The Auto-Brewery Syndrome: A Perfect Metabolic “Storm” with Clinical and Forensic Implications

Abstract

Auto-brewery syndrome (ABS) is a rare, unstudied, unknown, and underreported phenomenon in modern medicine. Patients with this syndrome become inebriated and may suffer the medical and social implications of alcoholism, including arrest for inebriated driving. The pathophysiology of ABS is reportedly due to a fungal type dysbiosis of the gut that ferments some carbohydrates into ethanol and may mimic a food allergy or intolerance. This syndrome should be considered in patients with chronic obstruction or hypomotility presenting with elevated breath and blood alcohol concentrations, especially after a high carbohydrate intake. A glucose challenge test should be performed as the confirmatory test. Treatment typically includes antifungal drugs combined with changes in lifestyle and nutrition. Additional studies are particularly needed on the human microbiome to shed light on how imbalances of commensal bacteria in the gut allow yeast to colonize on a pathological level.

Modeling Postmortem Ethanol Production/Insights into the Origin of Higher Alcohols

“…The detection of either higher alcohol in postmortem specimens could be due to either source alone, or due to a combination of both (as it is the case for ethanol). The postmortem higher alcohol detection due to ante mortem endogenous higher alcohol production, by microbial fermentation in the intestine (during the “auto-brewery” syndrome where ethanol is produced endogenously [ 4 ]), to our knowledge, is not reported in the literature; however, we are of opinion that, theoretically, it is possible to occur.…”

“…The possible sources of ethanol detected in postmortem specimens could be either antemortem ingestion by a living person who consumed alcoholic beverages, or antemortem endogenous production due to microbial fermentation in the intestine (“auto brewery” syndrome [ 4 ]), or postmortem microbial neoformation, either in corpse pre-sampling or in situ post-sampling [ 2 , 3 ]. However, the microbial-induced postmortem ethanol formation, as well as the source and integrity of the selected samples, is the major determinant that could complicate the interpretation of results [ 2 ].…”

Auto brewery syndrome

“…~ 83 ~  Fungal fermentation: Saccharomyces cerevisiae are commercially known as brewer's yeast has been used in the production of beer for centuries [7] . Diagnosis [3] There are no specific test to diagnosis a condition called auto brewery syndrome. The condition has been newly discovered but further research is needed to diagnose this condition.…”

“…Fecal samples are also taken to check for abnormal level of bacteria and fungi. Some additional test may help to determine gastrointestinal disorders [3] .…”

“…There are few cases of auto brewey syndrome which have been reported in years but the condition has been mentioned in the news for several times. This syndrome records abnormally high blood alcohol levels when they are not consuming alcohol [3] .…”