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AUTO BREWERY SYNDROME MAKES ALCOHOL INSIDE THE GUT
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OKAY BACK FROM THE BREWERY 🍺
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A MAN WHO FELT DRUNK WITHOUT DRINKING 🥴
A Case Report Describes A 25 Year Old Man
He Had No Medical History And No Previous Surgeries
His Chief Complaint Was Being Drunk Without Drinking
Two Months Earlier He Felt Very Drunk After His Usual Evening Beers
That Usually Meant One Or Two Beers Of 12 Ounces
Later He Felt Drunk Even When Fully Abstaining From Alcohol
He Felt This Way One To Two Times Per Week
His Wife Brought Him To The Emergency Department During An Episode
She Described Slurred Speech And Fatigue And Stumbling
Dizziness And Nausea Were Part Of Her Description
He Would Eventually Pass Out And Wake Up Without Symptoms
His Urine Drug Test And Liver Function Results Were Unremarkable
A Gastroenterologist And An Endocrinologist Also Saw Him
The Celiac And Thyroid Workups Were Unrevealing
His Wife Decided To Buy A Breathalyzer
The Report Says He Was Asymptomatic And Not Drinking Then
He Scored From 0.04 To 0.07 Percent On Her Device
She Served As A Control During Those Tests
Her Own Result Was 0 Percent On Those Occasions
When He Had Symptoms He Often Tested Around 0.2 Percent
Doctors Concluded Other Causes Were Ruled Out
They Made A Working Diagnosis Of Auto Brewery Syndrome
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WHAT AUTO BREWERY SYNDROME IS 🦠
Auto Brewery Syndrome Goes By Several Names In Medical Papers
A Systematic Review Suggests The Name Gut Fermentation Syndrome
Another Name Is Endogenous Alcohol Fermentation Syndrome
Endogenous Means Made Inside The Body
Systematic Reviewers Describe It As Rare And Underdiagnosed
In Auto Brewery Syndrome Consumed Carbohydrates Become Alcohol
Carbohydrates Include Sugars And Starches
Inside The Gut Fungi Or Bacteria Or Both Make Alcohol From Them
Reviewers Also List The Urinary Tract As A Possible Site
Glucose Can Ferment To Ethanol In Both Fungi And Bacteria
Ethanol Is The Alcohol In Beer And Wine
The Breathalyzer Case Report Blames Yeast Overgrowth In The Gut
It Notes Candida Yeasts And Other Fungi Are Part Of A Normal Gut
Bacteria Are Also Possible Causes According To The Review
Klebsiella And Escherichia Bacteria Are Linked To Gut Alcohol
In Short Bowel Syndrome Stagnant Food May Help Fungi And Bacteria Grow
Auto Brewery Symptoms Resemble Intoxication Without Any Drinking
Published Case Reports Supply The Review With Its Evidence
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HOW RARE AND HOW UNCERTAIN 📚
Systematic Reviewers Searched PubMed And Embase
The Search Ran Through September 2020
That Search Identified 821 Studies
Seventeen Case Reports Met The Inclusion Criteria
Together They Involved 20 Patients
That Is A Count Of Published Cases
It Is Not A Measure Of How Common The Syndrome Is
The Reviewers Also Noted Whether Patients Were Supervised
They Call Undisclosed Drinking An Important Concern In Diagnosis
Patients Were Under Strict Supervision In Eight Case Reports
For Nine Others It Was Not Clear Whether They Were Monitored
The Review Says Hidden Drinking May Still Have Occurred In Those
The Breathalyzer Case Report Raises A Similar Doubt
Its Authors Cannot Fully Rule Out Malingering Or Occult Drinking
Malingering Means Feigning Symptoms
Occult Drinking Means Drinking That Is Hidden
Those Authors Add That Breathalyzers Have Been Shown To Be Reliable
They Call Information On Auto Brewery Syndrome Limited
