Alcohol poisoning: The dangers

Moneybags journalist Jessica Anne Wood seeks to unpack the issue of alcohol poisoning, looking at what it is, how it happens and what the signs and symptoms are.

You don’t have to be a binge drinker to die from alcohol poisoning. Last month British paper, Metro, highlighted how Heidi Hopley (41) died after drinking just three glasses of vodka and lemonade. The post mortem revealed she had 380mg of alcohol in 100ml of blood (in South Africa the legal breath alcohol content is 0.24mg per 1,000ml or 0.5g per 100ml for blood content, while in the UK the drink-drive limit is 80mg).

So what exactly is alcohol poisoning and is everyone vulnerable to it? explains: “Alcohol poisoning, or acute intoxication, is when a large amount of alcohol is drunk, followed shortly afterwards by changes in mood or behaviour, impaired judgment or social functioning and one or more physical signs of drunkenness, such as slurred speech, unsteadiness, lack of co-ordination, impaired attention or loss of consciousness.”

In the United States there are 2,200 alcohol poisoning deaths per year, according to the Centre for Disease Control.

Dr Rika van Aswegen, emergency practitioner at Netcare Waterfall City Hospital, notes that exact figures on patients admitted with alcohol poisoning are not available in South Africa as this information is not collated. However, she points out that Netcare hospitals do see patients suffering from the effects of alcohol poisoning on a weekly basis.

“Although people of all ages are affected, young people who binge on large quantities of alcohol in a short space of time run a particularly high risk of alcohol overdose and alcohol poisoning,” says van Aswegen.

Alcohol consumption is SA

According to a study in The South African Medical Journal, published in 2012, South Africans consumed in excess of five billion litres of alcohol annually at that time. The country is among the highest per capita consumption rates for alcohol in the world, and this is continuing to rise.

Dr Stevan Bruijns, senior lecturer of Emergency Medicine Cape Town, chair of the Emergency Medicine Division Research Subcommittee, and editor in chief of the African Journal of Emergency Medicine, highlights that South Africa has one of the highest alcohol consumption rates in the world.

“[World Health Organisation research] shows that while our neighbours north of the border consume six litres (in pure alcohol*) per head, in South Africa its 11 litres per head (so nearly double). It also shows that South Africans like to binge drink. The binge drinking volume is nearly the same volume as the alcohol consumption volume (10.4 litres per head) suggesting that South Africans have trouble controlling themselves when it comes to alcohol intake and mostly display fairly risky drinking practices. As a result alcohol contributes to more than one out of 10 road traffic accidents and nearly six out of 10 cases of liver cirrhosis (a sever liver affliction that is largely irreversible). I think it is fair to say that excessive alcohol use in SA is an issue,” explains Bruijns.

(*No alcoholic beverage is made up of pure alcohol. Depending on the drink, alcohol content can vary between negligible up to 40% and higher for spirits. The reference to pure alcohol refers to just the alcohol content and ignores the type of drink.)

According to Bruijns, alcohol consumption to the extent that it is seen in South Africa is a symptom of a broken system, or the various lacking determinants of health.

“There are a number of determinants of health, such as genetics, individual factors, social and physical environment and access to quality health services. We have little control over genetics, but issues such as education, literacy, inequality, inequity, various forms of discrimination, poverty, etc. that describes the rest we can control better. Excessive alcohol use is indeed a burden on the health sector, but claiming that it is an individual’s choice is too simplistic. It can really only be addressed once the determinants of health have also been tackled. Until then we’ll just be papering over the cracks,” says Bruijns.

How does alcohol poisoning occur?

There are a number of ways that a person can get alcohol poisoning. Bruijns reveals that the most common cause of alcohol poisoning is over consumption. “Despite what many people think, having a sedative drug mixed in your drink for the purposes of date-rape is relatively uncommon. Mostly patients simply drink too much.”

But it’s not only the amount of alcohol that you consume that can lead to alcohol poisoning but the amount of alcohol you consume over a given period of time. Van Aswegen adds: “Binge drinking is typically defined as an individual consuming four to five drinks in quick succession. Consuming an entire bottle of wine or a number of beers within a short period of time could lead to alcohol poisoning.

“Normally, the human liver can only process and break down one unit of alcohol every hour. If one were to consume five or more units of alcohol in approximately one hour, they could be at risk of alcohol poisoning.”

Your weight could also be a factor. points out that the lethal dose of alcohol is 5-8 grams per kilogram for a 60kg person. This reduces to 3g/kg for children. In practical terms, 300g of alcohol could kill a person of 60kg, which equates to 30 standard drinks, or about one litre of spirits or four bottles of wine.

Lethal alcohol doses

Below is a breakdown of the effects that differing amounts of units of alcohol can have on your body, according to the National Health Service (NHS) in the UK.

A break down of the effects of alcohol on the body leading to alcohol poisoning.

Source: NHS website

According to the Automobile Association of South Africa (AA), to be below the legal limit in South Africa, the general rule is a maximum of one unit of alcohol per hour, which equates to 10ml of pure alcohol, based on an adult weighing 68kg.

In practical terms this equates to:

  • Two thirds of a beer or spirit cooler with a 5% alcohol content.
  • 75ml of red or white wine per hour with an alcohol content of 12% to 14%.
  • 25ml of whisky or brandy per hour.

The NHS advises that if you drink most weeks, you should not regularly drink more than 14 units of alcohol per week (for both men and women). If you drink as much as 14 units a week, you should spread this out over three or more days.

Signs and symptoms of alcohol poisoning

Van Aswegen notes that the symptoms and short-term effects of alcohol poisoning may include confusion, seizures, vomiting, loss of consciousness, slow or irregular breathing, hypothermia (extremely low body temperature) and blue or unusually pale skin. Not all of these symptoms will necessarily be present in all cases of alcohol poisoning.

The NHS lists the following signs and symptoms of alcohol poisoning:

  • Confusion
  • Severely slurred speech
  • Loss of co-ordination
  • Vomiting
  • Irregular or slow breathing
  • Hypothermia (pale or blue-tinged skin caused by low body temperature)
  • Stupor (being conscious but unresponsive)
  • Passing out and being unconscious

“In the most severe cases, alcohol poisoning can lead to coma, brain damage and death,” emphasises the NHS.

“Long-term effects may include seizures and physical injuries sustained during seizures, particularly if a seizure occurs while the individual is driving or near water. Alcohol poisoning can cause permanent brain damage due to lack of oxygen as a result of seizures or loss of consciousness, as well as liver cirrhosis and other organ damage,” says van Aswegen.

She stresses that if you or a friend show symptoms of alcohol poisoning you must take action. “It is always advisable to seek medical assistance as soon as possible. The best way to avoid harm is to limit your alcohol intake and to be mindful at all times of the amount of alcohol consumed.”

What to do if you suspect someone is suffering from alcohol poisoning

The first thing you should do is seek medical assistance immediately. The NHS warns that you should never leave a person alone to ‘sleep it off’. “The level of alcohol in a person’s blood can continue to rise for up to 30-40 minutes after their last drink. This can cause their symptoms to suddenly become much more severe.

“You also shouldn’t give them coffee or any more alcohol, put them under a cold shower or walk them around. These won’t help someone ‘sober up’ and may even be dangerous.”

The NHS suggests:

  • Try to keep the person sitting up and awake.
  • Give them water if they can drink it.
  • If they’ve passed out, lie them on their side in the recovery position and check they’re breathing properly.
  • Keep them warm.
  • Stay with them and monitor their symptoms.

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