University of Miami at JFK Medical Center Atlantis, FL, United States
Laura Suzanne K. Suarez, MD1, Larnelle N. Simms, MD2, Ayat Al Rubaye, MD3, Akiva J. Marcus, MD, PhD4 1University of Miami at JFK Medical Center, Atlantis, FL; 2University of Miami, Jackson Memorial Hospital, Atlantis, FL; 3University of Miami, JFK Medical Center Palm Beach, Atlantis, FL; 4University of Miami, JFK Medical Center Palm Beach, West Palm Beach, FL
Introduction: Auto-brewery syndrome (ABS), also known as Gut Fermentation Syndrome, is a rare condition wherein the ingestion of carbohydrates results in endogenous alcohol production leading to symptoms of inebriation in the absence of alcohol ingestion. Less than 100 cases are reported worldwide.
Case Description/Methods: A 26-year-old otherwise healthy woman presented with a five-month history of incoherence, confusion, dizziness, and poor recall of events. Episodes occurred late in the day and were correlated with the consumption of mashed potatoes, fries, and pasta. On one occasion, she called her husband from a restaurant saying she felt sick, later to be found by the police wandering the streets reeking of alcohol. Her husband stated that home breath analyzer readings during episodes were elevated, with a peak of 0.138%. During an emergency room visit for altered mental status, toxic, metabolic, and autoimmune workup was normal except for a serum alcohol level of 364 mg/dL. The lactulose breath test was positive for mild hydrogen dominant bacterial overgrowth. Esophagogastroduodenoscopy revealed reflux esophagitis. She was started on a low carbohydrate diet, probiotics, a 10-day course of amoxicillin-clavulanate, and pantoprazole. There was no recurrence of symptoms on her eight-week follow-up.
Discussion: Reports of spontaneous endogenous alcohol production in humans and laboratory animals are few. ABS has been associated with sudden infant death syndrome seemingly from a reaction of milk formula and overproduction of Candida spp in the stomach. In Uganda, a 5-year old boy’s death was linked to a large meal of sweet potatoes. Patients with d-lactic acidosis also exhibit altered behavior and neurologic symptoms however it does not have a strong association with food intake. ABS should be considered in patients presenting with an elevated blood alcohol level who deny alcohol ingestion. A good social history and dietary review are critical. Implicated causes of sugar fermentation to alcohol include gut dysbiosis secondary to yeast (e.g., Candida spp.), fungal (e.g., Saccharomyces), and bacterial overgrowth, short bowel syndrome, chronic obstruction, and hypomotility. Suggested diagnostic modalities include serum lactic acid and alcohol levels during events, breath analyzer tests, carbohydrate challenge tests, and microbial cultures and sensitivities of gut aspirate. Short courses of antimicrobials, probiotics, and low carbohydrate diet modification may result in improvement of symptoms.
Disclosures: Laura Suzanne Suarez indicated no relevant financial relationships. Larnelle Simms indicated no relevant financial relationships. Ayat Al Rubaye indicated no relevant financial relationships. Akiva Marcus indicated no relevant financial relationships.
Laura Suzanne K. Suarez, MD1, Larnelle N. Simms, MD2, Ayat Al Rubaye, MD3, Akiva J. Marcus, MD, PhD4. P1450 - Auto-brewery Syndrome: Drunk on Carbohydrates, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.