Alcohol Dosage Guide

## Blood Alcohol Concentration (BAC) and Effects BAC is measured as grams of alcohol per 100 ml of blood. The effects at each level vary by individual tolerance, but general thresholds are: | BAC (%) | Effects | |---------|---------| | 0.02-0.04 | Mild relaxation, slight mood elevation, minimal impairment | | 0.05-0.07 | Lowered inhibitions, impaired judgment, reduced coordination | | 0.08 | **Legal intoxication limit** in the US, Canada, UK. Significant impairment of motor control and reaction time | | 0.10-0.15 | Slurred speech, poor balance, blurred vision, significantly impaired judgment. Nausea and vomiting common | | 0.16-0.24 | Severe impairment. Dysphoria, nausea, "blackout" amnesia likely. Vomiting common and aspiration risk increases | | 0.25-0.34 | **Medical emergency.** Severe motor impairment, loss of consciousness likely, risk of aspiration, hypothermia, and respiratory depression | | 0.35-0.39 | **Potentially fatal.** Equivalent to surgical anesthesia levels. Coma, respiratory depression, loss of reflexes including gag reflex | | 0.40+ | **High lethality.** Respiratory arrest, cardiovascular collapse, and death. Approximately 50% of people will die at this level | For reference, the LD50 of alcohol in humans is estimated at a BAC of approximately 0.40-0.50%, though deaths have occurred at lower levels and some individuals with extreme tolerance have survived higher levels. ## Acute Alcohol Poisoning Symptoms Alcohol poisoning is a medical emergency that kills approximately 2,200 people per year in the United States alone (roughly 6 deaths per day). Key symptoms: - **Vomiting while unconscious** — the leading cause of alcohol poisoning death. Without a gag reflex, vomit is aspirated into the lungs, causing suffocation or aspiration pneumonia - **Seizures** — caused by severe dehydration, electrolyte imbalance, and the direct neurotoxic effects of acute alcohol exposure - **Hypothermia** — alcohol causes vasodilation (flushing, feeling warm) while actually accelerating core heat loss. Passing out in cold environments compounds this danger - **Slow or irregular breathing** — fewer than 8 breaths per minute, or pauses of 10+ seconds between breaths. This indicates dangerous central nervous system depression - **Blue-tinged or pale skin** — cyanosis indicates inadequate oxygenation - **Unconsciousness with inability to be roused** — if a person cannot be woken up, this is an emergency regardless of other symptoms ## What to Do (and What NOT to Do) **Do:** - Call emergency services (911/999/112) immediately if you suspect alcohol poisoning - Place the person in the **recovery position** — on their side with top knee bent forward - Stay with them at all times until paramedics arrive - Keep them warm with a blanket or coat - If they are conscious, encourage small sips of water - Tell paramedics everything you know about what they consumed, including other drugs **Do NOT:** - Give them coffee — caffeine does not counteract alcohol and may mask symptoms while worsening dehydration - Give them food — aspiration risk if consciousness is impaired - Put them in a cold shower — hypothermia risk and potential for falls - Try to make them vomit — aspiration risk - Let them "sleep it off" — BAC can continue rising for 30-90 minutes after the last drink as alcohol is still being absorbed from the stomach and intestine - Leave them alone — this is how most alcohol poisoning deaths occur ## Risk Factors That Lower the Lethal Threshold - **Body weight** — smaller individuals reach higher BAC faster with the same amount of alcohol - **Biological sex** — women generally have less body water and less alcohol dehydrogenase enzyme than men, reaching higher BAC per drink - **Empty stomach** — alcohol absorption is 2-3x faster without food - **Speed of consumption** — rapid consumption (shots, funneling, drinking games) overwhelms the liver's metabolic capacity - **Mixing with other depressants** — benzodiazepines, opioids, GHB, barbiturates, and antihistamines all compound respiratory depression. The majority of alcohol-related overdose deaths involve polydrug use - **Low tolerance** — individuals who rarely drink are at much higher risk. College freshmen and adolescents are disproportionately represented in alcohol poisoning deaths - **Genetic factors** — approximately 36% of East Asian individuals have an ALDH2 deficiency that impairs alcohol metabolism, causing acetaldehyde accumulation (the "Asian flush") ## Long-Term Organ Damage from Chronic Heavy Use While acute overdose is the immediate danger, chronic alcohol use causes cumulative, often irreversible organ damage: - **Liver disease** — progresses from fatty liver (reversible) to alcoholic hepatitis to cirrhosis (irreversible scarring). Cirrhosis kills approximately 50,000 people annually in the US. Once cirrhosis is established, the 5-year survival rate is approximately 50% - **Pancreatitis** — acute and chronic. Extremely painful, can be life-threatening, and significantly increases pancreatic cancer risk - **Cardiomyopathy** — chronic heavy drinking weakens and thins the heart muscle, leading to heart failure - **Cancer** — alcohol is classified as a Group 1 carcinogen by the IARC. It increases the risk of cancers of the mouth, throat, esophagus, liver, breast, and colorectum. Even moderate drinking (1-2 drinks/day) measurably increases breast cancer risk - **Brain damage** — chronic alcohol use causes cortical atrophy, white matter degeneration, and cerebellar damage. **Wernicke-Korsakoff syndrome** is caused by thiamine (vitamin B1) deficiency from chronic alcohol use — Wernicke encephalopathy involves acute confusion, ataxia, and eye movement abnormalities, while Korsakoff syndrome causes permanent anterograde amnesia and confabulation. It is preventable with thiamine supplementation but largely irreversible once established - **Peripheral neuropathy** — numbness, tingling, and pain in extremities from nerve damage - **Immune suppression** — chronic drinkers are more susceptible to pneumonia, tuberculosis, and other infections