911 in the US) immediately if they are unconscious or semi-conscious and cannot be roused, if their breathing is slow or irregular (fewer than eight breaths per minute), if they are vomiting while unconscious, or if they are having a seizure. Do not wait to see if they "sleep it off." Do not leave them alone.

The information below explains why these responses are the right ones. But the action comes first.

What Alcohol Poisoning Actually Is

Alcohol poisoning (acute alcohol toxicity) occurs when blood alcohol concentration reaches a level that directly impairs the brainstem functions responsible for breathing, heart rate, and the gag reflex. Alcohol is a central nervous system depressant; at high enough concentrations, it suppresses the involuntary functions that keep a person alive without any conscious effort on their part.

This is distinct from being very drunk. A person who is heavily intoxicated — stumbling, slurring, confused — has high BAC but is still conscious and their brainstem functions are intact. A person with alcohol poisoning has crossed into a range where the brainstem is being suppressed. This is not simply very drunk. It is a physiological emergency.

Blood alcohol concentration above approximately 0.3% (300mg/100ml) is considered dangerous. Above 0.4% (400mg/100ml) is potentially fatal. These levels can be reached in a single extended drinking session, particularly with spirits, fast consumption, or in individuals with lower body weight or no tolerance. They can also be reached in people who have developed high tolerance who consume their normal "large" amounts — high tolerance does not protect against the physiological toxicity of high BAC, it only masks the behavioural signs.

The Signs of Alcohol Poisoning

The specific indicators that distinguish alcohol poisoning from severe intoxication:

Unresponsiveness: The person cannot be roused by voice, shaking, or a sternal rub (pressing hard on the breastbone with a knuckle). They may appear to be sleeping but cannot be woken.

Slow or irregular breathing: Fewer than eight breaths per minute, or ten or more seconds between breaths, indicates respiratory depression from brainstem suppression. This is the mechanism by which alcohol poisoning kills — the person stops breathing.

Blue-tinged skin (cyanosis): Blueness around the lips, fingertips, or face indicates hypoxia — the tissues are not receiving adequate oxygen. This is a late and serious sign.

Cold, clammy, pale skin: The body is diverting blood from the periphery as it attempts to maintain core organ perfusion. Combined with other signs, this indicates significant physiological stress.

Vomiting while unconscious: The gag reflex is suppressed, meaning the person cannot protect their airway when vomiting. Aspiration of vomit is a common cause of death in alcohol poisoning.

Seizures: Occur in a minority of alcohol poisoning cases but are a direct sign of neurological emergency.

What to Do

Step 1: Call emergency services. Don't debate whether it's "bad enough" for an ambulance. If the person has the signs above, they need medical attention. Paramedics can assess BAC, monitor airway and breathing, and provide oxygen and IV fluids — none of which you can do.

Step 2: Don't leave them alone. A person with alcohol poisoning can stop breathing or begin vomiting at any moment. Someone must stay with them and monitor breathing until help arrives.

Step 3: Recovery position. If the person is breathing but unconscious, place them in the recovery position — on their side, with their upper knee bent forward to keep them from rolling onto their back, and their mouth angled down so vomit can drain rather than be aspirated. This single intervention prevents a significant proportion of alcohol poisoning deaths from aspiration.

Step 4: Keep them warm. Alcohol causes vasodilation and heat loss; hypothermia compounds the physiological stress of high BAC. Cover them with a coat or blanket while waiting for help.

Step 5: Don't give food, water, or coffee. These do not accelerate alcohol metabolism. They cannot reverse the BAC. Food can cause vomiting in a person with suppressed gag reflex. Coffee, a stimulant, can cause cardiac complications in the context of extreme intoxication.

The Myths That Kill People

"Let them sleep it off." The most dangerous myth. A person who is unconscious from alcohol poisoning can die during the "sleeping it off" period — from respiratory depression, from aspiration of vomit, from hypothermia. "Sleeping it off" is appropriate for someone who is drunk but conscious and responsive. It is not appropriate for someone who cannot be roused.

"Cold shower sobers them up." Cold showers do not affect BAC. They do, however, cause sudden cold shock — a significant cardiovascular stressor in someone already physiologically compromised. In rare cases, cold shock has contributed to cardiac events in severely intoxicated people. Don't.

"More alcohol helps." No. This is a myth with no pharmacological basis. More alcohol raises BAC further. There is no mechanism by which additional alcohol reverses the effects of alcohol poisoning.

"They'll be embarrassed if I call an ambulance." This concern is understandable and misplaced. Embarrassment is temporary. Death is permanent. Call the ambulance. The person can be embarrassed later — which is an outcome that requires them to be alive.

Who Is Most at Risk

Young people with low tolerance and binge drinking patterns are disproportionately represented in alcohol poisoning cases. The absence of tolerance means BAC rises faster per drink and the neurological effects are more pronounced. Mixing alcohol with other CNS depressants — benzodiazepines, opioids, sleep medication — dramatically increases alcohol poisoning risk at lower BAC levels because the combined suppressive effect on the brainstem is additive.

People with high tolerance are not protected from alcohol poisoning — they may simply show fewer behavioural signs at dangerous BAC levels, making the poisoning harder to recognise until it's more advanced. High tolerance can mask the emergency while the physiology remains dangerous.