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As with many other drugs, acute overdoses with alcohol may be fatal. Usually this occurs when very large doses of alcohol are consumed over a very short period of time. Rapid absorption of the ingested alcohol leads to a rapid and steep rise in blood alcohol concentration (BAC) which may lead to loss of consciousness, coma, progressive respiratory depression, and death in a relatively short period of time.

In general, the acute lethal dose of alcohol is considered to be from 5 to 8 mg/kg of body weight. This amounts to between 350 and 560 ml of pure alcohol, which translates to 12 to 19 fluid ounces of pure alcohol, in the "average 155 pound" (70/kg) man. This is the equivalent of about a fifth to a fifth and a half of 86-proof liquor. Acute doses of this size of alcohol can be expected to result in BACs in the range of .35 to .7. BACs in this range have been consistently found in acute alcohol overdoses that have had fatal outcomes. This is not at all surprising, since it is known that a BAC in excess of .4 will severely, and very likely lethally, depress respiratory function.

Of course, the exact lethal dose and BAC in any individual will vary with age, sex, general physical health, and the degree of prior tolerance to alcohol. All things being equal, a very large, healthy, young adult male will tolerate a dose of alcohol that might well be fatal for a small, medically ill, elderly female. This is true, only more so, for the alcohol-tolerant alcoholic as compared to the alcohol-naive, novice drinker. Thus an alcoholic may tolerate an acute dose of alcohol that would kill an otherwise comparable nonalcoholic individual. However, although chronic tolerance to alcohol may provide the alcoholic with some margin of safety, this protection is finite. Thus, even the most severe alcoholic may do himself in by consuming acutely a sufficient amount of alcohol to raise the BAC to the upper end of the lethal range. Therefore it is probably fair to say that a BAC of. 7 or more is virtually certain to be lethal in anyone. And the higher the level within the .35 and .7 range, the greater the risk of death.