10 Alcohol Poisoning Symptoms
Alcohol poisoning is a consequence of the ingestion of large amounts of alcohol, usually over a short period of time. Alcohol comes in many forms and all of them can cause toxic poisoning; however, in this article, we will focus solely on ethanol toxicity. In our daily life, we are very likely to come into contact with ethanol, since it can be found in many commercial products (i.e. food extracts, cold medications, etc.). However, the most common form of ethanol ingestion and subsequent toxicity is through alcoholic beverage consumption.
According to the CDC, about one in six adults in the US takes part in binge drinking almost four times per month, ingesting roughly seven drinks per event. Binge drinking is a common cause of ethanol poisoning, and it can harm a person’s health or even threaten their life. It is defined as a pattern of heavy drinking in a short timeframe that increases a person’s blood alcohol concentration (BAC) to 0.08% or higher. This pattern, in an adult, is equivalent to a male that ingests five or more drinks, or a female that consumes four or more drinks in roughly two hours.1National Institute on Alcohol Abuse and Alcoholism: Drinking Levels Defined. (2020, July 07). Retrieved September 02, 2020, from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
1. Nausea
Nausea can be defined as the urge to vomit. It can appear suddenly, but in some cases, it can have an insidious onset. Nausea is a manifestation of alcohol poisoning; however, it is not specific for this condition. Alcohol poisoning can be associated with many other conditions, and it can also be triggered by certain events or things in our surroundings. In alcohol poisoning, it is a sign of moderate to severe intoxication. It usually precedes vomiting, but it can be accompanied by other gastrointestinal symptoms such as diarrhea and abdominal pain.
As previously mentioned, ethanol is metabolized in the liver by several enzymes. An enzyme known as alcohol dehydrogenase converts ethanol into acetaldehyde. This substance is a toxic compound that must be rapidly converted to carbon dioxide and water. In binge drinking, the absorption of alcohol is much faster than its metabolism and oxidation. Thus, acetaldehyde accumulates in the blood, causing acetaldehyde intoxication. This contributes to common inebriation symptoms such as nausea, vomiting, and headache. Nausea can occur due to serious acid-base abnormalities (metabolic acidosis), and it can be secondary to alcohol-induced gastritis, peptic ulcer disease, and acute pancreatitis.
2. Vomiting
Vomiting or emesis refers to the expulsion of gastrointestinal contents through the mouth and nose. It is a non-specific symptom that can be associated with many conditions, or triggered by events in our surroundings. Vomiting is usually involuntary, forceful and it can be preceded by nausea. Similar to nausea, emesis can be a consequence of the accumulation of toxic byproducts of ethanol in the blood and several alcohol-induced gastrointestinal and metabolic conditions. In binge drinking, symptoms like nausea and vomiting can start at a blood alcohol level (BAC)of ≥ 0 .20% for most people. However, some people may even experience these symptoms at lower BACs.
Vomiting is common with moderate or severe ethanol intoxication; thus, it can be accompanied by symptoms of central nervous system depression. Hence, the intoxicated person, may exhibit alterations of their mental status (i.e. disorientation) and eventually enter into a pathological state of sleepiness and unresponsiveness. Alcohol also weakens the gag reflex; thus, putting someone in this neurologic state at risk of aspirating and choking on their vomit. Furthermore, prolonged vomiting can result in dehydration, which can lead to low blood pressure and electrolyte abnormalities. If you suspect that someone has alcohol poisoning, call for medical attention immediately. While you wait for help, if the person is vomiting and unconscious, be sure to roll them onto one side to prevent choking.
3. Slurred Speech
Slurred speech is characteristic of a well-known speech disorder known as dysarthria. It is a nonspecific symptom, given that dysarthria can occur in countless other conditions. Dysarthria can also be described as nasal, slurred, or breathy speech. Most of us need words to communicate. Hence, we need fine motor control, or the ability of our tongue and mouth to coordinate, so our words are clear. This and many other motor functions are mostly coordinated by a part of the brain known as the cerebellum. Importantly, the cerebellum also works with other parts of your brain to create speech.
Alcohol poisoning can be a temporary cause of dysarthria; thus, causing slurred speech. However, if alcohol abuse is prolonged over time, it can cause permanent damage to the CNS, and dysarthria may become permanent. Ethanol poisoning can cause slurred speech because it affects cerebellar functions. This generally occurs at BACs of 0.1% or even lower. Given this correlation, slurred speech is often used by law enforcement as a sign of alcohol poisoning. Slurred speech may be accompanied by other signs of cerebellar dysfunction like nystagmus (rapid involuntary movements of the eyes) and ataxia or a lack of muscle control of voluntary movements (i.e. picking up objects or walking).
4. Palpitations
Palpitations can be defined as the sensation of a rapid or irregular heartbeat. It is a non-specific symptom that is commonly associated with certain lifestyle factors, such as the consumption of stimulants (coffee, nicotine, stress, exercise), drugs, and several medical conditions. For example, fever, anemia, hypoglycemia (low blood sugar), anxiety disorders, heart conditions, and thyroid disorders can trigger palpitations. Alcohol can also cause palpitations due to various reasons. Ethanol poisoning can cause excessive fluid loss through vomiting and urination, which can result in hypotension. In compensation for this low blood pressure, the heart rate will increase (compensatory tachycardia) and the affected individual may experience palpitations.
Chronic and acute alcohol consumption can have a toxic effect over the heart, directly on its muscular tissue (myocardium). It can even induce high blood pressure in some people. These aspects, in conjunction with other factors, can alter the cardiac function and trigger cardiac complications during alcohol poisoning. Cardiac arrhythmia is a cardiac complication that can cause palpitations in alcohol poisoning. It can be loosely defined as a disorder where the heart beats with an irregular rhythm. Interestingly, there is a condition known as “Holiday heart syndrome”, where heart arrhythmias (atrial fibrillation) occur after bouts of binge drinking, even in healthy people.
5. Confusion
The alteration of a person’s mental status or brain function can sometimes be characterized as confusion. It is a nonspecific symptom, and it can be seen in many conditions. A person in this state will usually have disturbances in attention and thought content, meaning that they will probably have difficulty focusing during a conversation and they will have random and disorganized thoughts. Simultaneously, people in a confused state can exhibit alterations of awareness or disorientation on time and place. Finally, alterations on arousal (hyper-alert or unarousable), memory, and behavior can occur at the same time.
Alcohol poisoning can cause alterations in the brain’s functioning or confusion, through several mechanisms. As mentioned previously, it works as a Central Nervous System depressant. For instance, it binds directly to inhibitory receptors in the CNS known as GABA receptors. This causes a sedative effect that can range from confusion to loss of consciousness. In fact, its effect is similar to benzodiazepines (i.e. alprazolam), drugs that also act on GABA receptors. Additionally, alcohol poisoning can cause dehydration, hypothermia, metabolic disturbances, electrolyte abnormalities, and other conditions that can also be responsible for alterations in mental status.
6. Slow Breathing
The normal respiratory rate varies in a healthy adult at rest, but it usually stays between 12-20 respirations per minute. A respiratory rate below this limit defines slow breathing, also known as bradypnea. As a consequence of slow breathing, the ventilation in the lungs will be insufficient to carry out the pulmonary gas exchange that the body requires, leading to many complications. Furthermore, slow breathing can be a sign of respiratory depression. This happens to be a common side effect of many substances that suppress certain central nervous system functions. These include opiates (i.e. heroin), benzodiazepines, and barbiturates.
Ethanol poisoning can induce slow and irregular breathing because it is a central nervous system depressant as well. As previously mentioned, ethanol can cause respiratory depression by binding directly to inhibitory receptors in the CNS, known as GABA receptors. Specifically, respiratory depression can be attributed to the actions of ethanol on the brainstem, which is responsible for the control of automatic life-sustaining functions (i.e. breathing). Respiratory depression can progress to respiratory failure (breathing stops); thus, it constitutes a serious and lethal complication of alcohol poisoning that must be treated promptly. Note that ethanol’s actions over the CNS can be potentiated by other drugs. Thus, if you are helping a person that has alcohol poisoning and has abused other drugs, be sure to notify their healthcare provider.
7. Dry Mouth
Having a dry mouth sensation is a common symptom of dehydration. It is usually accompanied by dry mucous membranes in general (i.e. eyes, tongue). This condition is the result of a negative fluid balance, meaning that it occurs when a person uses or loses more fluid than they consume. Generally, the body of a dehydrated person lacks enough fluids to carry all their biological functions. Other signs and symptoms of dehydration in adults include dizziness, confusion, fatigue, excessive thirst, increased respiratory and cardiac rates, and decreased urination. If dehydration advances untreated, organ failure and death can result from a severe decline in circulating blood volume (hypovolemic shock). Alcohol poisoning can induce dehydration through excessive fluid loss. This happens in two ways: urination and vomiting.
A short-term effect of alcohol ingestion is excessive urination. Have you ever wondered why every time you drink alcohol; you seem to urinate a higher amount of liquid than what you actually consumed? This is not your imagination! It happens because alcohol acts on a gland in your brain, known as the posterior pituitary gland, and interferes with your body’s water regulation mechanisms. Alcohol reduces the secretion of this gland, specifically of a hormone known as Vasopressin or ADH. In normal conditions, when you are dehydrated this hormone will stop you from urinating to preserve any fluids present in your system. However, when consuming alcohol, ADH production will be low and so will be the amount of water you will hang on to (no matter how much additional water you ingest). If you observe signs of dehydration in someone who has consumed excessive alcohol, call for medical help as soon as possible.
8. Cold Skin
Having cold skin is a symptom of conditions or situations that trigger a decrease in blood flow to the blood vessels of the skin and possibly other non-vital organs. In alcohol poisoning, cold skin can be caused by several mechanisms. As previously mentioned, ethanol can lower general blood volume through excessive fluid loss (vomiting and urination). Eventually, this can cause dehydration and low blood pressure or hypotension. As a response, the body will shunt most of the blood towards vital organs (i.e. heart, brain), away from the skin, causing a cold skin sensation.
Ethanol poisoning can directly cause hypothermia. However, it is also a risk factor for this condition because it can impair a person’s judgment on the need to find protection from cold-weather. Hypothermia can be defined as the decrease in human body temperature below 35.0 °C or 95.0 °F. Possible mechanisms for alcohol-induced hypothermia include rapid heat loss from the skin through blood vessel widening, and decreased shivering response to generate body heat. Common symptoms of this condition include cold skin, shivering (or lack of), and mental confusion. Finally, hypothermia can slow most bodily functions and eventually cause cardiac arrest. Thus, it is a medical emergency and it should be treated promptly.
9. Dizziness
Dizziness is defined as the loss of balance and/or the feeling of being lightheaded. It is a subjective sensation that can have an acute onset and may cause a person to feel unwell. When experiencing dizziness, it is important to try to sit down as soon as possible to prevent falls that could result in serious injuries. Dizziness is a nonspecific symptom that can be caused by many conditions.
Ethanol poisoning can cause dizziness due to a variety of reasons. For instance, it is a central nervous system depressant, which can cause dizziness and mental status alterations. On the other hand, it can cause dehydration and metabolic disturbances that can also cause this symptom. Finally, it can alter the functions of the cerebellum, which is a part of the brain that regulates balance, possibly causing dizziness as a side-effect. In alcohol poisoning, dizziness is a very important symptom because it can lead to potentially dangerous falls and life-threatening injuries.
10. Poor Coordination
Most of our movements are usually coordinated and seamless, to the point of almost looking effortless. Poor coordination is a colloquial term that mostly refers to a pathological lack of synchronization of limb movements. However, ataxia is the correct medical term that encompasses this symptom. Ataxia is the impairment of muscle control and coordination of all voluntary movements. This can include movements that involve limbs (i.e. walking, picking up objects), as well as others that involve speech or eye movement. Poor coordination is an unspecific symptom, that can be present in many conditions.
In alcohol poisoning, poor coordination is produced by alterations of the cerebellar function. Ethanol can affect the cells of the cerebellum, which is the part of your brain that controls muscle coordination, and produce temporary or permanent ataxia. In people with alcohol poisoning, poor coordination can be easily detected by observing the way the affected person walks or picks up objects. It will usually be abnormal, with uncoordinated limb movement and a constant loss of balance. Poor coordination in alcohol poisoning can be dangerous because it can cause falls and injuries that can be life-threatening.
