If someone near you is throwing up from drinking, the most important thing you can do right now is keep them awake, sitting upright or on their side, and watch them closely. Vomiting after heavy drinking is the body’s attempt to get rid of excess alcohol, but it comes with real risks, especially choking, if the person is too impaired to protect their own airway. Here’s exactly what to do and what to watch for.
Keep Them Upright or on Their Side
The single biggest danger when someone is vomiting while intoxicated is choking. Alcohol suppresses the gag reflex, which means a person who vomits while lying on their back can inhale that vomit into their lungs without coughing it out. This can cause a fatal interruption of breathing. Never leave a drunk, vomiting person lying flat on their back.
If the person is still conscious and can sit up, have them lean slightly forward over a bucket or toilet. If they’re too impaired to sit, place them in the recovery position:
- Raise the arm closest to you above their head.
- Gently roll them toward you onto their side, guiding their head so it doesn’t hit the floor.
- Tilt their head up slightly to keep the airway open.
- Tuck their nearest hand under their cheek to keep the head tilted and the face off the ground.
This position lets any vomit drain out of the mouth instead of pooling in the throat.
Stay With Them and Keep Checking
Do not leave the person alone, even if they seem to be “just sleeping it off.” Blood alcohol levels can continue rising for 30 to 40 minutes after the last drink, meaning someone who seems okay right now can become unconscious shortly after. Wake them frequently. If they respond to your voice or a gentle shake, that’s a good sign. If they don’t wake up at all, that’s an emergency.
Check their breathing. Normal breathing is steady and regular. Count the breaths: fewer than 8 per minute, or gaps of 10 seconds or more between breaths, signals alcohol poisoning. Also look at their skin. Cold, clammy, pale, or bluish skin is a warning sign that their body is struggling to maintain basic functions.
When to Call 911
You do not need to wait for every symptom on a checklist. The National Institute on Alcohol Abuse and Alcoholism is clear on this: if you suspect alcohol overdose, call immediately. A person who has passed out can die. Call 911 if you see any of these:
- They can’t be woken up or stay conscious
- Breathing is slow (under 8 breaths per minute) or irregular
- Seizures
- Skin is bluish, very pale, or cold and clammy
- Vomiting while unconscious or semiconscious
- Mental confusion beyond normal drunkenness, more like a stupor
Vomiting by itself, while the person is awake and responsive, is usually the body doing its job. But vomiting combined with any of the signs above means the situation has moved past “drunk” into potential alcohol poisoning.
What to Give Them (and What Not To)
Once the vomiting slows down and the person can keep liquids in, offer small sips of water. The goal is to prevent dehydration, not to flood the stomach. A few sips every 10 to 15 minutes is enough. Avoid giving large glasses of water while they’re still actively vomiting, as it just comes right back up and doesn’t help.
Do not give them acetaminophen (Tylenol). Alcohol and acetaminophen are both processed by the liver, and combining them puts serious stress on it. In heavy drinkers, alcohol depletes a key protective substance in the liver, making even normal doses of acetaminophen potentially toxic. If they have a headache the next day, ibuprofen is generally a safer choice, though it can irritate an already-upset stomach.
Skip the coffee. Caffeine does not speed up the removal of alcohol from the body. The liver processes alcohol on a fixed schedule, roughly one standard drink per hour, and nothing changes that rate. Coffee just creates a person who is both drunk and wired. Cold showers don’t work either, and they can cause a dangerous drop in body temperature in someone whose system is already struggling to regulate heat.
Why Alcohol Triggers Vomiting
Alcohol increases acid production in the stomach and directly irritates the stomach lining, a condition called gastritis. This inflammation, combined with the toxic effects of alcohol on the brain’s vomiting center, triggers nausea and vomiting as a protective reflex. The body is essentially trying to stop you from absorbing more of a substance it recognizes as poisonous at that concentration.
This reflex typically kicks in around a blood alcohol concentration of 0.15%, roughly twice the legal driving limit in most states. At that level and above, you also see loss of balance, drowsiness, confusion, and mood changes. The vomiting itself, while miserable, is actually a sign the body’s defenses are still working. The real danger comes when someone drinks enough to suppress even that reflex.
The Morning After
Repeated vomiting strips the body of fluids, electrolytes, and nutrients. Once the person can eat and drink again, prioritize hydration with water or an electrolyte drink. Simple, bland foods like toast, crackers, or bananas are easier on an irritated stomach than anything greasy or acidic.
Heavy drinking depletes B vitamins, especially thiamine (vitamin B1), which is critical for brain function. A single episode won’t cause a deficiency, but if this is part of a pattern of heavy drinking, replenishing B vitamins through food or a supplement matters more than most people realize. Chronic thiamine deficiency from alcohol use can lead to serious, permanent brain damage.
If vomiting continues for more than 24 hours after the person stopped drinking, or if there’s blood in the vomit (which can look bright red or like dark coffee grounds), that’s no longer a hangover. It’s a sign of possible internal bleeding or severe gastric irritation that needs medical attention.