Alcohol Poisoning (Overdose)

Alcohol Intoxication vs Alcohol Poisoning

Alcohol poisoning is a life threatening condition caused by drinking large amounts of alcohol in a short time ^[1].

While during alcohol intoxication, a person remains conscious and can walk, during alcohol poisoning, a person loses most of self-control, which means inability to walk and often a loss of consciousness. There is no clearly defined line between alcohol intoxication and poisoning, though.

Amount of Alcohol That May Cause Poisoning

There is no safe minimal amount of alcohol that could not cause alcohol poisoning, but poisoning is common at blood alcohol concentrations (BAC) above 0.2 g/100 mL blood, which can result, for example, from drinking of 1.5 drinks/hour by a 30 lbs toddler, 6 drinks/hour by a 140 lbs woman, 9 drinks/hour by a 160 lbs man or 12 drinks/hour by a 240 lbs man ^[2,3].

The BAC 0.44 g/100 mL was recorded in a 15-day-old infant treated with alcohol-containing dressings; the infant was initially in coma and has recovered well after treatment ^[4].

Sometimes, heavy chronic drinkers with BACs above 1.0 g/100 mL may have relatively mild symptoms. In 1982, a 24 years-old woman admitted to emergency room of University of California (UCLA), U.S., had BAC 1.33 g/100 mL and she was “conscious and oriented” ^[5].

In December 2010, in Easter Cape in South Africa, a 50-year-old man who was driving a car while drunk had BAC 1.6 g/100 mL ^[6]. In 2 other cases, persons with BACs 1.1 and 1.5 g/100 mL were only “slightly confused” ^[7-p.406].

What increases the risk of alcohol poisoning?

• Inexperience with drinking
• Fast drinking, drinking games
• Drinking spirits
• Drinking on an empty stomach
• Reference: ^[9]

Symptoms

• Alcohol smelling breath (which alone does not speaks for poisoning, since it may be present even after a single drink)
• Confusion or hallucinations (which may occur during intoxication or from 10 hours to 10 days after the last drink as part of alcohol withdrawal)
• Vomiting repeatedly or vomiting without waking up
• Pale or bluish, cold, clammy skin due to hypothermia or drop of the blood pressure
• Seizures triggered by dehydration after repeated vomiting, or by hypoglycemia
• Stupor – drowsiness, from which you can briefly arouse the person only by a deep pinch or face slapping
• Passing out – unconsciousness, from which you cannot arouse the person
• Dilated pupils poorly responsive to light in an unconscious person who was drinking speak for severe alcohol poisoning ^{[7-p.393; 8]}.
• Breathing slower than 8 breaths per minute or breathing with pauses longer than 10 seconds between breaths due to a depressing effect of alcohol on the respiratory center.
• Death due to alcohol poisoning may occur at blood alcohol concentrations above 0.3 g/100 mL blood.
• References: ^[9,10]

Treatment

Treatment of an otherwise healthy person with alcohol poisoning usually requires one-day hospital stay and may include:

• Pumping the stomach to remove any eventual alcohol that has not already been absorbed
• Fluids through a vein (in dehydration)
• Thiamin + folate + glucose (in hypoglycemia)
• Hemodialysis or peritoneal dialysis (in life-threatening poisoning)

Active charcoal does not significantly reduce alcohol absorption ^[15]. There are no known ethanol antagonists. Caffeine does not reduce sedating effect of alcohol ^[17]. Untreated alcohol poisoning may result in death due to ^[9]:

• Stopping breathing (alcohol depresses breathing center in the brain stem)
• Irregular heart rhythm (arrhythmia)
• Severe dehydration due to repeated vomiting (if a person survives prolonged dehydration, it may still have a permanent brain damage)
• Chocking on the person’s own vomit (alcohol depresses gag reflex)
• Injury, burning, drowning.
• Hypothermia.A severely intoxicated person may die from hypothermia in his or her own apartment at temperature as high as 50 °F [10 °C]. ^[16]
• Hypoglycemia, usually in a chronic alcoholic who has not eaten for few days.

Complications

Heavy binge drinking followed by coma and compression of the limb (for example, falling asleep on the stairs with a compressed leg) may result in skeletal muscle disintegration (acute alcoholic myopathy or alcoholic rhabdomyolysis) with severe pain, weakness and swelling of the affected limb and passing dark urine ^[11,12,13]. Further complications, caused by substances leaked from the damaged muscles, include kidney failure with inability to pass urine, and pulmonary embolism or stroke. In treatment, intravenous fluid infusion, hemodialysis and surgical decompression of the affected limb may be required ^[11]. Successful treatment may result in full recovery within few days to weeks, but death due to kidney failure or other complications is possible.

If you suspect someone has alcohol poisoning, call the emergency (911 in the United States) immediately. Do not assume someone will “sleep off” alcohol poisoning. In an unconscious person, alcohol absorption from the gut may continue and the blood alcohol concentration may continue to rise for more than an hour after last drink. Until the medical help comes, you can do ^[14]:

Lethal Dose of Ethanol

Lethal dose of ethanol (LD50; the dose, which would, presumably, kill half of the population) is the one that brings the blood alcohol concentration to 0.4-0.5 g/100 mL blood ^[18,19]. This BAC could be achieved, for example, after eight drinks in 1 hour by a 100 lbs woman, or 17 drinks in 1 hour by a 160 lbs man ^[2]. Much lower doses have killed people, and doses resulting in BACs over 1 g/100 mL have not killed others, though.

• The BAC 0.31 g/100 mL was detected in an 18-year-old female student who died after 2 drinking parties at Radford University, U.S. in 1996 ^[20].
• After drinking 24 oz [710 mL] hard liquor (16 drinks) in 1 hour, an 18-year-old male student died at Rutgers University in y. 1988 ^[20].
• The BAC 0.34 g/100 mL was detected in a 20-year-old male student who died after drinking “at least six beers and 12 shots of vodka in 2 hours” in Frostburg State University in 1996 ^[20].
• The BAC 0.59 g/100 mL was detected in a 20-year-old male student who died after binge drinking at several parties at Louisiana State University in 1997 ^[20].

The lethal dose of alcohol for a child is about 1.5 g per pound (3 g per kilogram) of body weight ^[21]. However, much lower alcohol doses may kill a small child, because ethanol is not only toxic by itself, but may also cause a deadly hypoglycemia.

• The BAC 0.04 g/100 mL was detected in an 14-day-old infant, who died in Russia in 2011 after his mother breastfed him after drinking 1 liter of port wine. The mother’s blood alcohol concentration was 0.25 g/100 mL ^[22]. Another newborn with blood alcohol concentration 0.04 g/100 mL died in Russia in January 2012, after his mother breastfed him after drinking 50 grams wine and 1.5 liters beer ^[23].
• The BAC 0.47 g/100 mL was detected in an 3-month-old infant who died in Florida, U.S. in 2004 after his parents gave him a mixture of vodka, water and sugar in order to help him fall asleep ^[24].
• The BAC 0.20 g/100 mL blood was detected in a six-month-old infant who died in Pennsylvania, U.S., in 2007 after his mother gave him alcohol in order to stop crying ^[25].
• The BAC 0.31 g/100 mL was detected in a 4-year-old boy who has died after he has probably drunk about 12 oz [~350 mL] of mouthwash containing 10% alcohol (about 30 g alcohol) ^[26].