Alcohol poisoning (acute alcohol intoxication)

Alcohol poisoning occurs when a person consumes a high number of alcoholic drinks within a short period. The actual toxic substance is called ethanol. Alcohol poisoning is hazardous to people’s health and, in the worst cases, can result in death.

Acute alcohol poisoning requiring hospital admission primarily involves adolescents and young adults. This is mostly due to binge drinking, a term used when men drink more than five or women drink more than four standard alcoholic beverages within a short period, e.g. four or five 0.3-liter bottles of beer in one evening.

High-risk alcohol consumption begins when men drink more than two small glasses of beer per day or women drink more than one small glass of beer per day. If health damage occurs as a result of the alcohol, this is referred to as harmful alcohol consumption. Alcohol dependence exists when certain other criteria are met.

The symptoms of alcohol poisoning depend on the blood alcohol level. Strictly speaking, as ethanol is a cell poison, even slight intoxication can be described as a symptom of poisoning. The symptoms intensify the faster the blood alcohol level rises. However, people can react very differently to alcohol. The following list therefore only provides rough guidance.

Blood alcohol levels up to 0.5 per mille:

• relaxation, inhibition
• increased talkativeness
• reduced control for small, precise movements

Blood alcohol levels between 0.5 and 1.0 per mille:

• limited judgment
• limited control of movements and coordination
• limited reaction speed

Blood alcohol levels between 1.0 and 2.0 per mille:

• unsteadiness, swaying
• slurred speech
• mood and behavioral changes

Blood alcohol levels between 2.0 and 4.0 per mille:

• nausea and vomiting
• hypothermia
• incomprehensible speech
• memory gaps
• disorientation
• double vision
• ocular tremors

Blood alcohol levels over 4.0 per mille:

• respiratory paralysis, respiratory arrest
• unconsciousness, coma
• cardiac arrest
• death

Alcohol poisoning in small children usually occurs unintentionally. Firstly, this can result from them getting hold of alcoholic drinks that have not been placed out of reach or confusing clear, high-percentage fluids with water. Secondly, children can drink other alcohol-containing fluids such as mouthwash solutions, cough syrups or fermented fruit juices. Rubbing the gums with high-percentage alcohol to prevent toothache can also lead to poisoning.

Small children react to alcohol with symptoms of poisoning faster than adults. Even low amounts of alcohol can lead to a dangerous drop in their blood sugar. If severe hypoglycemia is not rectified, this can lead to seizures and even a coma.

In the case of small children however, the typical symptoms of drunkenness such as impaired consciousness, motion control or balance or even respiratory paralysis often only occur once the blood alcohol level is extremely high – unlike with adolescents and adults. With low quantities of alcohol, the symptoms tend to be non-specific. In such cases, the children complain about stomach ache, behave unusually or stop sleeping and eating/drinking properly.

A differentiation is made between acute alcohol consumption within the last few hours or days and chronic alcohol consumption over weeks and months. Acute alcohol poisoning occurs when a large amount of alcohol is drunk within a short period. Such behavior is also referred to as binge drinking. With chronic alcohol consumption, symptoms of acute poisoning often only occur when blood alcohol levels are extremely high.

There are many reasons why adolescents and young adults in particular tend to binge drink. The individual’s personality, the behavior of the circle of friends, peer pressure and problems at home, school or socially play a role. Furthermore, low prices and easy access to alcohol make drinking simpler.

Alcohol enters the blood directly via the mucous membranes in the gastrointestinal tract. The following factors influence the rate at which the blood alcohol level rises:

• The higher the alcohol concentration in the drink, the faster the blood alcohol level rises.
• A food-filled stomach slows the absorption of the alcohol into the blood.
• Women’s blood alcohol level increases faster than men’s. This is because their body contains less water in which the alcohol can disperse due to the higher fat content.
• In large, heavy people, the alcohol is distributed around more mass overall. Their blood alcohol levels are therefore lower even if they have drunk the same amount of alcohol.

Alcohol is distributed throughout the body via the blood. Acute alcohol poisoning primarily affects the brain. Alcohol inhibits nerve activity, similar to an anesthetic. The brain becomes unable to properly process information and conscious movements and the balance are impaired.

Alcohol affects the brain via certain binding sites, which are actually there for other messenger substances. If people drink heavily over a long period, the body forms ever more such binding sites so the alcohol cannot occupy them all. As a result, alcohol only has the same effect at higher blood alcohol levels. This means the person has to drink more and more alcohol to get the same feeling of intoxication. The body develops an alcohol tolerance.

In addition to the disorders in the brain and nervous system, alcohol also directly affects the blood vessels. The vessels in the skin expand and have good circulation. This creates a feeling of warmth. If the external temperature is cold, this heat is lost to the outside. As alcohol also leads to low blood sugar levels, the body no longer has sufficient energy to produce enough heat and a risk of hypothermia ensues.

Alcohol causes people to excrete more water in their urine than they have drunk. In other words, it dehydrates the body and changes the composition of the minerals in the blood. Alcohol also inhibits the supply of sugar from the liver to the blood. This can trigger hypoglycemia. Both mechanisms lead to people feeling thirsty and weak after intoxication. These sensations are often compounded by a headache – in such cases, people talk about having a “hangover”.

Further to the above, alcohol and its by-products are toxins that damage the body cells. The heart, liver and brain are particularly susceptible to alcohol damage. Chronic alcohol consumption can also lead to inflammation of the pancreas and the stomach and intestinal mucosa as well as to cancer.

Alcohol is a widely used and socially accepted intoxicant, especially in Western cultures. In Germany, approximately 18 percent of adults drink risky amounts of alcohol, about 3 percent drink harmful amounts and a further 3 percent are alcohol dependent. Acute alcohol poisoning is most common among adolescents and young adults.

In 2018, almost 20,500 children, adolescents and young adults in Germany aged between 10 and 20 years were hospitalized with alcohol poisoning. The overall figure was lower than in the previous years but a clear increase was recorded in the number of 10 to 15 year olds. According to a 2014 survey, almost 13 percent of 12 to 17 year olds and slightly over 35 percent of 18 to 25 year olds binge drink at least once a month.

Men binge drink about twice as often as women. Regular binge drinking is most common among 18 to 29 year olds. People with a higher level of education generally binge drink less than those with a lower level.

Alcohol can be detected in the breath, the blood or the urine. People who have demonstrably consumed alcohol and are displaying the typical symptoms of severe intoxication can be assumed to have alcohol poisoning. This can be decisively determined by a doctor testing the blood alcohol level.

If a person is acting drunk, other causes of the impaired consciousness have to be ruled out regardless of whether or not the person has been drinking. Such causes can include an accident involving a head injury, sepsis (blood poisoning), encephalitis (inflammation of the brain), a seizure, poisoning with other substances, hypothermia, a high temperature, thyroid dysfunction, a lack of oxygen and other metabolic disorders.

In many cases, other blood values are therefore also checked when taking a blood sample. The blood values can also be used to determine if someone has already been consuming too much alcohol for a long time.

In some cases, an imaging scan of the skull is performed, for example using computed tomography (CT). This makes it possible to detect internal damage to the head, which could have occurred in an accident for instance.

As alcohol can cause acute cardiac arrhythmia (an irregular heartbeat), doctors sometimes also perform an ECG examination of the heart.

The treatment of alcohol poisoning primarily involves monitoring the vital functions until the alcohol in the blood has been broken down again. It is particularly important to keep the airways clear and prevent the inebriated person from inhaling vomit. People who are unconscious should therefore be put in the recovery position. As the unconscious person can quickly get cold, it is also useful to cover them up.

Many people with alcohol poisoning have too little fluid and sugar in their blood. Doctors therefore administer fluid intravenously, for example in the form of a sugar solution. If they also suspect chronic alcohol abuse, they additionally administer vitamin supplements, especially vitamin B1, to prevent further nerve damage.

Once the inebriated person has sobered up, doctors will try to talk to them and possibly offer further appointments. The aim is to change the person’s drinking behavior and reduce the level of alcohol consumption.

The consequences of alcohol poisoning can vary greatly depending on its severity. If people who do not suffer from chronic alcohol abuse get slightly drunk, this does not generally cause any lasting damage.

In the worst case scenario, severe alcohol poisoning, on the other hand, can sometimes be fatal, even for healthy people. Fatal complications are caused by situations such as fatal accidents, suffocating on vomit, respiratory paralysis or hypothermia after falling unconscious outdoors.

Acute alcohol poisoning may cause liver inflammation. In the case of existing liver damage, alcohol poisoning can lead to acute liver failure. Further complications include sudden hypoglycemia, seizures, acute cardiac arrhythmia and permanent heart failure.

The acute poisoning damage can also be accompanied by other undesirable consequences. People under the influence of alcohol are far more likely to behave in a way that puts them at risk or have an accident that results in permanent injury. As high blood alcohol levels reduce the feeling of pain, injuries are often only noticed once people have sobered up again. Furthermore, drunkenness increases the likelihood of people being involved in criminal behavior or acts of violence, having unprotected sex or experiencing unwanted pregnancies.

Alcohol poisoning is essentially prevented by drinking no or very little alcohol. People should particularly avoid drinking large amounts of alcohol within a short period.

It is important not to play down the risks of drinking alcohol. Everyone should know how harmful alcohol is to the human body. The alcohol consumption of their parents, who should set a good example, also plays a role in how adolescents behave.

If people have to be treated in hospital for alcohol poisoning, this is always a sign of harmful alcohol consumption. They should be encouraged to seek advice. The aim of providing advice at an early stage is to change drinking habits and prevent chronic alcohol damage.

As acute alcohol poisoning predominantly affects young people, there are numerous campaigns and information leaflets on alcohol prevention that have been specially designed for them. The German Protection of Young Persons Act (Jugendschutzgesetz) also prohibits the sale and distribution of high-percentage alcohol to people under the age of 18, with the aim of preventing harmful consumption. In other countries, high prices and sales and advertising restrictions have proven to be effective prevention measures.

Information about alcohol prevention can be found on the website of the Federal Center for Health Education (BZgA).

Detailed information on alcohol and numerous other useful contacts can be found on the website of the German Center for Addiction Issues (Deutsche Hauptstelle für Suchtfragen – DHS).