Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
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
exhibit to indicate alcohol intoxication.
Major factors accounting 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 novice drinker may have severe symptoms with the ingestion of a moderate amount of alcohol. As a person's drinking increases, his/her liver will increase its capacity to metabolize alcohol. In addition,
the brain of a heavy drinker becomes used to frequent, even constant, high blood alcohol concentrations. This habituation in a heavy drinker can backfire if this person suddenly stops drinking. The person may go into alcohol withdrawal and develop
seizures or a condition called delirium tremens (DTs).
Taking medications: The effects of alcohol are enhanced if a person is taking other
prescription medications, especially those of the sedative class such as sleeping pills or
anti-anxiety medications. A person who is not habituated to either alcohol or sedatives may experience serious harm, or even death, if taking prescribed doses. Together, they can be a deadly combination.
A person may be taking medications prescribed by a doctor or over-the-counter medications, and may not know about these unintended consequences.
Medical conditions: The presence of a wide variety of medical conditions may affect how
a person 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
blood alcohol concentration. 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 two standard drinks per day), there is a rough correlation
between blood alcohol concentration and how the person acts.
Blood alcohol concentration. Blood alcohol concentration commonly is expressed in milligrams per deciliter (mg/dL). Using this measure, 100 mg/dL roughly is equal to
one 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
intoxicated when operating a motor vehicle.
To find out more about blood alcohol concentration and how it affects
a person, go to the
Blood Alcohol Educator Web site of the Century Council and the University of Illinois.
TThe following scale details the expected effects of alcohol at various
blood alcohol concentrations. 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
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
Other conditions that look like alcohol intoxication: It is important
to recognize the symptoms of alcohol intoxication not only to confirm the
presence and severity of the alcohol effect, but also to be able to
differentiate the symptoms from other conditions that may coexist, mimic, or
mask the symptoms of alcohol intoxication.
Alcohol-related psychosis is a secondary psychosis with predominant hallucinations occurring in many alcohol-related conditions, including acute intoxication, withdrawal, after a major decrease in alcohol consumption, and alcohol idiosyncratic intoxication.