Saturday, 20 July 2013

Alcohol and vomiting

Most people have vomited at least once in their lives. In fact, many people have a great vomit story – particularly relating to their alcohol consumption! Though unpleasant, vomiting can be the body's way of protecting itself, trying to get rid of harmful toxins. Alcohol is certainly a powerful toxin ...

For many young people vomiting is the most likely reported negative outcome that they experience when they drink alcohol. In the 2011 ASSAD survey more than one in five (21.6%)12-15 year old male current drinkers (those who drank in the previous week) and well over a quarter of females (28.5%) of the same age reported vomiting after drinking in the past 12 months. Not surprisingly, far more 16-17 year olds were likely to report the practice, with 45.7% of male current drinkers of that age and 45.8% of females vomiting after drinking alcohol.

What continues to concern me in the school context is how few young people I meet who have any idea how to look after a vomiting friend. Even more worrying is the growing number who believe that vomiting is just a part of the 'drinking process' and that it is just a bit of fun and nothing can go wrong. One of the first deaths I was ever involved with was almost 20 years ago involving a vomiting young man.

A 16 year old had been having a big party night. It was a friend's birthday and a large number of teens were partying at the birthday boy's home. The parents had not supplied alcohol but partygoers were able to bring their own and there were a number of teens who were getting pretty intoxicated. The young man started to feel unwell and told a couple of his mates that he was going to the toilet to throw up. No-one thought anything of it and he wandered to the bathroom. When he didn't return a couple of guys decided to go and check on him. Unfortunately the bathroom door was locked when they got there and when they knocked their was no answer, although they could hear what they thought sounded like a gurgling sound. Eventually they became extremely concerned and broke the door down. The young man was curled over the toilet - he had passed out while throwing up and had choked on his own vomit.

Since that time I have been involved with a number of alcohol-related deaths due to vomiting. It is not a 'bit of fun' and it certainly isn't harmless. No-one should ever be left alone when being sick and every young person should be provided some basic information on how to look after someone when they are vomiting. What constantly amazes me is how many parents think it is perfectly okay to send their teenager off to a party on a Saturday night yet not provide them with any skills on how to look after themselves or their friends. When you look at the figures above - almost half of all 16-17 year old current drinkers had vomited at some time after drinking - how in heaven do they know what to do when that happens?

So what causes someone to be sick on this most popular drug?

Most alcohol is metabolized by the liver, where an enzyme called alcohol dehydrogenase, or ADH, breaks down ethanol into acetaldehyde, which in turn is broken down by another enzyme into acetate, which is excreted. The intermediate product, acetaldehyde, is a toxic chemical that can make a person feel sick. Although under normal circumstances acetaldehyde is broken down quite rapidly, intense feelings of nausea and illness will result if it is accumulated in the body.

Alcohol is removed from the body very slowly, at a rate of about one standard drink per hour, so if you drink too quickly the toxins build up in the body and your body needs to expel them. That’s where vomiting comes in – your body doesn’t want the toxins anymore and as a result the stomach’s contents are expelled!

Apart from choking on their own vomit, there are other ways that deaths can occur when someone is sick after drinking. Dehydration and salt imbalances are the biggest concerns in most vomiting episodes. Signs of dehydration are increased thirst, infrequent urination or dark yellow urine, dry mouth, eyes that appear sunken, crying without tears, and skin that has lost its normal elasticity.

Of course we can't call an ambulance to look after every vomiting drunk teen, but having other drunk adolescents looking after someone in this condition is not a good idea. Calling a responsible sober adult to assist is most probably the best thing to do in most cases, but how do you know if a person is just drunk or actually suffering from something much more serious - like alcohol poisoning? It’s difficult, but a basic rule of thumb is that if you see any one of the following, you should seek medical help immediately – this is not something you can deal with alone:
  • the person is unconscious and can’t be awakened by pinching, prodding or shouting
  • the skin is cold, clammy, pale or bluish or purplish in colour, indicating they are not getting enough oxygen
  • the person is breathing very slowly, if there are more than 10 seconds between breaths – this is an emergency
  • vomiting without waking up
No vomiting should be taken lightly – no person who is vomiting should be left alone – people do die from choking on their own vomit. And it doesn’t take much – it is believed that a person can choke on one tablespoon of vomit which can build up and block the airway!

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