What are the signs and symptoms of alcohol poisoning, and what should you do?
Slow breathing, blue skin or no waking means alcohol poisoning. What to do in the first minutes, what never to do, who to call in South Africa, and what to do if it keeps happening.
If someone who has been drinking cannot be woken, is breathing slowly or has a seizure, call 10177 for an ambulance or 112 from any mobile. Those are symptoms of alcohol poisoning, and the NIAAA says not to wait for all of them. Stay with them until help arrives, because the NHS warns they could choke on their own sick or stop breathing. Keep them sitting up while they are awake, and roll them into the recovery position if they pass out. Renewed Life Center in Cape Town treats the drinking behind repeat episodes.
Tonight is over and you want to stop it happening again? Message us on WhatsApp. We reply the same day and tell you whether a medical detox is needed.
What are the signs and symptoms of alcohol poisoning?
Alcohol poisoning means so much alcohol in the blood that the body’s basic functions start to fail, most dangerously breathing. The NHS lists confusion, slurred or lost speech, being unable to coordinate movement, being sick, pale or blue-tinged skin, slow or irregular breathing, a seizure and loss of consciousness as the signs.
You do not need all of them. The US National Institute on Alcohol Abuse and Alcoholism (NIAAA) says to get help immediately and not to wait for the person to have all the symptoms. One serious sign is enough.
Signs to act on, and what each one means for you
- Cannot be woken, or passes out. Call the ambulance. Loss of consciousness is on the NHS list of signs.
- Slow or irregular breathing. NIAAA gives fewer than 8 breaths a minute as a critical sign. Call first.
- Pale or blue-tinged skin. Another NHS sign.
- A seizure or fit. The NHS says to call an ambulance for a seizure in someone who has been drinking.
- Being sick while drowsy or confused. Vomiting on its own is common. Vomiting with confusion or falling asleep is a reason to stay beside them and phone.
- Cannot speak or move properly. Slurring and clumsiness are ordinary drunkenness until they turn into no speech and no coordination.
Call an ambulance now if someone who has been drinking cannot be woken, or has lost consciousness; is breathing slowly or irregularly, or has stopped breathing; is having a seizure or fit; or has pale or blue-tinged skin, or keeps being sick and cannot speak clearly. The NHS says to call an ambulance if you think someone has alcohol poisoning, or if they have a seizure, lose consciousness or stop breathing. The national number is 10177, and in Cape Town you can also call 112, toll-free, or the City of Cape Town emergency line 021 480 7700. If you think the drinking was an attempt to end their life, say so to the crew and call the Suicide Crisis Helpline on 0800 567 567.
How do you tell alcohol poisoning from someone who is just very drunk?
If you can wake them and they answer you, and their breathing is steady, they may simply be very drunk. That can still change, because alcohol already in the stomach keeps entering the blood. Any of the signs below means possible poisoning. When you cannot tell, call.
| Very drunk | Possible alcohol poisoning |
|---|---|
| Waking | |
| Sleepy, but wakes and answers you | Cannot be woken, or passes out |
| Speech and movement | |
| Slurring, stumbling, repeating themselves | Confused, cannot speak, cannot coordinate movement |
| Breathing | |
| Steady | Slow or irregular, or stops |
| Skin | |
| No change you can see | Pale or blue-tinged |
| Other | |
| Not sick again and again, no seizure | Sick repeatedly, or a seizure |
The right-hand column follows the NHS list of signs. Not sure which column? NIAAA says not to wait for every symptom, so call.
What should you do right now, and can you treat it at home?
Alcohol poisoning is not something to treat at home: call for an ambulance, stay with the person, and keep their airway safe until the crew arrives. The NHS says to sit them up if they are awake, or put them in the recovery position if they have passed out. Everything else can wait until the crew arrives and tells you what they need.
The first minutes, in order
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Call
Dial 10177 for an ambulance, or 112 from any mobile. In Cape Town the city also runs a toll-free emergency line, 021 480 7700. The Western Cape Government also lists the Poisons Information Helpline of the Western Cape on 0861 555 777.
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Stay
The NHS says to stay with them because there is a risk they could choke on their own sick or stop breathing. Do not go to the kitchen, do not go to bed, do not assume someone else is watching.
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Sit them up, or roll them onto their side
If they are awake, the NHS says to sit them up. If they have passed out, NIAAA says to roll them onto one side with an ear toward the ground to prevent choking.
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Watch the breathing
Keep watching the chest. Fewer than 8 breaths a minute is a critical sign.
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Tell the crew what happened
What they drank and roughly when, whether they have taken tablets, and whether they have fallen or hit their head. Say it even if you are embarrassed. The crew has heard all of it.
What should you never do?
Never give coffee, never use a cold shower, never walk them around, and never leave them to sleep it off. Each of these feels like doing something, and NIAAA says cold showers, coffee and walking do not reverse an overdose and could make things worse. What helps is the ambulance, and someone staying beside them until it arrives.
Four things that feel helpful and are not
- Coffee. The NHS says not to give coffee or drinks containing caffeine because this can dehydrate people with alcohol poisoning, and the MSD Manual (consumer version) says coffee and other home remedies do not reverse the effects of alcohol.
- A cold shower or bath. The NHS says not to put them in a cold shower or bath because there is a risk they could get too cold.
- Walking them around. NIAAA says cold showers, hot coffee and walking do not reverse the effects of alcohol overdose and could make things worse.
- Leaving them to sleep it off. The NHS says to stay with them, and NIAAA says blood alcohol can keep rising even when a person is unconscious.
“He will sleep it off” sounds calm and sensible at two in the morning. On a night like this it is the wrong call.
Why is alcohol poisoning dangerous, and why can it get worse after they stop drinking?
Alcohol poisoning is dangerous because alcohol keeps arriving in the blood after the last drink. NIAAA explains that alcohol in the stomach and intestine continues to enter the bloodstream, so blood alcohol can keep rising when a person stops drinking or is unconscious. A person who looks stable now can be worse an hour later.
The second danger is the airway. Someone who is drowsy and being sick cannot always protect their lungs. The MSD Manual says vomited material may enter the lungs, sometimes leading to pneumonia and death. That is the reason for sitting up, for the side position and for staying in the room.
The third is the level itself. The MSD Manual gives a blood alcohol level of 400 mg/dL or more as possibly fatal. Nobody at home can measure that, which is exactly why the rule is to call on the signs and not to wait for a number.
What causes alcohol poisoning?
Alcohol poisoning is caused by drinking a large amount of alcohol in a short time, faster than the body can clear it. Speed matters more than experience. Shots, drinking games, spirits on an empty stomach and a glass that someone keeps topping up all push the level up before the drinker feels how drunk they are.
Most cases follow a binge: a lot of drinks in a couple of hours, at a party, a braai or a night out. Because alcohol already in the stomach and intestine keeps entering the bloodstream, NIAAA says, the last drinks of the night are still arriving after the person has stopped. That is how someone can seem fine at midnight and be impossible to wake at two.
How is alcohol poisoning treated in hospital?
In hospital, alcohol poisoning is treated by watching the person until it is safe and treating what needs treating. The NHS says you will need to go to hospital to be monitored, and may be given fluids into a vein through a drip. If breathing is affected, they can protect the airway.
The MSD Manual says that people in a coma, or whose breathing is suppressed, may need a tube inserted in the airway to keep them from choking on vomit. It sounds frightening, and it is the reason hospital is the right place.
Go to the nearest emergency department, private or public, and let the ambulance crew decide where the person goes. The conversation about the drinking can wait for a calmer day.
How long does alcohol poisoning last?
Alcohol poisoning lasts until the body has cleared enough alcohol for breathing and waking to be safe again, and there is no fixed number of hours to plan around. Alcohol already in the stomach keeps reaching the blood after the last drink, which is why the NIAAA warns that a person can get worse after they stop drinking. So the doctors watching them decide when it is over, and the clock does not.
Ask the doctors when it is safe to go home, and follow what they say. Before you leave, ask what to watch for at home and when to come back. If the question afterwards is how long the alcohol stays in the body, or in a test, see how long alcohol stays in your system.
What is a blackout, and is it a warning sign?
A blackout is a gap in memory, not a loss of consciousness. The person stays up, talks, even seems the life of the party, and later cannot recall the period. The MSD Manual describes an intoxicated person who may seem gregarious and talkative but will have limited memory of the blackout period.
That is what makes blackouts easy to miss. Nobody sees one happen. The person looked fine, so the night is filed as a good one, and the only evidence is a hole in the next morning. It is also a night in which nobody, including the drinker, could tell how much was too much.
One blackout can be a single bad night. Blackouts that come back, or a night that ended in an ambulance and the same drinking pattern again a month later, belong in the next section.
What if this has happened before?
If alcohol poisoning has happened before, it is a pattern. A person who drinks until they black out or need an ambulance more than once is drinking in a way their body cannot manage. A promise made the next morning is not a plan. What changes the pattern is treatment, and it starts with the question of what the drinking was doing for them.
For many people, the drink did a job that night. It quietened anxiety, made sleep possible, closed a long day, or numbed something they had not said out loud. Take the alcohol away without dealing with that, and the job is still waiting.
There is also a measurable pattern here. NIAAA describes binge drinking as five or more drinks for a man, or four or more for a woman, in about two hours for a typical adult, counting US standard drinks of 14 g of alcohol, and says that this pattern increases the risk of many short- and long-term consequences. You may not think of yourself as a heavy drinker and still end up in an emergency department after one big night.
Locally, alcohol is common in treatment. Of everyone admitted to 33 specialist treatment centres in the Western Cape in the first half of 2025, 26% came primarily for alcohol, according to SACENDU, the South African Medical Research Council’s monitoring network.
To check your own drinking privately, take the AUDIT check for yourself. Where the drinking is daily, read what happens when a heavy drinker stops before anyone stops suddenly. If you are watching someone else’s drinking, the signs of alcoholism are laid out for families. Relatives will find the morning after hardest, so there is a guide on how to start that conversation. And where cocaine was in the mix, read why the combination is riskier than either.
Finding out what job the drinking was doing is work for a psychologist, and a family cannot do it over breakfast. At Renewed Life Center the psychological side is led by Dr Ruby Weber, who has worked in the addictions field for over two decades with international and South African clients and has a particular interest in how trauma feeds dependence. She is the person who asks what the drinking was for, and what should take its place.
Who looks after this at Renewed Life Center?
Once the hospital has done its part, the drinking itself is treated by a resident GP, a psychologist and a counselling team working together. At our centre in Lakeside, medical detox starts with a risk assessment before withdrawal begins, then monitoring by nursing staff 24 hours a day. Medication is used only when clinically indicated and prescribed by a medical professional.
Our resident GP does the medical assessment and brings a background in mental health and emergency medicine. During detox, nursing observation continues through the night. If the drinking has been daily, read what alcohol withdrawal looks like to see why that watch matters.
Dr Ruby Weber leads the psychological work. Angelica Nel, our lead counsellor, works in the same team, and John Roberts, our operations manager, has 39 years of personal recovery behind him.
Want a clinician to look at what happened and what should come next? Message us on WhatsApp for a free, confidential call. A clinical assessment follows within three days of first contact.
Why Renewed Life Center?
People choose Renewed Life Center because the medical care and the therapy sit in the same house. After the hospital, someone who has been through a frightening night is assessed, kept under 24-hour nursing supervision during medical detox if withdrawal is a risk, and then starts the work of finding out why, under one plan. Our detox page explains how medical detox runs here.
One programme rather than a chain of handovers. Primary residential care, the later phases, sober living with therapeutic support and aftercare coordination sit inside one programme. You can read about the whole path on our alcohol treatment page and the sober living and aftercare page.
Paid directly. No scheme decides how long you lie in a bed. You and the team decide it together, on what the assessment shows.
A calm place in Cape Town, with the family kept close. The centre is in Lakeside, in the Southern Suburbs, close to Muizenberg beach, with a mountain ridge directly behind the property and staff on site 24 hours a day. Family therapy runs in person and by video, with a family meeting on Zoom every Wednesday evening, and airport transfers at Cape Town International are included in both directions.
How do you start at Renewed Life Center?
Start with a free conversation of twenty to forty minutes, by WhatsApp, video or phone. A clinical assessment follows within three days. Admission can be immediate and typically happens within three days of first contact. A relative can make the first call, and we reply the same day.
On the call we ask what happened that night, how often the drinking goes this far, and whether there have been shakes or sweats on the days without a drink. You come away with a clear sense of whether a medical detox is likely, what treatment would look like and when it could start, and the clinical assessment then confirms it. Nothing is decided unless you want it to be, and the person does not need to be on the line.
From first call to admission
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A free first call
Twenty to forty minutes, confidential, no obligation. Tell us what happened, in your own words.
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Clinical assessment
Within three days, covering the drinking, the physical risk and what else is going on.
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Admission
Sometimes the same day, usually within three days of that first call. Airport transfers are included in both directions.
Message us on WhatsApp to set up your free first call, or write to us if you would rather write first. Either way, you hear back the same day.
Questions people ask
Yes. The MSD Manual gives a blood alcohol level of 400 mg/dL or more as possibly fatal, and says inhaled vomit can lead to pneumonia and death. That is why the rule is to call early and stay with the person.
No. Blood alcohol can keep rising while a person is unconscious, and the NHS says to stay with them because they could choke or stop breathing. Someone asleep is not necessarily someone safe.
Yes. It is about how much and how fast, not how long someone has been drinking. NIAAA defines binge drinking as five or more drinks for a man, or four or more for a woman, in about two hours, in US standard drinks, and that pattern raises the risk of many short- and long-term problems.
Start with how frightened you were, not with what they did wrong. Choose a time when both of you are calm and sober. There is a longer guide on how to talk to a loved one about rehab, and you can also talk it through with us first, free and in confidence.
This article is general information, not medical advice.
Sources
- NHS, Alcohol poisoning, page last reviewed 4 June 2026
- NIAAA, Understanding the dangers of alcohol overdose, updated December 2025
- MSD Manual Consumer Version, Alcohol use, last updated July 2026
- NIAAA, Alcohol drinking patterns
- SACENDU Research Brief, South African Medical Research Council, volume 29(1), 2026
- Emergency numbers, Western Cape Government
- City of Cape Town, Emergency contact numbers
- South African Depression and Anxiety Group, helplines
After a night like this, talk to us.
A free, confidential call of twenty to forty minutes, for yourself or for someone you love. Medical detox with 24-hour nursing where indicated, therapy for what the drinking was doing, and admission that can be immediate, typically within three days. We reply the same day.
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