Alcohol Poisoning

Alcohol poisoning is acute ethanol toxicity: a rising blood alcohol concentration (BAC) produces progressively deeper central nervous system depression. Ethanol enhances inhibitory GABA-A transmission and inhibits excitatory NMDA glutamate transmission. The result may begin as impaired judgment and coordination, then progress to confusion, stupor, loss of protective airway reflexes, respiratory depression, coma, and death. The dangerous progression is not simply “being very drunk.” As sedation deepens, the person may no longer cough, swallow, or reposition when vomiting. Vomitus can then enter the airway, causing fatal aspiration. Ethanol also suppresses gluconeogenesis and can deplete glycogen stores, making hypoglycemia a reversible contributor to altered consciousness—particularly in children, adolescents, malnourished people, and those with chronic heavy alcohol use. A BAC near 0.08% is the level used by NIAAA to define binge drinking, although impairment begins at lower levels. A BAC of approximately 0.31% or higher is often life-threatening, with severe depression of consciousness and respiratory-arrest risk. These numbers are not dependable substitutes for assessment: a person with chronic heavy use may appear less impaired because of tolerance, but tolerance does not protect the...