Makamae Auli'i Ah Mook Sang arrived at Straub Clinic & Hospital on July 30 with a blood alcohol level of .433 — the equivalent of drinking a pint of vodka in just an hour — and became the first person to die of alcohol poisoning this year and the eighth in the past three years.

She was just 15 years old.

Although relatively rare in Hawai'i, deaths from alcohol poisoning are on the rise and Carol McNamee worries that other young people won't learn from Makamae's death.

With a blood alcohol level more than five times the .08 driving limit in Hawai'i, Makamae "had an extraordinary amount to drink," said McNamee, who founded the Hawai'i chapter of Mothers Against Drunk Driving, which works to prevent underage drinking.

"I don't think getting to the point of death is a common occurrence here," McNamee said. "But many, many young people are drinking way too much and getting, very, very sick. Teenagers are just not educated about the dangers of drinking so much."

It can take as little as two drinks to start feeling impaired and Dr. William Haning, a psychiatrist and professor at the University of Hawai'i's John A. Burns School of Medicine who specializes in addiction, believes more drinkers may be in trouble than they realize.

"More often," Haning said, "people get very close to death without actually knowing it."

Services were scheduled for last night and today for Makamae, with burial at 1 p.m. today at Valley of the Temples Memorial Park.

She "was a beautiful girl," said Audrey Wolz, who had been her counselor at Roosevelt High School last year. "She always lit up the room when she walked in with her smile."

Makamae earned good grades, was popular with the other kids, paddled and danced hula in a Merrie Monarch-winning halau.

"She could be a little sassy but she didn't get in trouble," Wolz said. "She definitely had spirit."

DRINKING TO DEATH

Police say Makamae and at least four underage friends had been drinking on July 30 at the Hawai'i Kai home of Michael Clark, 24. He was charged Thursday night with five counts of promoting intoxicating liquor to a person under 21, a misdemeanor.

He posted $10,000 bail and is scheduled to make his initial appearance in Honolulu District Court at 8:30 a.m. Sept. 18.

Investigators aren't certain how much or what kind of alcohol Makamae drank at Clark's home, said Honolulu police Sgt. Kim Buffett.

But, Buffett said, "we believe he was serving the drinks to her" and four of her friends.

Makamae, of Papakolea, was found unresponsive at Clark's home and was taken to Straub, where she died.

The Honolulu Medical Examiner's office lists Makamae's cause of death as "acute alcohol intoxication" and it appears to be the first death of its kind so far in 2009, state Health Department officials said.

Between 1991 and 2008, Hawai'i saw 22 deaths that were considered "unintentional alcohol poisonings," according to Dan Galanis, epidemiologist with the Health Department's Injury Prevention and Control Program. A total of 39 other people died of drug poisonings in which alcohol was a contributing factor, Galanis said.

Because of the way deaths are reported, "it is likely that alcohol was involved in a lot more of the drug poisonings," Galanis said.

During the same period, 88 patients were treated every year on average for nonfatal injuries that included the "toxic effect of alcohol," Galanis said.

Most troubling is the increase in deaths connected to alcohol poisoning in 2007 and 2008.

In addition to the two people who died of alcohol poisoning in 2007 and five more in 2008, two others in 2007 and four more in 2008 also died of drug poisoning in which alcohol was involved, Galanis said.

With a blood alcohol level of .433 grams per deciliter, the odds were against Makamae, Haning said.

Whether they're 15 years old or 50, half of all people who consume enough alcohol to reach a level between .4 and .5 will die, Haning said.

"The alcohol will reach back, squeeze down hard on your respiratory center activity until you essentially stop breathing," Haning said. "Or it may cause you to suppress an adequate gag reflex. If you're comatose and you throw up, you'll end up aspirating it and getting it in your airways."

People process alcohol according to physical size or body mass — and gender.

But after two beers, two glasses of wine or two shots of hard alcohol, a typical person will reach a blood alcohol level of .03 to .04 and be feeling the effects, Haning said.

By the time they get to .08, they are legally too drunk to drive in Hawai'i and most other states.

"Older people may have developed a tolerance and the adaptive skills of being drunk," Haning said. "They may be acquainted with the business of being drunk. But, unfortunately, it still leads people to doing stupid things like driving."

The difference for young drinkers is that they're unaccustomed to the effects, Haning said, and "may panic faster or underestimate the impact of the alcohol."

The amount of alcohol needed to get to .1 may vary.

"But even though they had to drink substantially different amounts to get to the same level," Haning said, "a 100-pound female at .1 is as stupid and intoxicated as a 300-pound linebacker who is also at .1."

At .2, a drinker will feel the effects of a low-level coma.

"Most people won't be able to hold their beer glass anymore," Haning said. "They may be having a great time and may not remember the night before — that 'lampshade on the head' effect."

By the time a drinker reaches a blood alcohol level of .3, "she would be pre-comatose. You're very close to stopping breathing."

SOMBER MESSAGE

Makamae would have been a junior at Roosevelt when the school year began on Aug. 3.

Instead, it was Makamae's parents, Jason and Tracy, and other family members who showed up when the entire student body of 1,400 gathered in two separate assemblies on Aug. 14.

The students cheered as class leaders were introduced and listened as school rules were reinforced. But at the end of each assembly, Makamae's parents spoke for about five minutes and implored students to learn from their daughter's death, said Wolz, her former counselor.

Tracy "talked about how hard it was for her to lose her daughter — and if it could happen to her daughter, it could happen to anyone," Wolz said. "She talked about having respect for themselves and not taking for granted what they have; that there are so many people who care about them and want them to do well.

"It was a very powerful message," Wolz said.

Some of Makamae's friends wore T-shirts that carried Makamae's picture in her memory. They also put up two large banners around the campus so Makamae's friends could write down their thoughts of how much she meant to them.

And when each of the banners was presented to Makamae's family at the end of the two assemblies, students, faculty and family cried.

But Wolz worries that the moment — and its message — will be forgotten.

"A lot of kids think, 'It might have happened to Makamae but it'll never happen to me,' " Wolz said. "They think they're bullet-proof. We need to keep sending the message home that they're not."