hangover

What does a hangover feel like? Signs & Symptoms of a Hangover

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What are the signs and symptoms of a hangover? What does a hangover feel like? Other than nausea, diarrhea, fever, headache and depression what other signs are thought to be severe? Can you die from a bad hangover? Keep on reading to find out.

What does a Hangover feel like? Signs & Symptoms of Hangovers

Normally, signs and symptoms of a hangover show up after excessive drinking of alcohol. So what does it feel like and why?

If you a have a hangover, following is what you are likely to experience

  • Feeling of sleepiness
  • You will feel dizzy
  • You may experience mild to severe headaches
  • You will feel confused and thirsty
  • Light headed
  • Dry throat
  • You may feel like your stomach is spinning
  • You may feel depressed
  • You may throw up

A high percentage of the above feelings are attributed to dehydration (lack of water in your body)

However, the feelings may differ depending on an individual. For beginners, the feelings are more pronounced and unbearable while for experienced drinkers they may seem normal. Read on to find out more about these feelings

symptoms & signs of a hangover-nausea,diarrhea, depression,fever,sweats and how it feel like to have a hangover

A hangover victim

Hangover Nausea

Hangover headaches can be a handful to most people and so is hangover nausea. The throb versus the vomit. You would probably choose the throb as with nausea, you will be a stride away from the loo and probably will not have to put anything in the mouth a good part of the day. Nausea is a sensation that is seen to precede vomiting during which you feel that you have an upper gut discomfort. It occurs involuntarily as an urge that may extend to the middleman, retching beyond which food in the stomach is forced upwards by abdominal muscles to the exterior.

Hangover nausea occurs alongside other symptoms of hangover and results through various pathologies in the gastrointestinal tract.

Causes

Gastritis

This is a disease that involves inflammation of the stomach wall lining. Alcohol intake and excess of it may cause irritation of the stomach wall. Mucosa cells are not able to withstand the excessive corrosion and mucous production by these cells onto the stomach wall is not as significant.

Inflammation that ensues with alcohol irritation results in symptoms of nausea, vomiting accompanied with gassy feel and loss of appetite. Acute gastritis is a result of a one-time drinking and will not be severe at this stage.

Acute gastritis may however lead to severe case of acute gastritis with changes in the color tinge of vomitus. You may notice colors of green, yellow or red indicating blood in the vomit.

Gastroenteritis

Gastroenteritis, also called the stomach flu is one disease that has vomiting as its signs. Vomiting, with its counterpart, diarrhea are ways of eliminating pathogens. This infection of the gut may be caused by alcohol.

Alcohol breaches the gut epithelium and causes overgrowth of gram negative bacteria. This results in increased production of a toxin that leads to gastroenteritis and may even spread into blood circulation and infect the liver.

In a study, the relationship between alcohol consumption and bacterial growth has been shown to occur in the duodenum (Hauge et al., 1997)[i]. The studies conducted however have not shown the correlation between the two in neither dose-dependent manner or specificity in the type of bacteria affected.

Build-up of metabolites and toxins

Both alcohol dehydrogenase and acetaldehyde dehydrogenase have been found in the stomach and the esophagus. These enzymes are involved in the firs-pass metabolism of alcohol and therefore, acetaldehyde, which is a toxin is produced.

The rate of breakdown of the acetaldehyde is not as fast as its synthesis and therefore accumulates in the gut. The implication of this is that the stomach detects the presence of toxins and send impulses to the vomit center of the brain.

Any other toxins that may be present in the blood either due to the composition of the alcoholic drink you took or metabolites of alcohol may be detected by the area prostema. This acts as the vomit-inducing center of the brain.

What happens in the morning is that the body thinks it can have a shot in the clearance of toxin in the gut and induce vomiting but since it is already in circulation, you may end up with a green-yellow vomit indicating the presence of bile.  Acute aldehyde toxicity is evidenced by nausea/vomiting, headaches, light sensitivity and flushing of the face.

Suppression of the immune system

Alcohol consumption has an adverse effect on the immune system. The immune system of the body manifests as blood cells, skin and endogenously produced fluids such as mucus. With your army of defenders tarnished, you are at a higher risk of infections.

In normal body physiology, the body’s defense forces, the innate and the adaptive systems are triggered when exposed to an antigen. The innate immune system exists in the body before exposure to pathogens and is what you are born with mostly inherited from your mother.  Components of this system are non-other than cytokines, white blood cells and natural killer cells.

The adaptive immune system comes into play after an initial exposure to a pathogen after which memory is stored so that upon exposure to the same pathogen, defense is stronger and recovery is faster. The T and B cells are part.

With alcohol, both of these systems are suppressed. The ability of the white blood cells to fight off infectious pathogens is significantly reduced. Cytokines are also disrupted in their production. The most interesting bit is that excessive alcohol consumption may lead to an override of a slump in the level of the defense cells and mediators. With lowered immunity, bacteria thrive and may result in an infection in the gut. This may lead to stomach discomfort, nausea and vomiting.

Basic tips

  1. Before you start drinking, have a good meal. Take plenty of non-alcoholic beverages. This will help slow down the metabolism of alcohol in the gut that may lead to production of toxic metabolites. It will also help dilute any gastric effects.
  2. Have a ‘one on one’ alcoholic drink and water to flush out excessive alcohol metabolites before they could harm you.
  3. Space out your drinks and possibly take a bottle per hour. Make sure after this, you observe the ‘one on one’.
  4. Rehydrate after every rush to the loo to vomit

Drugs and medications

You may take Dihydomyricetin (DHM). This plant extract will help you metabolize both alcohol and acetaldehyde faster making sure that acetaldehyde does not accumulate. It also has some antimicrobial effect hence will help prevent any acute gastritis or gastroenteritis. Its inflammatory effect on the stomach wall is cytoprotective and adding its antioxidant effect, prevents destruction of stomach mucosa cells (dhmdepot.com).

For gastritis, the following medications may be used:

  1. Pepto-Bismol
  2. Antacid tablets e. g. tums
  3. Proton-pump inhibitors such as omeprazole and pantoprazole

The first two will help reduce the irritation imposed on the stomach wall by alcohol. Pepto-Bismol in particular, also eliminated bacteria that lead to gastro-enteritis. It also prevents the secretion of fluids from irritated cells.

For people who cannot stop vomiting, promethazine is usually prescribed.

Severe acute gastritis is treated with the proton-pump inhibitors and it is unlikely that you will use this for your hangover nausea unless your acute gastritis graduates to a severe case.

Hangover Diarrhea-How does Alcohol and Diarrhea relate?

The link between alcohol and diarrhea

Diarrhea, alongside vomiting, is also a common complaint in some people. It also occurs as a result of binge drinking and you would say that it is the last thing you would want to happen to you. You wonder how this happens after you drink.

Diarrhea, like vomiting is also a way through which the body eliminates toxins when the gut reports to the brain via the gut-brain axis. This section explains the mechanistic link between the two.

Alcohol is irritative to the wall of the gastrointestinal tract

When alcohol is being absorbed in the intestines, more specifically the large intestine (colon), it causes a whole lot of irritation on the epithelial tissues. Whenever there is irritation on the cells of the epithelia, inflammation occurs.

Inflammation then results in loss of integrity of the colon. It is worthwhile noting that alcohol induced irritation and inflammation not only occurs in the colon, but can occur all along the gut from the mouth to the colon. Since the colon is the most actively involved in the absorption of fluids, it becomes the most targeted victim.

Alcohol results in inflammation of the gut and it is this inflammation that causes inflammatory cell infiltrations – this occurs when cells that are inflammation mediators such as eosinophils, lymphocytes and neutrophils infiltrate around blood vessels. A typical case of perivascular infiltration.

The implication of this is more inflammation. This affects the normal function of secretory cells that are essential for the secretion of digestive enzymes. What follows is poor digestion. Inflammation of the epithelial cells of the colon prevents the absorption of water and is instead passed out as diarrhea.

Alcohol is a biological and environmental stressor

Alcohol itself and its metabolites result in biological stress. This is because the body is forced to upgrade its function to meet the demands. Such demands are stressors and also lead to stress.

It is also an environmental stressor too with adverse effects occurring during drinking such as hampered judgement and effects of diuresis and vomiting that you need to obey. All these affects the brain-gut axis. There lies an interaction between the enteric nervous system and the brain. This leads to a wide array of GIT disorders including diarrhea J Gastroenterol Hepatol.

  1. Changes in GIT secretion
  2. Increased permeability to colonic molecules
  3. Negative effects on normal intestinal flora
  4. Alterations in intestinal normal flora

Dysbiosis which is an imbalance in the intestinal flora is what can be best liked to diarrhea. The imbalance pre-exposes exposes the intestinal wall to bacterial toxins. The ‘bad’ bacteria gets a good chance to adhere on the walls and toxin-induced diarrhea.

Alcohol hampers with the normal motility of the colon

Since the enteric nervous system is inhibited, there occurs dysmotility and delayed movement of food along the gut. Coupled to low secreted enzymes, there is indigestion. In acute drinking, the colonic propulsive motility is increased after consuming alcohol and contributes to diarrhea.

Alcohol hangover with both diarrhea and vomiting

The occurrence of both diarrhea and vomiting are signs of gastroenteritis. Remember, you have microbes in the intestine and the gut and an alteration in the balance of intestinal normal flora. Such a case is seen with Clostridium difficile overgrowth in the intestines.

The two may also occur with the direct effect of alcohol and acetaldehyde in the gut. Alcohol causes the irritation in the stomach tissues as it is being absorbed and acetaldehyde, being 10 time more toxic than alcohol, triggers the vomit center of the brain. Gastritis with stomach flu (gastroenteritis) will lead to this array of signs.

Treatment

When the toxins are completely flushed out of your GIT and the systemic circulation, the diarrhea will eventually stop. When the dysbiosis is corrected, it will too stop. Diarrhea may go on for 2-3 days but may persist with different people. If you are a chronic alcoholic, your GIT may have undergone enough damage to get repaired within that span of time and your immunity may be too low to fight off infections. Infections are easy to get and for such people, it takes longer to heal.

Imodium (Loperamide) is a drug that has been approved for non-specific diarrhea and is indicated for adults and children for its relief. It reduces the volume of discharge from various sections of the GIT including the ileostomies and colostomies.  It also provides relief from diarrhea produced by microbes such as bacteria.

The action of loperamide is on basis of binding to opiate receptors on the gut wall. This leads to a decrease in the circular and longitudinal muscle activity. This reduces the dysmotility in the colon. It also inhibits fluid and electrolyte secretion during diarrhea. It also increases the tone of the anal sphincter to prevent any incontinence that may occur according to Consumer Product Safety Commission[ii]

Drink plenty of fruit juice and other non-alcoholic fluids to rehydrate your body. Take Pedialyte for rehydration too.

Hangover Depression?

Among the commonly known symptoms of a hangover, depression is least anticipated. The myth is that when you indulge in the life of alcohol and parties, you will be happier and stress free. In fact, most people involve in binge drinking to relieve themselves off worry and stressors such as school work, family issues and their internal conflicts. Little do they know, depression after a night of heavy drinking is real.

Remember, alcohol is a depressant drug. It not only depresses your brain physiologically, but also psychologically.

Mechanism

Alcohol hinders the metabolism of serotonin which is synthesized from tryptophan. Therefore, serotonin is reduced in the brain and since it is a mood enhancing chemical, depression may occur.

Another reason as to why depression occurs is due to stressors that occur during drinking such as the signs and symptoms of toxicity. Initially, alcohol causes stimulation of the brain as by inhibiting the neurotransmitter gamma amino butyric acid (GABA), it causes an increase in the dopamine production in the brain. Brain regions that are involved with reward circuitry are excited.

You therefore become motivated to take more alcohol to achieve the reward state. Most people think that the reward state is social disinhibition and their ability to tackle their fears. However, with increased consumption, inhibition of the glutamate neurotransmitter, which is the excitatory transmitter in the brain, depression finally overrides stimulation.

You become less attentive, get alterations in memory and mood changes. Continued consumption gets you lethargic, confused and amnesic. All these result in depressed feeling state (Draski and Deitrich 1995)[iii].

How to deal with it

The silver lining is that with time, the hangover depression will come to pass. What is most worrying is that there is no definite treatment to alcohol induced depression. The best tips involve having enough sleep and staying hydrated.

Take a few minutes to meditate and relax like in yoga and you will feel relaxed. If the depression symptoms persist after all attempts to stop it, then it is time to stop drinking. Depression will make you drink even more and once it become a vicious cycle, you will never be sure from where it started. You will not stop and addiction will catch up with you.

Hangover Fever-Can a Hangover cause a Fever?

Hangover can also be associated with a fever. When alcohol plays and messes your immune system, cytokine may be produced in high levels. Cytokines are immune mediators that transmit signals to immune cells to fight off antigens. Alcohol has been shown to trigger cytokine release and this causes symptoms that are similar to inflammation. They have an interplay with inflammatory mediators such as histamine.

Moreover, congeners and other components in alcoholic beverages such as histamine itself is able to trigger inflammatory effects. Inflammation has four cardinal signs and one of them is fever.

Infection due to opportunistic gastroenteritis can also cause a fever. This is because microbial infections result in inflammation and consequentially, a fever.

Hangover Sweats and Chills

Sweats and chills are mechanisms by which the body regulates its body temperature. It also occurs after binge drinking. Since alcohol affects virtually every organ, including the central nervous system and cardiovascular system, sweats and chills can occur. Drinking will increase your heart rate and cause vasodilation by triggering inflammatory mediators. Histamine itself is a vasodilator. When the blood vessels in the skin are dilated, flushing and sweating occur.

Chills follow a low body temperature and it is a way of acquiring warmth. The reason there is a fluctuation in the body temperature log is due to the slump in liver function. Remember you took too much alcohol which has to be metabolized in the liver among performing 500 other functions for the body. The liver is close to shutting down and important functions such as generating warmth are not efficiently done.

 Signs of a Hangover in Summary

  1. Anxiety/Depression
  2. Diarrhea
  3. Bloodshot eyes
  4. Dizziness
  5. Halitosis (bad breath)
  6. Flatulence
  7. Stomachache
  8. Irritability
  9. Moodiness
  10. Lethargy, tiredness, fatigue, listlessness
  11. Body and muscle aches
  12. Nausea
  13. Depression
  14. Sensitivity to light (Photophobia)
  15. Problems focusing or concentrating
  16. Sensitivity to loud sounds
  17. Trembling or shakiness, erratic motor functions
  18. Accelerated heartbeat
  19. Thirst
  20. etc

Severe Symptoms of Hangovers-Adverse & Dangerous Symptoms

What signs and symptoms of a hangover are said to be dangerous?

Some severe signs have already been mentioned above. Following is a list of more adverse and dangerous symptoms and effects

  1. Irregular breathing rhythm
  2. Breathing slows down to less than eight inhalations per minute
  3. Change of skin to pale
  4. Confusion or stupor
  5. Drop in body temperature
  6. Fits (seizures)
  7. The patient passes out (loses consciousness)
  8. Vomiting continues and does not abate.

Can you die from a bad hangover?

Can a hangover really kill you? Without much thought the answer is yes! However, is not direct as such. Here is the explanation.

You already know that alcohol in itself is a depressant and of course it can be lethal. What makes it deadly is the dehydration, poisoning and/or severe CNS (central nervous system) depression of excessive drinking.

As some folks will put it, a hangover can cause death but it might be a contributing factor more than the actual cause of death. But the point is, it is dangerous and can definitely cause death. So it isn’t just another liquid or drink to play around with. If you must have it, take it responsibly. You are informed enough to make the right decision.

Recommended Further Reading

  1. What is a hangover? Meaning, Causes, without drinking & Help
  2. How long do Hangovers last? 2-3 & 4 Day Hangover Symptoms & Causes
  3. How to get over a Hangover-Remedies to get Rid, Cure, Fix, Prevent Hangovers fast
  4. Blowfish, Alka Seltzer, Berocca & Pepto Bismol Reviews, Ingredients & Side Effects-Best Hangover Medicine & Pills
  5. Best Food for Hangover, Drinks and other good foods for hangover recovery & Relief
  6. Hangover Headache-Cure & Relief

Sources and References

[i] Mucosal bacterial growth in the upper gastrointestinal tract in alcoholics (heavy drinkers). Hauge T, Persson J, Danielsson D

[ii] Consumer Product Safety Commission. Requirements for child-resistant packaging; products containing loperamide. Fed Regist 1993; 58: 38961

[iii] DRASKI, L.J., AND DEITRICH, R.A. Initial effects of ethanol on the nervous system. In: Deitrich, R.A., and Erwin, V.G., eds. Pharmacological Effects of Ethanol on the Nervous System. Boca Raton, FL: CRC Press, 1995. pp. 227–250

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