The symptoms of alcohol poisoning include mental confusion, vomiting, seizures, slow or irregular breathing, clammy skin, bluish or pale skin color, extremely low body temperature, and difficulty staying conscious. Any one of these symptoms on its own can signal a medical emergency, but several often appear together as blood alcohol levels climb into dangerous territory.
The Full List of Symptoms
Alcohol poisoning happens when there’s so much alcohol in the bloodstream that it starts shutting down basic functions the brain controls automatically, like breathing, heart rate, and temperature regulation. The symptoms tend to escalate as more alcohol is absorbed, but they don’t always follow a predictable order. Someone can go from seeming “just drunk” to unresponsive quickly, especially if they consumed a large amount in a short window.
The critical signs to watch for:
- Mental confusion or stupor: not just slurred words, but an inability to understand where they are or what’s happening around them
- Difficulty staying conscious: repeatedly passing out, or being completely unable to wake up
- Vomiting: particularly dangerous if the person is unconscious, since the gag reflex may stop working
- Seizures
- Slow breathing: fewer than 8 breaths per minute
- Irregular breathing: gaps of 10 seconds or more between breaths
- Slow heart rate
- Clammy skin
- Extremely low body temperature: skin that feels cold to the touch
- Bluish, gray, or pale skin color: especially around the lips and fingertips, which signals the body isn’t getting enough oxygen
One detail people often miss: the loss of the gag reflex. Normally, if something enters your airway, your body reflexively coughs or gags to clear it. Alcohol at toxic levels can suppress that reflex entirely. This is why people die from choking on their own vomit during alcohol poisoning. It’s not that they were too drunk to roll over. Their body literally stopped protecting its own airway.
How Blood Alcohol Levels Relate to Danger
Blood alcohol concentration (BAC) gives a rough framework for understanding when poisoning becomes likely. At a BAC of 0.30% to 0.40%, alcohol poisoning typically sets in along with loss of consciousness. Above 0.40%, the risk of coma and death from respiratory arrest (the lungs simply stopping) becomes real. For context, the legal driving limit in most states is 0.08%, so alcohol poisoning territory is roughly four to five times that level.
These thresholds vary. A smaller person, someone who hasn’t eaten, or someone who drinks rarely will reach dangerous BAC levels with less alcohol than a larger person with higher tolerance. The speed of drinking matters enormously too. Binge drinking, drinking games, and consuming shots in rapid succession are the most common paths to alcohol poisoning because the body simply can’t metabolize alcohol fast enough. The liver processes roughly one standard drink per hour, whether that’s a 12-ounce beer, a 5-ounce glass of wine, or a 1.5-ounce shot of liquor. Anything beyond that pace means alcohol is accumulating in the blood faster than the body can clear it.
Why the Body Starts Shutting Down
Alcohol is a depressant, meaning it slows the central nervous system. At low doses, that produces the relaxed, loosened-up feeling people associate with drinking. At toxic doses, it depresses the brain regions that handle involuntary functions you never think about: breathing rhythm, heart rate, body temperature, and the gag reflex.
The drop in body temperature (hypothermia) is particularly insidious. Alcohol dilates blood vessels near the skin, which makes a person feel warm even as their core body temperature is falling. Someone with alcohol poisoning may not shiver or complain of cold, even if their body is dangerously chilled. Low blood sugar is another hidden risk, since alcohol interferes with the liver’s ability to release stored glucose. This combination of suppressed breathing, falling body temperature, and dropping blood sugar can create a cascade where multiple systems fail at once.
What to Do if You See These Symptoms
Call 911 immediately if someone shows any of the symptoms listed above. You cannot reliably tell the difference between “sleeping it off” and losing consciousness from alcohol poisoning just by looking at someone, and the consequences of guessing wrong are severe.
While waiting for help, the most important thing you can do is put the person in the recovery position if they’re unconscious but still breathing. Roll them onto their side so they’re leaning slightly face-down, with their head positioned a bit lower than their stomach. This lets vomit, mucus, or other fluids drain out of the mouth instead of pooling in the airway. Stay with them and keep checking that they’re still breathing. You can hold the back of your hand near their mouth to feel for breath.
Do not leave them alone. Do not lay them flat on their back. And do not assume they’ll be fine once they “sleep it off.” Blood alcohol levels can keep rising for 30 to 40 minutes after a person’s last drink, because alcohol in the stomach and intestines is still being absorbed. Someone who seems stable can deteriorate.
Common Mistakes That Make Things Worse
Strong coffee, cold showers, walking someone around the block: none of these sober a person up or reverse alcohol poisoning. The liver clears alcohol at a fixed rate of about one standard drink per hour, and nothing speeds that up. A cold shower might make someone more alert temporarily, but it does nothing to lower their blood alcohol level, and the shock of cold water on someone with an already low body temperature can be dangerous on its own.
Giving food or water to someone who is vomiting or barely conscious is also risky. If their gag reflex is impaired, they can choke. The impulse to “help them sober up” is understandable, but the only intervention that matters at the point of alcohol poisoning is professional medical care.
The Scale of the Problem
Alcohol poisoning is not rare. In 2022, alcohol contributed to more than 4.2 million emergency department visits in the United States, including 3 million visits for men and 1.3 million for women. Between 2020 and 2021, roughly 178,000 people per year died from causes tied to excessive alcohol use, a 29% increase compared to 2016 and 2017. Alcohol-related poisonings (sometimes involving other drugs as well) ranked among the leading causes of those deaths, alongside liver disease, heart disease, and accidents.
Mixing alcohol with other substances raises the stakes further. Estimates suggest alcohol played a role in at least 8.4% of emergency department visits and about 16% of deaths due to opioid overdoses in 2022. Combining alcohol with opioids, benzodiazepines, or even some over-the-counter medications that cause drowsiness amplifies the depressant effect on breathing and heart rate, making a fatal outcome more likely at lower amounts of each substance than either would cause alone.