Alcohol poisoning

Too much alcohol too fast, suppressing breathing and the gag reflex. Never let somebody sleep it off on their back.

What it is

Dangerous depression of the nervous system from a large amount of alcohol in a short time.

Alcohol suppresses breathing, the heart rate, the gag reflex and the ability to maintain body temperature, and it lowers blood sugar. The commonest cause of death is inhaling vomit while unconscious, which is entirely preventable by positioning.

The blood alcohol level continues to rise for a while after the last drink, so somebody who seems merely very drunk when they lie down can be unconscious an hour later. That is the reason the advice is to stay with them.

It is more dangerous in young people, in older people, in anybody small, in anybody who has also taken drugs or medicines, particularly sedatives and opioids, and in people who do not drink often.

**Never let somebody sleep it off alone, and never lay them on their back.**

Coffee, cold showers, walking them around and making them sick do not help and can cause harm.

Repeated episodes are a signal about drinking that deserves following up once the emergency is over. See alcohol dependence.

Suspect something else, particularly a head injury, in anybody who seems more affected than the amount they drank explains.

Signs you might notice

Confusion, slurred speech, loss of coordination.

Vomiting.

Slow or irregular breathing, fewer than eight breaths a minute, or gaps of more than ten seconds.

Pale, bluish, cold or clammy skin.

Being unable to stay awake, or being unrousable.

Seizures.

999 immediately for: unconsciousness or inability to wake them; slow, shallow or irregular breathing; seizures; blue or grey lips or skin; being cold; repeated vomiting while drowsy; or any suspicion of a head injury or other drugs.

Also seek help for: anybody young, small, or who does not usually drink; anybody who has taken drugs or medication as well; or anybody diabetic, where hypoglycaemia is a real risk.

How it can affect day-to-day life

Fear of getting somebody into trouble is the main reason people delay calling for help, especially among students and young people. Nobody is arrested for calling an ambulance for a friend, and saying that plainly saves lives.

Positioning is the whole of first aid here: on their side, head tilted back slightly, chin forward, and stay with them.

Keeping them warm matters; alcohol causes heat loss and hypothermia is a real risk outdoors.

In a person who drinks heavily and regularly, sudden withdrawal after an admission can be dangerous in its own right, causing seizures and delirium tremens, and needs medical management rather than abstinence alone.

The following day is the moment when a brief, non-judgemental conversation about drinking has the most effect, and it is usually not had.

For anybody dependent, never stop drinking abruptly without medical advice.

Supporting someone well

Call 999 for any of the danger signs. Do not wait to see if they sleep it off.

Put them on their side in the recovery position, and stay with them. Never leave them on their back and never leave them alone.

Keep them warm.

Do not give coffee, do not make them vomit, do not put them in a shower, and do not walk them around.

Do not give more alcohol, and do not give food or drink to someone drowsy.

Tell the ambulance crew everything taken, including drugs and medicines. Nobody is in trouble for this.

Check for head injury; if in doubt, say so.

The next day, have the conversation about how much and how often, without judgement.

For dependent drinkers, get medical advice before stopping.

Where to get help

999 for any of the emergency signs.

NHS 111 for advice where someone is unwell but rousable and breathing normally.

A GP practice or a local alcohol service afterwards.

Alcohol Change UK for information and support, and We Are With You for free local drug and alcohol services.