Clinical cases
Acute alcohol intoxication: a case-based approach
This is an illustrative educational case — not a real patient. Most people who drink too much simply feel unwell and recover, but heavy intoxication can tip into alcohol poisoning, which can be fatal. This case shows how to tell the difference and what to do while waiting for help.
Education and reference only. This article explains how treatments work in plain language — it contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician.
The presentation
A 19-year-old is brought to a friend's attention after drinking heavily at a party. They are very drowsy, difficult to wake, have vomited, and their breathing seems slow. Their skin is cold and slightly clammy. These features — reduced consciousness, vomiting, slow or irregular breathing and cold, pale or bluish skin — are the warning signs that this is more than "being drunk"; it may be alcohol poisoning, and it is potentially life-threatening.
Why alcohol poisoning is dangerous
Alcohol depresses the brain and body. In large amounts it can slow or stop breathing, drop body temperature, cause dangerously low blood sugar, and suppress the gag reflex — so someone who vomits while unconscious can choke or inhale vomit. Blood alcohol can keep rising even after the person stops drinking, as alcohol already in the stomach is absorbed. This is why a heavily intoxicated person should never simply be "left to sleep it off" unsupervised.
First aid while waiting for help
If someone is very drunk and cannot be roused, the priorities are to keep them safe: call 999, place them on their side in the recovery position to protect their airway if they vomit, keep them warm, and stay with them and monitor their breathing. Do not give them coffee, make them sick, put them in a cold shower, or let them "walk it off" — these do not help and can be harmful. If breathing stops, be ready to start CPR on the 999 call handler's instructions.
When it is a 999 emergency
Call 999 if a person who has been drinking cannot be woken, is breathing slowly or irregularly, has cold, clammy, pale or bluish skin, is having a seizure, or has vomited and may have inhaled it. It is always better to call for help than to risk a preventable death. Emergency services would far rather assess someone who turns out to be recovering than be called too late.
What the case teaches
The lesson is recognition and action: heavy intoxication with drowsiness, slow breathing and cold clammy skin is a medical emergency, not something to sleep off. Putting the person safely on their side, keeping them warm, staying with them and calling 999 can be life-saving. Beyond the emergency, repeated heavy drinking is worth addressing, and support is available without judgement.
In short
Key takeaways
- Heavy intoxication can become alcohol poisoning, which can be fatal.
- Warning signs: cannot be woken, slow or irregular breathing, cold/clammy/bluish skin, vomiting, seizures.
- Never leave a heavily intoxicated person to "sleep it off" alone — blood alcohol can keep rising.
- First aid: call 999, recovery position, keep warm, stay and monitor breathing; don't give coffee or induce vomiting.
- Educational illustration only — if someone can't be roused or is breathing abnormally, call 999.
Answers
Frequently asked questions
Is this a real patient?
No — it is a fictional teaching case for education and is not advice for any individual.
What should I do if a friend is dangerously drunk?
If they cannot be woken, are breathing slowly or irregularly, or have cold/clammy/bluish skin, call 999. Put them on their side in the recovery position, keep them warm, and stay with them until help arrives. Do not leave them alone to sleep it off.
Does coffee or a cold shower sober someone up?
No. Only time removes alcohol from the body. Coffee, cold showers and walking around do not help and can be harmful. Keep the person safe and seek help if they are very drunk.
Go deeper
Related guides
Sources
Where this is drawn from
- NHS — Alcohol poisoning
- St John Ambulance / Resuscitation Council UK — first aid and the recovery position
- NICE CG100 — Alcohol-use disorders (acute)
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