# Death by losing constitution

This question regards the pathfinder setting:

I'm having a bit of confusion as to how a death by constitution drain would take place, specifically with these rulings taken from the Pathfinder SRD:

Each roll of a Hit Die (though a penalty can never drop a result below 1—that is, a character always gains at least 1 hit point each time he advances in level). This rule suggests to me that a character will always have at least 1hp per HD, regardless of penalties, such as constitution drain. However, when looking under how much hp is lost after constitution drain, you find this:

Damage to your Constitution score causes you to take penalties on your Fortitude saving throws. In addition, multiply your total Hit Dice by the Ability Damage penalty and subtract that amount from your current and total hit points. Lost hit points are restored when the damage to your Constitution is healed.

So now, if we take a 5th level character (5 HD) with 16 Constitution and 35hp who took 7 points of constitution damage. Following the rules of how much hp is lost: 5 x 7 = 35 (HD x Ability Points Lost). Does this mean this fifth level character would die when hitting a constitution of 9? Or does this mean for every constitution point under 9, he only has a maximum of 1hp, as per the ruling stating a player always gains at least 1hp per HD gained?

• You can die from simply having 0 Con. You might want to clarify whether that is relevant to your question. – starwed Aug 21 '12 at 23:15
• The rule about 1hp per HD minimum is only relevant to gaining a level. It means that no matter your CON penalty and how low you roll for new hp, you gain at least 1hp when you gain a level. – SevenSidedDie Aug 22 '12 at 0:39

In addition, multiply your total Hit Dice by the Ability Damage penalty and subtract that amount from your current and total hit points."

For every 2 points of damage you take to a single ability, apply a –1 penalty to skills and statistics listed with the relevant ability.

Hp lost: 5 x -3 = -15. After another 7 ( 14 total ) the HP lost would be 5 x -7 = -35. With a Con of 2, and 0hp, he is conscious ( barely ), but not dead, because of: "When a creature's hit points drop below 0, it becomes unconscious. When a creature's hit points reach a negative total equal to its Constitution score, it dies."d20pfsrd

A further 1 point of damage will not do anything. An additional 1 point of damage after that will kill the character: "A character with a Constitution score of 0 is dead."d20pfsrd

• So 'Ability Damage Penalty' is not refering to the amount of ability damage you took in total? Only the modifier that is the result of the Ability Damage? – RuleofThree Aug 22 '12 at 1:58
• Correct. So you'd have to go to a very low CON - unless of course you've taken hit point damage from other sources. CON damage/drain is very easy to die of. – mxyzplk Aug 22 '12 at 2:19
• Also you die when you reach a number of negative HP equal to your Con score. So if you are at -8 HP and you have Con 8, you are dead. So you die really quick with a Con drain – user4000 Aug 22 '12 at 13:24
• @MrJinPengyou - Good point! I didn't even think of that as I wrote the answer. – Phill.Zitt Aug 22 '12 at 16:29

You need to consider several things.

1. The rules for attribute drains presume temporary loss to attributes. This goes back to the d20 SRD, and is inherited by Pathfinder. In Pathfinder, according to the Beta, it's restored at 1 point per day of bedrest.

2. the penalty for attribute drains is not the same as the penalty for a low attribute, even tho' it is related conceptually and is parallel in magnitude. For a character with an even attribute, this actually is less severe by one point than for a refiguring of attribute modifier and its application; its the same for characters whose base value is odd.

3. The reduction in Max and Current HP can be seen as a systemic shock, rather than direct damage, but it automatically is restored as the con damage is healed.

4. If dead, you stop healing. But death is not until HP = -10 or -(Con), whichever is further from zero.

5. 1st level HP are maxed, and the worst is a d6.

So...

Remembering that Con drain is temporary, healed by bedrest...

The worst case is a Con 11 wizard (+0 HP/HD from Con), and has minimum HP every level, who takes 10 point loss to Con (-5 HP/HD from drain).
At level 1, HP=6 he's merely reduced to 1 Max HP.
At level 2, with minimum 11 HP, he's merely reduced to 2 Max HP.
At level 3, with minimum 12 HP he's merely reduced to -3 Max HP. Coma - see below. Enters coma when Con drain is 8 points.
At level 4, with the minimum 13 HP, he's reduced to -8 Max HP. Coma - See Below. Enters coma when Con drain is 6 points. But note - he could have raised con, and have Con 12, and been minimum 17 HP, and thus not be subject to coma until Con drain hits 8 points.
At level 5, with the minimum 14 HP, he's reduced to -11 Max HP. Dead. Enters coma when Con drain is 6 points, for max HP=-1.
At level 6, with the minimum 15 HP, he's reduced to -15 Max HP. Dead. Enters coma when Con drain is 6 points, for max HP=-3.
At level 7, with the minimum 16 HP, he's reduced to -19 Max HP. Dead. Enters coma when Con drain is 6 points, for max HP=-2.
At level 8, with the minimum 17 HP, he's reduced to -23 Max HP. Dead. Enters coma when Con drain is 6 points, for max HP=-5.
At level 9, with the minimum 18 HP, he's reduced to -27 Max HP. Dead. Enters coma when Con drain is 4 points, for max HP=0.

Coma - the rules don't call it this, and it's an interesting effect that occurs. If your con is drained, and your Max HP drop below 0, you aren't dead if someone stablizes you before the death point is reached. Sure, you can't heal until the con comes back. You're unconscious, immobile, and will need special care. But if tended, you WILL get better, when your con returns.

Note that some things that can keep you from entering a coma state - Temporary hit points being the most obvious - and temporary boosts to Con. Or any ability that allows you to act while HP is below 0.

• Drain is permanent (until cured by magic), damage temporary: d20pfsrd.com/basics-ability-scores/… – Tommi Aug 28 '12 at 6:18
• They changed the terminology - drains in d20 and in the beta are damage to attribute under the PFsrd terminology. – aramis Aug 28 '12 at 22:16
• Drain in D20 and PF is permanent, damage temporary: d20srd.org/srd/specialAbilities.htm#abilityScoreLoss . I don't know about PF beta. I don't see any mention of it in the question. – Tommi Aug 29 '12 at 5:28
• Drain isn't temporary. I hesitate to call it "permanent," because I've had people think that this means it's completely incurable, which isn't the case. It just doesn't heal naturally: you need some kind of special effect (usually magic) to cure it. – The Spooniest May 2 '14 at 2:39