POISONED CHALICE

If one of Gazza's mates can die from alcohol poisoning after a heavy night
on the bottle, asks Hilary Bower, are we risking our lives when we have a
tipple?

Can you really die of a few pints of lager and some grappa? After the
coroner's confirmation last week that Gazza's second best mate, David
Cheek, died not of a respectable heart attack, but of acute alcohol
poisoning, it's the question on the lips of everyone who lets a few units
of amber liquid slip down their throats of an evening.

Death by alcohol poisoning is for old men with strawberry noses, holes in
their shoes and cans of extra strong lager in their fists. It's surely not
young 40-somethings out for a meal at the Italian with their mates, even if
one of them is Gazza.

It's true, five pints of lager - that's 10 units or 150 milligrams of
alcohol in technical parlance - shouldn't kill you. According to Derek
Rutherford, director of the Institute for Alcohol Studies, it takes at
least 450 milligrams of alcohol - or 30 units - to send a person of average
build into a coma. And another three to nine units to tip you into the
hereafter. That's 17 or so pints of beer, or a similar number of small
glasses of wine or shots of spirits to you and me.

Poor David Cheek by his friends' reckoning was nowhere near that amount.
The trouble, say pollsters and doctors, is that almost everyone, except
teenage boys seeking liquid kudos, underestimates their drinking by at
least 40 per cent.

Part of this may simply be that unless you are a very light drinker, you
probably won't remember exactly how much you drank - what with refills,
rounds that arrive when you're in the loo, and the fact that relaxing with
a tipple is not conducive to statistical calculations. But, says Dr Peter
Abrahams of the Medical Council on Alcohol, it's also because we're not
aware enough of the unit value of what we drink.

"In our culture, we learn how to drink in a way that doesn't kill us, but
when inexperienced drinkers get into competitive situations like initiation
ceremonies, or when you get birthday parties or other occasions where
having as much to drink as possible is equivalent to having a good time, we
can make mistakes." Brewers, he adds, don't help the situation by refusing
to note the unit count of their beer on labels, while cocktails really
clock up the milligrams. David Cheek's lost 40 per cent was probably the
"shooter" cocktails - the potent mix of Tia Maria, Grand Marnier and
Baileys that the group downed postprandially at a nightclub.

Working out how much alcohol is dangerous is far from an exact science:
factors like weight, sex and race have a significant impact on the way the
body processes alcohol. A heavy man can add a few units on to every
recommendation, while women are more susceptible to the effects of alcohol
not, as commonly thought because they are smaller or carry more fat which
doesn't absorb alcohol, but because they have less of the stomach enzyme
alcohol dehydrogenase which is vital to the body's detox process.
Asians,infamous for their rapid response to alcohol, are also the victims
of a lack of a detoxifying enzyme which breaks down alcohol residue once it
gets into the blood stream.

Like any other drug user, says MCA education officer Dr Michael Wilks,
heavy drinkers can build up a tolerance. But, he warns, this tolerance can
suddenly break down as the liver becomes increasingly impaired and unable
to process alcohol.

"One problem is that the difference between the dose of alcohol that will
cause acute alcohol poisoning and one that is not quite enough to do it is
very small," adds Wilks.

Alcohol poisoning is not the next, and lethal, step up from a hangover,
which has more to do with the chemicals that are added to alcohol which
dehydrate the brain. Poisoning is brought on by the sheer volume of alcohol
in the blood and does its damage by gradually anaesthetising the body's
systems.

"Alcohol works by depressing the central nervous system - it starts with
the areas of the brain that control judgment, then speech, then gait and
then slowly moves into the medulla oblongata - the part of the brain that
controls all your vegetative functions like breathing," says Derek
Rutherford.

At this level of intoxication, the brain loses control of the muscles that
keep the airways open even in sleep.

"You basically strangle yourself," explains Dr Ian Calder, consultant
anaesthetist at the National Hospital of Neurology and Neurosurgery. This
itself can cause death, but it is also often compounded when the person,
unable to control their airway, inhales their own vomit.

While in the past the anaethetising ability of alcohol was put to good use
in a medical operations, Calder says anyone who is unrousable after
drinking heavily these days is in a very vulnerable state. "Turn them on
their side with their head down to allow any vomit to drain out rather than
be sucked back and get them to hospital urgently," he says.

Sliding scale of drink:

1-3 units: flushed skin, speeding heart, talkative, feeling good, reduced
vision 4-6 units: judgment slows, giddiness, impaired coordination 7-9
units: vision blurs, speech becomes fuzzy, reaction time slows 10-15 units:
staggering, loss of balance, double vision 20 plus: skin clammy, pupils
dilated, loss of bladder control 30 plus: unconsciousness, respiratory
distress and, ultimately death.