Alcohol poisoning shows up as a cluster of dangerous physical signs: slow or irregular breathing, vomiting, seizures, confusion, loss of consciousness, and cold or bluish skin. Fewer than 8 breaths per minute, or gaps of 10 seconds or more between breaths, signals a life-threatening emergency. If you’re seeing even a few of these signs in someone who has been drinking heavily, call 911 immediately.
The Warning Signs to Watch For
Alcohol poisoning happens when there is so much alcohol in the bloodstream that the areas of the brain controlling breathing, heart rate, and temperature regulation begin to shut down. The signs reflect that shutdown in real time:
- Mental confusion or stupor. The person can’t hold a conversation, doesn’t know where they are, or seems completely unresponsive.
- Difficulty staying conscious. They drift in and out, or you cannot wake them up at all.
- Vomiting. Especially dangerous because alcohol suppresses the gag reflex, meaning a person can choke on their own vomit without waking up.
- Seizures. Alcohol can cause blood sugar to drop low enough to trigger seizures.
- Slow breathing. Fewer than 8 breaths per minute.
- Irregular breathing. A gap of 10 seconds or more between breaths.
- Slow or irregular heartbeat.
- Clammy skin, bluish tint, or paleness. Bluish color around the lips or fingertips means the body isn’t getting enough oxygen.
- Extremely low body temperature. The person may feel cold to the touch.
You do not need to see every symptom on this list. A person who is unconscious and breathing slowly is in danger, even if they aren’t seizing or turning blue. One or two of these signs in someone who has been drinking heavily is enough to warrant emergency help.
Why Alcohol Poisoning Is So Dangerous
The core danger is that alcohol is a central nervous system depressant, and at high enough concentrations it suppresses the automatic functions your body runs without conscious effort. Your brainstem keeps you breathing, keeps your heart beating at a steady rate, and maintains your body temperature. When alcohol floods these control centers, each of those functions can slow or fail.
A blood alcohol concentration (BAC) between 0.30% and 0.40% typically causes loss of consciousness and alcohol poisoning. Above 0.40%, the risk of coma and death from respiratory arrest, a complete stop in breathing, becomes very real. For context, legal intoxication in the U.S. is 0.08%, so alcohol poisoning territory is roughly four to five times that level. Binge drinking, drinking on an empty stomach, and mixing alcohol with other sedating substances all make it easier to reach these levels faster than you might expect.
The most common way alcohol poisoning kills is through choking. When someone vomits while unconscious and their gag reflex has been suppressed by alcohol, vomit can enter the airway and block breathing entirely. Dangerously low body temperature is another serious complication, because the same brain systems that regulate your internal thermostat are being shut down by alcohol. An irregular heartbeat can also become life-threatening on its own.
How to Tell It Apart From Being “Really Drunk”
The line between very drunk and alcohol poisoning isn’t always obvious, which is why people sometimes hesitate to call for help. The key difference is responsiveness. A very drunk person can still react to you. They might slur their words or stumble, but they answer questions, they pull away if you pinch their skin, and they can generally be roused if they fall asleep.
A person with alcohol poisoning is different. They may not respond to shouting or shaking. Their breathing may sound labored, irregular, or unusually slow. Their skin may feel cold and look pale or slightly blue. If someone has passed out from drinking and you cannot wake them, do not assume they are “sleeping it off.” Blood alcohol levels can continue to rise even after a person stops drinking, because alcohol in the stomach and intestines is still being absorbed. This means someone can seem stable one moment and deteriorate quickly.
What to Do While Waiting for Help
If you suspect alcohol poisoning, call emergency services first. Then focus on keeping the person safe until help arrives.
If they are awake, sit them up. If they are unconscious, roll them onto their side into the recovery position. This keeps their airway clear so that if they vomit, it drains out of the mouth rather than back into the throat. Stay with them and monitor their breathing. Count their breaths: if you’re seeing fewer than 8 in a minute, or long pauses of 10 seconds or more between breaths, relay that information to the 911 dispatcher.
Do not try to “sober them up” with coffee, cold water, a cold shower, or walking them around. None of these methods lower blood alcohol levels. Coffee adds caffeine but does nothing to speed up the liver’s processing of alcohol. A cold shower can worsen hypothermia in someone whose body temperature is already dropping. Walking an unconscious or semi-conscious person risks falls and injury. The only thing that removes alcohol from the bloodstream is time, and in a poisoning situation, the person may not have enough time without medical intervention.
Do not leave them alone to “sleep it off,” even if they seem to be resting quietly. And do not worry about getting someone in trouble. Emergency responders are focused on keeping people alive, not on who drank what.
Who Is Most at Risk
Alcohol poisoning can happen to anyone who drinks enough, but certain situations raise the risk significantly. Drinking games and challenges that encourage consuming large amounts quickly are a common trigger, because the body absorbs alcohol faster than it can process it. Smaller body size means a given amount of alcohol produces a higher blood concentration. People who don’t drink regularly have less tolerance and can reach dangerous levels with fewer drinks than an experienced drinker.
Mixing alcohol with sedatives, opioids, or sleep medications is especially dangerous because these substances suppress the same brain functions alcohol does. The combined effect on breathing and heart rate can be far greater than either substance alone. Even over-the-counter antihistamines that cause drowsiness can amplify alcohol’s depressant effects.
Young adults and college-age drinkers face elevated risk not because of biology but because of drinking patterns. Rapid, high-volume drinking in social settings is the most direct path to alcohol poisoning, regardless of age or experience.