Alcohol poisoning shows up as a cluster of dangerous physical signs: slowed or irregular breathing, inability to stay conscious, vomiting, seizures, clammy skin, and bluish or pale skin color. If someone has even two or three of these symptoms after heavy drinking, they need emergency help. A person does not have to show every sign on the list to be in serious danger.
The Warning Signs
The critical symptoms of alcohol poisoning, as outlined by the National Institute on Alcohol Abuse and Alcoholism, are:
- Slow breathing: fewer than 8 breaths per minute
- Irregular breathing: gaps of 10 seconds or more between breaths
- Mental confusion or stupor: beyond normal drunkenness, the person seems barely aware of their surroundings
- Difficulty staying conscious: they drift in and out, or you cannot wake them up at all
- Vomiting, especially while unconscious or semi-conscious
- Seizures
- Clammy skin
- Extremely low body temperature, sometimes with bluish, gray, or pale skin
- No gag reflex: a dulled response that makes choking on vomit far more likely
- Slow heart rate
You do not need to confirm all of these before calling for help. Any combination of slowed breathing, unconsciousness, or seizures is enough to treat the situation as life-threatening.
Drunk vs. Dangerously Poisoned
Someone who is very drunk might stumble, slur their words, and act loud or emotional. That is intoxication, and while it carries its own risks, it is not the same as poisoning. The line between “very drunk” and “alcohol poisoning” comes down to what the brain can still control.
A person who is simply drunk can still talk to you, respond when you say their name, and breathe at a normal rate. Once alcohol levels climb high enough to suppress the brain’s basic life-support functions, breathing slows or becomes erratic, body temperature drops, the gag reflex disappears, and consciousness fades. Those are the red lines. The person’s body is losing its ability to keep itself alive without intervention.
One important thing to understand: blood alcohol levels can keep rising even after someone stops drinking. Alcohol in the stomach and intestines continues to absorb into the bloodstream for up to 40 minutes or more after the last drink. So a person who seems “just drunk” when they stop drinking can slide into poisoning territory while they sleep. This is why passing out after heavy drinking is not something to shrug off.
How Dangerous the Numbers Get
Blood alcohol concentration (BAC) gives a clinical picture of how much danger someone is in. At a BAC of 0.30% to 0.40%, alcohol poisoning is likely, and loss of consciousness is expected. Above 0.40%, the risk of coma and death from respiratory arrest becomes very real. For context, the legal driving limit in most U.S. states is 0.08%, so poisoning-level BAC is roughly four to five times that threshold.
You obviously can’t measure someone’s BAC at home, which is why watching for physical symptoms matters so much. The breathing rate is probably the single most useful thing a bystander can check. Count breaths for 30 seconds and double it. If the number is below 8 per minute, or if you notice long pauses between breaths, that person needs emergency medical care immediately.
What Happens if It Goes Untreated
Alcohol poisoning can kill in several ways. The most common is choking: the person vomits while unconscious and, because their gag reflex is suppressed, inhales vomit into their lungs. This can cause fatal suffocation or lead to a severe lung infection.
Breathing can slow so much that it simply stops. Even if breathing continues at a reduced rate, the brain may not get enough oxygen, which can cause permanent damage. Severe alcohol poisoning also drops body temperature dangerously low (hypothermia) and can crash blood sugar levels, potentially triggering seizures. Heart rhythm can become irregular. Any of these complications on their own can be fatal, and in alcohol poisoning they often overlap.
The scale of the problem is enormous. Excessive alcohol use killed an average of roughly 178,000 Americans per year during 2020 and 2021, a 29% increase from just a few years earlier. That translates to about 488 deaths per day. One in eight deaths among U.S. adults aged 20 to 64 has been attributed to excessive alcohol use.
What to Do Right Now
If you are with someone showing signs of alcohol poisoning, call emergency services. While waiting, turn the person onto their side in what is called the recovery position. This keeps their airway open and lets vomit drain out of the mouth instead of being inhaled into the lungs.
To get someone into the recovery position from flat on their back: move the arm closest to you out to the side, bent at the elbow like they are waving. Take their far hand and bring it across their body. Then roll them toward you onto their side so their face tilts slightly downward, with their head positioned a bit lower than their stomach. This angle helps fluids flow out naturally.
Stay with the person and keep monitoring their breathing. Do not leave them alone “to sleep it off.” Do not give them coffee, food, or a cold shower. None of these things lower blood alcohol levels or reverse the poisoning. Do not try to make them vomit, as this increases choking risk when reflexes are dulled.
What Happens at the Hospital
Diagnosis is straightforward. Medical teams assess based on known or reported alcohol consumption combined with visible symptoms like slowed breathing, reduced responsiveness, and vomiting. They will typically check heart function, overall blood chemistry, and monitor breathing closely. The main goal is to keep the person’s airway clear, maintain their body temperature, and support their breathing and circulation until the body processes the alcohol.
There is no quick antidote for alcohol poisoning. Recovery depends on how much alcohol is in the system and how well the body can metabolize it. For most people, the liver processes roughly one standard drink per hour, so someone with a very high BAC may need many hours of medical support before they are out of danger.