Intoxication without alcohol: Auto-brewery syndrome

How can someone have alcohol intoxication without consuming alcohol? Auto-brewery syndrome, a rare condition in which gut fungi create alcohol through fermentation, is described in a case study in the Canadian Medical Association Journal.

“Auto-brewery syndrome carries substantial social, legal, and medical consequences for patients and their loved ones,” writes Dr. Rahel Zewude, University of Toronto, with co-authors.

“Our patient had several [emergency department] visits, was assessed by internists and psychiatrists, and was certified under the Mental Health Act before receiving a diagnosis of auto-brewery syndrome, reinforcing how awareness of this syndrome is essential for clinical diagnosis and management.”

Emergency department (ED), gastroenterology, and infectious disease specialists discuss the case of a 50-year-old woman who had visited the ED at least seven times for extreme daytime sleepiness and slurred speech and, despite not drinking alcohol, had elevated blood alcohol levels and alcohol on her breath.

She had been on several antibiotic courses for recurrent urinary tract infections alongside a proton pump inhibitor.

At the seventh visit, she was given a possible diagnosis of auto-brewery syndrome, antifungal medication, and referral to a gastroenterologist.

Antifungal medication and low-carbohydrate diets are the main treatment for the condition.