Alcohol Intoxication Definition and Causes

Definition: A person is said to suffer from alcohol intoxication when

the quantity of alcohol the person consumes exceeds the individual's
tolerance for alcohol and produces behavioral or physical
abnormalities. In other words, the person's mental and physical
abilities are impaired. The person can't function and certainly should
not be operating a motor vehicle.

• Causes: Alcohol is a generic term for ethanol, which is a

particular type of alcohol produced by the fermentation of many
foodstuffs—most commonly barley, hops, and grapes. Other
types of alcohol commonly available such as methanol (common
in glass cleaners), isopropyl alcohol (rubbing alcohol), and
ethylene glycol (automobile antifreeze solution) are highly
poisonous when swallowed, even in small quantities. Ethanol
produces intoxication because of its depressive effects on
various areas of the brain causing these impairments in a
progressive order as the person gets more and more drunk:

o Disinhibition of normal social functioning (excessive

talking, showing off)

o Loss of memory

o Confusion

o Disorientation

o Movement not coordinated

o Progressive lethargy

o Coma

o Ultimately the shutdown of the respiratory centers (death)

• What happens in the brain: Alcohol increases the effect of the

body's naturally occurring neurotransmitter GABA (gamma
amino butyric acid). Neurotransmitters are substances that
chemically connect the signals from one nerve to the next
allowing a signal to flow along a neural pathway. An inhibitory
neurotransmitter (alcohol) reduces this signal flow in the brain.
This explains how alcohol depresses both a person's mental and
physical activities. By way of comparison, cocaine does the
opposite by producing a general excitatory effect on the nervous
system.

• Available forms and measurement: A standard "drink" of

ethanol consists of 10 grams. This amount is equal to 10 ounces
 (300 cc) of regular beer (5% alcohol content); 3-4 ounces of wine
(12% alcohol content); or 1 ounce of hard liquor (40% alcohol
content, 80 "proof").

• Absorption: Approximately 20% of ethanol is absorbed into the

bloodstream directly from the stomach, and 80% from the small
intestine. Consequently, the longer the ethanol/alcohol remains
in the stomach, the slower it will be absorbed and the lower will
be the peak in the blood alcohol concentration (known as BAC).
•
o This explains the apparent sobering effect of food, which
slows the process of emptying the stomach contents, slows
the absorption of alcohol, and reduces the peak BAC
reached.

o When alcohol is taken with food, absorption generally is

complete in 1-3 hours during which time the BAC will peak.
If no further alcohol is consumed, sobering up will follow
this peak level of BAC.

• Distribution: Ethanol is highly soluble in water and is absorbed

much less in fat. So alcohol tends to distribute itself mostly in
tissues rich in water (muscle) instead of those rich in fat.

o Two people may weigh the same, yet their bodies may
have different proportions of tissue containing water and
fat. Think of a tall, thin person and a short, fat person who
both weigh 150 pounds. The short, fat person will have
more fat and less water making up his body than the tall,
thin person. If both people, in this example, consume the
same amount of alcohol, the short, fat person will end up
with a higher BAC. This is because the alcohol he drank
was spread into a smaller water "space."

o Women's bodies, on average, have more fat and less water

than men's bodies. Using the same logic, this means that a
woman will reach a higher BAC than a man of the same
weight when both drink the same amount of alcohol.

• Metabolism (elimination): Metabolism is the method by which

the body processes alcohol (and everything else you eat). Some
of the alcohol is converted to other substances (such as fat, as in
"beer belly"). Some is burned as energy (and converted to water
and carbon dioxide). A small amount is excreted unchanged (in
your breath and urine). The liver metabolizes about 90% of the
ethanol. The lungs excrete about 5% during exhalation
(breathing out). Alcohol excretion by the lungs forms the basis
for Breathalyzer testing. Another 5% is excreted into the urine.
 o The average person metabolizes about 1 standard drink
(10 grams) per hour.

o Heavy drinkers have more active livers and may be able to

metabolize up to 3 drinks per hour.

o People with liver diseases will metabolize less than 1 drink

per hour. In many chronic alcoholics, the liver gets burned
out and can no longer metabolize alcohol, or anything else,
efficiently. This is known as alcoholic cirrhosis.

o In alcoholic cirrhosis, the liver cells become badly scarred.

This scarring has the effect of blocking blood flow through
the liver, impeding exchange of metabolic chemicals into
and out of the liver cells and damaging the cells' ability to
function.

Alcohol Intoxication Signs and Symptoms

The effects of alcohol vary widely from person to person. Several

factors can account for obvious differences in how certain amounts of
alcohol can affect one person more than another. These factors also
affect the particular signs and symptoms the person may have to
indicate alcohol intoxication.

Major factors account for this variation in signs and symptoms:

• Prior experience with alcohol. A longtime, heavy drinker may

achieve blood alcohol concentration levels that would kill the
average casual drinker. Conversely, a college student (typically a
freshman) who is a novice drinker may get knocked out by a 6-
pack of beer. As a person's drinking increases, his or her liver will
increase its capacity to metabolize alcohol. Put simply, a heavy
drinker will be able to burn off drinks much faster. In addition, a
heavy drinker's brain gets used to frequent, even constant, high
blood alcohol concentrations (BAC). This habituation in a heavy
drinker can backfire if this person suddenly stops drinking. The
person may go into withdrawal and develop seizures or a
condition called delirium tremens (DTs).

• Taking drugs. The effects of alcohol are enhanced if someone

may be taking other drugs, especially those of the sedative class
such as sleeping pills or antianxiety medications. A person who is
not habituated to either alcohol or sedatives may cause serious
harm, or death, in taking sub-lethal doses of each. Together,
they can be a deadly combination. The person may be taking
medications prescribed by a doctor or over-the-counter drugs
and may not intend for the drugs to enhance the effects of the
alcohol.

• Medical conditions. The presence of a wide variety of medical

conditions may affect how someone reacts to alcohol.
• Smell of alcohol on the breath. There is a very poor
correlation between the strength of the smell of alcohol on the
breath and the BAC. Pure alcohol has very little smell. It is the
metabolism of other substances in alcoholic beverages that
produces most of the smell. This explains why a person who
drinks large amounts of high-proof vodka (a more pure form of
alcohol) may have only a faint smell of alcohol on the breath. On
the other hand, a person who drinks a modest amount of beer
may have a strong smell of alcohol on the breath.

• Scale of effects. In the average social drinker (defined as

someone who drinks no more than 2 standard drinks per day),
there is a rough correlation between blood alcohol concentration
(BAC) and how the person acts.

o Blood alcohol concentration. BAC commonly is

expressed in milligrams per deciliter (mg/dL). Using this
measure, 100 mg/dL roughly is equal to 1 part alcohol in
1000 parts of water (or blood). Consequently, 100 mg/dL
would be equal to a 0.1% concentration. In most states,
100 mg/dL represents the threshold concentration above
which a person is legally drunk when operating a motor
vehicle.

 To find out more about BAC and how it affects you,

go to the Blood Alcohol Educator Web site of the
Century Council and the University of Illinois for
some startling interactive activities.

 The following scale details the expected effects of

alcohol at various BACs. There is a tremendous
variation from person to person, and not all people
exhibit all the effects. This scale would apply to a
typical social drinker:

 50 mg/dL: Loss of emotional restraint,

vivaciousness, feeling of warmth, flushing of
skin, mild impairment of judgment

 100 mg/dL: Slight slurring of speech, loss of

control of fine motor movements (such as
writing), confusion when faced with tasks
requiring thinking, emotionally unstable,
inappropriate laughter

 200 mg/dL: Very slurred speech, staggering

gait, double vision, lethargic but able to be
aroused by voice, difficulty sitting upright in a
chair, memory loss
  300 mg/dL: Stuporous, able to be aroused only
briefly by strong physical stimulus (such as a
face slap or deep pinch), deep snoring

 400 mg/dL: Comatose, not able to be aroused,

incontinent (wets self), low blood pressure,
irregular breathing

 500 mg/dL: Death possible, either from

cessation of breathing, excessively low blood
pressure, or vomit entering the lungs without
the presence of the protective reflex to cough
it out

Home Care

The majority of people with simple alcohol intoxication can be cared for
by a friend or relative at home.

• Remove the person from all sources of alcohol. Remove the

person from the bar or party. If in a home environment, get rid of
all the liquor.

• Provide a safe environment (prevent falls, keep away from

dangerous machines and objects, keep from driving vehicles).

• Find out if only ethanol has been ingested. Determine if the

person has taken any medications, illegal drugs, or nonethanol
alcohols.

• See if the person is easy to arouse when spoken to or with a

slight shake of a shoulder.

• Make sure that the person’s condition is not due to an underlying

medical cause or injury. Ask about other conditions and look for
any evidence of a head injury.

• Have someone in constant attendance to ensure that the person

is improving and to obtain medical assistance as needed. If the
care-taking person does not feel comfortable monitoring the
condition of the intoxicated person, then it would be best to take
the person to the hospital.

• No medications will speed up the sobering process. Caffeine (by

drinking coffee) and cold showers have a minimal and very
temporary effect.

NOTE: It is extremely common for an intoxicated person to vomit once.

However, vomiting more than once may be a sign of head injury or
other cause of serious illness. If a drunken person vomits more than
once and is not completely coherent, then he or she should be taken to
the hospital's emergency department for evaluation.

Alcohol Intoxication, Physician Treatment and Follow-up

Treatment: No specific treatment can reverse the effects of alcohol

intoxication.

• Intoxicated people often receive IV fluids and B complex vitamins

for dehydration (alcohol is a diuretic and increases urine output)
as a precaution or treatment for vitamin deficiency.

• In severe cases—those of severe stupor and coma—the person

should be intubated (breathing tube placed in airway) to support
respirations (which may stop spontaneously) and to protect the
lungs from filling with vomit.

o Intubation involves placing a short, flexible plastic tube

into the windpipe to just below the vocal cords and
connecting the tube to a respirator machine. The tip of the
tube has a small donut-shaped balloon around it, which is
inflated to seal the end of the tube to the inside of the
windpipe. This accomplishes two things:

 It prevents the air from the respirator from leaking

out into the mouth instead of going into the lungs.

 It provides a protective seal so that a large amount

of vomit in the mouth would be prevented from
entering the lungs where it would cause a great deal
of damage and possibly suffocation.

Follow-up: Barring any major complications, most intoxicated people

may go home from the hospital's Emergency Department. For some
medical and many legal reasons, most hospitals prefer to keep people
suspected of alcohol intoxication under observation until their blood
alcohol concentration (BAC) falls to below 100 mg/dL.

• In most people, the liver metabolizes about 10 grams of ethanol

per hour. This corresponds to a BAC fall of about 20 mg/dL per
hour. Thus, the length of time a person (and family) will need to
wait until discharge may be expressed by the formula (BAC-
100)/20 = the wait in hours. Example: The BAC from a blood
sample drawn at midnight is 280. (280-100)/20 = 9. The BAC
should fall to 100 mg/dL by 9 am (midnight plus 9 hours).

• A social worker may talk with the intoxicated person prior to

discharge from the hospital. The social worker may advise the
person to go to an alcohol treatment center. This is an extremely
difficult situation because many people either don't recognize
their problem, if they are chronic drinkers, or don't have any
desire to correct the situation.