ask the expert

alcohol poisoning

December 27, 2007|By Holly Selby

Just about anyone who has attended a too-rowdy party knows the scene: Someone begins drinking and doesn't know when to stop. Rambunctious behavior, slurred words, an uneven gait and sometimes even unconsciousness follows.

While drinking in moderation can be pleasurable, drinking too much can lead to alcohol poisoning, a severe and potentially fatal reaction to an overdose. Too much alcohol can shut down parts of the brain that control the gag reflex (which prevents choking) and breathing, says McRae Williams, an emergency-room physician at Greater Baltimore Medical Center.

What is alcohol poisoning?

As far as I know, there is no formal definition for alcohol poisoning. The law tries to define it in terms of being able to drive a car, but it is not like there is an alcohol level that signals poisoning. It is a gray scale. Drinking too much alcohol in a short period of time can cause alcohol poisoning.

What happens when a person has alcohol poisoning?

Alcohol is basically a solvent, so it travels through all membranes and has affects on almost everything. It has a global affect on the brain. It affects balance and coordination. It affects the speech center, so it affects how you talk. It has very specific affects on the hippocampus, so people can be just conscious enough to do things but can't remember them, and that is called blacking out. Someone with alcohol poisoning can eventually stop breathing. If a person has a lower respiratory rate, that is a sign of poisoning. If they are in really bad shape, and they are vomiting, they run the risk of aspirating the vomit and dying from that. And alcohol can affect one of the most primitive parts of the brain so that the brain forgets to breathe.

If you're at a party and someone has had a lot to drink, how do you know when to call for help?

If you are worried about someone, bring them to the hospital. We are always happy to take a look at them. But the most practical answer to this question is that as long as the person is still ambulatory and capable of communicating, they are probably OK. Cut them off from drinking and watch them for awhile.

Signs of trouble might include confusion, loss of consciousness, vomiting, seizures, slow breathing or hypothermia [which includes low body temperature and bluish skin color]. If a person is unresponsive or has some of these symptoms, call a professional.

How much alcohol can cause poisoning?

There is no set amount. A beer an hour -- that is what your body is capable of digesting. The way people really get alcohol poisoning is drinking large amounts of alcohol in short amounts of time: chugging, beer bongs, contests.

Can someone sleep off alcohol poisoning?

No, a danger is that even after a person passes out, he can continue to digest alcohol so that even if a person is unconscious, alcohol in the stomach can continue to be absorbed into the bloodstream.

What is the treatment for alcohol poisoning?

I watch them. I make sure they are breathing and have a gag reflex so if they vomit, they cough and don't choke. We use a pulse oximeter, which measures the percent of oxygen in hemoglobin and counts the respiratory rate. As long as the oxygen level doesn't fall, we let them sleep for three or four hours. At that point, they are no longer becoming more intoxicated, and if they have family to come get them, we send them home. Otherwise, I wait and send them home in the morning.

But for people who are way too intoxicated and don't have the gag reflex or a normal respiratory rate or oxygen level, we intubate them [pass a tube into the trachea to help the patient breathe]. We leave the tube in until the blood alcohol level comes down significantly. This generally involves a stay in the intensive care unit.

Is there anything you'd like to add?

That, generally, minors are terribly poor judges of a person's condition. The person who makes a decision [about whether to take the person to a hospital or call 911] should be an adult and should be sober. You don't make good judgment when you are drunk. And when in doubt, come to the hospital. We can always send them home; and if there is a problem, we can keep them in the ER.


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