The spectre of “alcohol poisoning” looms over every bar, college campus, and raging party, but what is it exactly? And what happens if you get it? With Drunkfest (otherwise known as New Year’s) on the horizon, we sat down with a top-notch emergency room doctor to find out exactly what goes down.
What Is Alcohol Poisoning?
First of all, “‘Alcohol poisoning’ is a layman’s term,” says Doctor L, our ER doc-friend who asked to remain anonymous due to her university affiliation. “Alcohol intoxication is a spectrum and there isn’t a specific threshold that one crosses and suddenly becomes ‘poisoned.’” Makes sense. After all, alcohol is a toxin and our body treats it as such, regardless of quantity. Even a single glass of champagne (or wine, or beer, or whatever) will result in some “poisoning”, it just won’t be very severe for most people. On the other hand, some people have a very tiny threshold for alcohol, and even half a glass can send them running to the bathroom. Food intake, sleep, and a person’s physiology are just a few of the variables (you can read about that here).
What Happens In A Mild Case
So, you were bad off enough that someone brought you to the hospital. Hopefully it was your friends, not the cops. For mild cases, it mostly comes down to what’s known as “supportive care.” Doc L says:
Often it is just a matter of watching the patient until he/she recovers. Intravenous fluids are often administered to help hydrate the patient as alcohol is a diuretic (promotes urination). One to two litres is fairly standard. While this may help the patient feel a little less crummy and correct their vital signs faster (dehydration comes with a rapid heart rate and, when severe, low blood pressure) it is often not absolutely necessary… most physicians will not, and should not, be comfortable sending a patient home with a vital sign abnormality as mentioned above.
So the average party-goer who overindulges and ends up in an Emergency Department can anticipate the placement of an IV, some intravenous fluids and a several hour period of observation. Some physicians will check lab values others won’t. It varies from hospital to hospital and also depends on how clear the story is. An individual who has no specific complaint of pain or injury and has friends or family that can attest to the patient’s alcohol consumption and lack of trauma or other complicating factor, may not need any additional testing or treatment.
While this doesn’t sound like absolute agony, it’s certainly not the way you want to kick off the new year. Not only that, it’s liable to be very expensive.
How About Severe Cases?
This is when you’re beyond just “drunk”. You’ve probably passed out. You’re probably unresponsive. Maybe you’re vomiting uncontrollably. This can be a life-threatening situation, and the hospital will respond accordingly. From Doc L:
There is no “antidote” for alcohol, so regardless of how severe the intoxication, the goal is to maintain adequate breathing and circulation until the body (mainly the liver) metabolises the alcohol. Alcohol is a depressant. It depresses the respiratory drive and may result in inadequate oxygen levels and/or excess carbon dioxide levels. A patient may be placed on an oxygen and/or carbon dioxide monitor to watch for signs of this and may need supplement oxygen. Worse case scenario the patient may need to be intubated (plastic breathing tube through the mouth and into the trachea) and placed on a ventilator (breathing machine) until they become more awake.
Alcohol also depresses mental status and with this a person’s “gag reflex”. This means vomiting, which is common due to over consumption and distension of the stomach and may lead to aspiration (vomit in the trachea). This can be life threatening. The goal of treatment is “airway protection”.
That’s When They Pump My Stomach, Right?
That’s what we’d assumed, but actually, no. It turns out the pumping the stomach is virtually never used for alcohol intoxication nor any other type of poisoning anymore. “Pumping the stomach (gastric lavage is the medical term) is considered more dangerous than beneficial in most cases,” says Doctor L. “It often leads to vomiting and can cause perforation of the oesophagus or stomach (the tube is HUGE… think garden hose).” *Shudder.* Good riddance.
Instead, once the patient is intubated, a different, smaller tube is inserted through the mouth or nose, then threaded through the oesophagus and into the stomach. The tube is placed on suction, which decompresses the stomach and greatly reduces the risk of vomiting. Even if the patient does throw up, their trachea (their airway) is largely protected because the breathing-tube is taking up most of the room. In case you were wondering, all of this is extremely unpleasant.
We all know that drinking can lead to accidents and injury, but when you show up at the ER with signs of trauma and you’re so intoxicated that you can’t recall or articulate what happened, your treatment is going to be become much more extensive (and expensive). “In medicine we talk about patients as ‘historians’ and intoxicated patients make very poor historians and thus cannot be trusted,” says Doc L. “If they have a black-eye they will very likely end up with a CT scan of their head. If their heart rate is elevated and doesn’t improve with intravenous fluids they will likely end up on an EKG (tracing of the heart rhythm) and with a whole lot of blood work. The bottom line is that the intoxicated patient gets a lot more testing than the sober patient is there is anything concerning in the history or the exam.”
Plus, heavy and frequent alcohol consumption puts you at risk for a very long list of medical conditions, some which may be triggered by drinking. People think that more regular drinking will result in an increased tolerance, which is true in some ways, but in some cases you may actually become more sensitive. For example, once a person begins to experience “blackout” episodes, evidence suggests that it actually becomes easier and easier to revert to that state. Patients with diabetes (which you may not be aware that you have) may encounter some very dangerous complications when consuming alcohol.
Bottom line: we want you to have fun this New Year’s Eve. But increased alcohol consumption does not equal increased fun on an infinite scale. There is a point of diminishing returns, and it is a very steep drop-off. Hanging out (or worse, passing out) in a hospital is no fun at all. Go slowly, keep checking in with yourself, and follow some of these other guidelines for increasing your tolerance, but above all, be smart. Have fun, be safe, and start 2013 off right.
Thanks much, Doctor L!