Healthy living Acute alcohol poisoning (ethanol intoxication)

Acute alcohol poisoning impairs brain functions. For example, it impairs awareness and cognitive functioning. It changes people’s perception of reality and their behavior. In short, it makes people intoxicated, i.e., drunk. Different people experience intoxicating effects after consuming different amounts of alcohol. Whether and how quickly a person becomes intoxicated depends to a significant degree on how accustomed to alcohol their body is.

The risk of alcohol poisoning increases if people consume a large number of alcoholic drinks within a short period. The toxic substance in alcoholic drinks is called ethanol. Alcohol poisoning with ethanol is hazardous to people’s health and, in the worst cases, can result in death. Other alcohols, such as methanol or isopropanol, can also result in alcohol poisoning. However, this article only discusses alcohol poisoning with ethanol.

Acute alcohol poisoning requiring hospital admission primarily involves adolescents and young adults. This is mostly due to binge drinking. This term describes situations where men drink more than 5 standard alcoholic drinks or women drink more than 4 within a short space of time. A standard drink is 0.3 liters of beer, for example.

There is no such thing as risk-free alcohol consumption. High-risk alcohol consumption begins when men drink more than two small glasses of beer a day. The equivalent volume for women is more than one small glass of beer a day. If alcohol causes health problems, this is referred to as harmful alcohol consumption. Frequent consumption can also result in alcohol dependence.

The symptoms of alcohol poisoning depend on the blood alcohol level. Alcohol, in this case ethanol, is a cytotoxin, which means that it damages and destroys cells. Therefore, even mild intoxication is technically a symptom of poisoning. The symptoms intensify the faster the blood alcohol level rises. However, people can react very differently to alcohol. The values indicated below are therefore provided as guidelines only.

Blood alcohol levels up to 0.5 per mille:

• relaxation, loss of 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
• involuntary eye movements

Blood alcohol levels over 4.0 per mille:

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

Alcohol poisoning in young children usually occurs unintentionally. It can happen if they get hold of alcoholic drinks that have not been placed out of reach. Alternatively, children may mistake clear, high-strength alcoholic liquids for water. Another potential hazard is presented by alcohol-containing liquids such as mouthwash, cough syrups or fermented fruit juices. Even rubbing the gums with high-strength alcohol to relieve teething pain can also lead to poisoning. 

Young children react differently to alcohol than adults and are more sensitive to its effects. Even low amounts of alcohol can lead to a dangerous drop in their blood sugar. If severe hypoglycemia is not treated, this can lead to seizures and even a coma. 

It can be difficult to detect alcohol poisoning in young children, as the symptoms may initially be quite generalized. In such cases, the children complain about stomach ache, behave unusually or sleep poor and have difficulty eating or drinking. In contrast to adolescents and adults, young children often only show typical signs of intoxication with alcohol if their blood alcohol level is dangerously high.

A distinction is made between acute alcohol consumption over a few hours or days and chronic alcohol consumption over weeks and months. The risk of acute alcohol poisoning is particularly high when a large volume of alcohol is drunk within a short period. This type of consumption is known as binge drinking. With chronic alcohol consumption, on the other hand, signs 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, how their parents and their friends consume alcohol, peer pressure and problems at home, in school or in their social life all play their part. Low prices and easy access to alcohol also make it easier for them to drink.

Alcohol enters the bloodstream directly through the mucous membranes of 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.
• Having food in the stomach slows the absorption of the alcohol into the blood.
• Women’s blood alcohol level increases faster than men’s. Women’s blood alcohol levels tend to rise faster than men’s because, on average, they have a higher proportion of body fat and less body water in which alcohol can be distributed.
• In larger, heavier people, alcohol is distributed throughout a greater body mass. Their blood alcohol levels are therefore lower even if they have consumed 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 drug. The brain becomes less able to process information properly, and conscious movements and balance are impaired.

Alcohol affects the brain via certain binding sites that normally bind other messenger substances. If alcohol occupies these binding sites, information cannot be transmitted normally, resulting in impaired brain functioning. 

In addition to disruptions in the brain and nervous system, alcohol also directly affects the blood vessels. The vessels in the skin expand and more blood than usual flows through them. As a result, the body loses a lot of heat through the skin within a short space of time. This is particularly dangerous in a cold environment. Alcohol simultaneously causes blood glucose levels to drop. As a result, the body no longer has enough energy to quickly replace the lost heat and so is in danger of becoming hypothermic.

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 release of glucose from the liver into the bloodstream. This can trigger hypoglycemia. These two mechanisms contribute to feelings of weakness and thirst following intoxication. These sensations are often accompanied by a headache – together, they are commonly described as a “hangover”.

In addition, 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 continues to be a widely used and socially accepted intoxicant, especially in Western cultures. In 2024, a total of 3.9 million adults between the ages of 18 and 64 experienced alcohol-related disorders. An alcohol-related disorder is any health condition that can be caused by alcohol consumption. These include alcohol dependence, acute alcohol poisoning, the effects of alcohol withdrawal, and various secondary health conditions that can occur following chronic alcohol consumption.

Around one third of adults in Germany get drunk at least once a month. Clear differences can be seen between different population groups. Binge drinking is particularly widespread among adolescents and young adults.

A study in 2023 found that around 17 percent of adolescent males and around 13 percent of adolescent females reported that they had got drunk within the past 30 days. The figure for young men was around 46 percent and, for young women, 32 percent.

In 2023, 9,263 children, adolescents and young adults in Germany aged 10 to 20 were hospitalized with alcohol poisoning. This represented a decrease compared to 2022, when the equivalent figure was 11,472.

Alcohol can be detected in breath, blood or urine. People who have consumed alcohol and are displaying the typical symptoms of severe intoxication may have alcohol poisoning. A doctor can determine the blood alcohol level to confirm alcohol poisoning.

If someone appears drunk – showing signs of impaired consciousness – other possible causes must be ruled out, regardless of whether they have been drinking. Such causes can include an accident involving a head injury, blood infection (sepsis), encephalitis (inflammation of the brain), a seizure, poisoning with other substances, hypothermia, fever, thyroid dysfunction, a lack of oxygen and other metabolic disorders.

In many cases, other blood tests are therefore also performed. Blood tests can also provide information about whether someone has been drinking excessively over a longer period.

In some cases, a head scan 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 cardiac arrhythmias (an irregular heartbeat), doctors sometimes examine the heart with an ECG.

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

Many people with alcohol poisoning are dehydrated or have low blood sugar. Doctors may therefore administer intravenous fluids and, if necessary, glucose. If they also suspect chronic alcohol abuse, they may also administer vitamin supplements, especially vitamin B1, to prevent further nerve damage.

Once the intoxicated 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. In people without a pattern of chronic alcohol abuse, a single episode of mild intoxication generally does not cause permanent damage.

In the worst-case scenario, severe alcohol poisoning, on the other hand, can sometimes be fatal, even for healthy people. Fatal complications can result from accidents, choking on vomit, respiratory paralysis, or hypothermia after losing consciousness outdoors.

Acute alcohol poisoning may cause liver inflammation. In people with existing liver damage, alcohol poisoning can lead to acute liver failure. Further complications include sudden hypoglycemia, seizures, cardiac arrhythmias and permanent heart failure.

Alcohol poisoning can also have other harmful consequences. People under the influence of alcohol are far more likely to engage in risky behavior or have an accident that results in permanent injury. As high blood alcohol levels reduce sensitivity to pain, injuries are often only noticed once people have sobered up. In addition, drunkenness increases the likelihood of criminal behavior and violence, unprotected sex, and unintended pregnancy.

Alcohol poisoning can be prevented by avoiding alcohol or drinking only small amounts. People should particularly avoid drinking large amounts of alcohol within a short period.

It is important not to underestimate the risks of drinking alcohol. Everyone should be aware of the physical and psychological dangers of alcohol. Parents’ alcohol consumption also plays a role in adolescents’ drinking behavior, so parents should set a good example.

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 counseling. The aim of early counseling 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) prohibits the sale and distribution of high-strength alcohol to people under the age of 18, with the aim of protecting them from harmful consumption. In other countries, high taxes and restrictions on sales and advertising have proven to be effective prevention measures.

Information about alcohol prevention is available on the website of the Federal Institute for Public Health (Bundesinstitut für Öffentliche Gesundheit, BIÖG).

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