Alcohol poisoning shows up as a cluster of warning signs: unresponsiveness or inability to stay conscious, slow or irregular breathing, vomiting while passed out, clammy skin, and a bluish or pale skin color. If someone has even two or three of these signs after heavy drinking, treat it as a medical emergency. A blood alcohol concentration over 0.31% can cause coma or death, and the person’s BAC can keep rising even after they stop drinking as alcohol continues to absorb from the stomach.
The Warning Signs to Look For
Alcohol poisoning isn’t just “being really drunk.” It’s a point where the amount of alcohol in the bloodstream starts shutting down basic body functions, including breathing, temperature regulation, and the gag reflex. The signs fall into two categories: ones that look alarming and ones that are easy to miss.
The obvious signs include repeated or continuous vomiting, confusion so severe the person can’t respond to questions, and loss of consciousness. You might try to wake them and get no response, or only get incoherent mumbling. Seizures can also occur.
The subtler signs are just as dangerous. Check their skin: clammy, cold skin signals the body is losing its ability to regulate temperature. Bluish or pale skin, especially around the lips and fingertips, means oxygen levels are dropping. Their body temperature may feel unusually low to the touch. Listen to their breathing. Slow, irregular breathing, or long gaps between breaths, means the alcohol is suppressing the part of the brain that controls involuntary functions.
Why “Sleeping It Off” Can Be Fatal
The most dangerous misconception about alcohol poisoning is that the person just needs to sleep. Here’s why that logic fails: alcohol continues absorbing into the bloodstream from the stomach and intestines long after the last drink. Someone who seems moderately drunk when they pass out can reach life-threatening BAC levels 30 to 60 minutes later, without taking another sip.
At a BAC between 0.16% and 0.30%, a person may experience blackouts, vomiting, difficulty walking, and loss of consciousness. Above 0.31%, the risk of coma and fatal respiratory failure rises sharply. The problem is that you can’t measure someone’s BAC at a party. You have to rely on what you can see and hear.
The gag reflex is one of the body’s last defenses, and high alcohol levels suppress it. That means a person who vomits while unconscious may not be able to clear their airway. Choking on vomit is one of the most common causes of death from alcohol poisoning.
Who Reaches Poisoning Levels Faster
Not everyone who drinks the same amount faces the same risk. Women typically reach higher blood alcohol levels than men from the same number of drinks. This is partly because women tend to have higher body fat percentages and lower levels of the stomach enzymes that begin breaking down alcohol before it hits the bloodstream. The result: more alcohol enters circulation, faster.
Body composition matters regardless of sex. A person with more muscle mass absorbs alcohol into tissue more efficiently, while fat does not absorb alcohol well. Someone who is smaller, less muscular, or hasn’t eaten recently will reach dangerous levels on fewer drinks. Mixing alcohol with other substances that slow the nervous system, including sleep aids and certain medications, dramatically increases the risk of poisoning at lower amounts of alcohol.
What to Do Right Now
If you’re reading this because someone near you might have alcohol poisoning, call emergency services. Don’t wait to see if they “get better.” The signs that matter most are inability to wake up or stay conscious, slow or irregular breathing, vomiting while unconscious, very cold or bluish skin, and seizures. Any one of these is enough to call.
While waiting for help, place the person on their left side. Position their right hand under their head to keep the airway open, and bend their right knee forward to prevent them from rolling onto their stomach. This is called the recovery position, and it keeps vomit from blocking the airway if they throw up. Stay with them. Monitor their breathing continuously.
Do not give them coffee, food, or a cold shower. None of these speed up the body’s processing of alcohol, and a cold shower can cause a dangerous further drop in body temperature. Do not try to make them vomit, as this increases the risk of choking when the gag reflex isn’t working properly. Do not leave them alone, even for a few minutes.
Alcohol Poisoning vs. Being Very Drunk
The line between severe intoxication and alcohol poisoning is real, but it’s not always obvious from the outside. A very drunk person can still respond when you talk to them, walk with help, and maintain a roughly normal skin color. They’re impaired, but their body is still managing its basic functions.
Alcohol poisoning looks different. The person may be completely unresponsive. Their breathing may be noticeably slow, shallow, or irregular. Their skin may feel cold and look pale or bluish. If you pinch the back of their hand and the skin stays “tented” or they don’t react at all, that’s a serious sign. Vomiting without waking up is another clear signal that the brain is too suppressed to protect the airway.
When in doubt, err on the side of calling for help. There is no social consequence that outweighs the risk of someone dying from a preventable cause. Emergency responders would rather respond to a false alarm than arrive too late.