SHM Converge Scientific Abstract ePoster Gallery-When Your Gut Gets You Drunk: Auto-Brewery Syndrome

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This case report describes auto-brewery syndrome (ABS), a rare condition in which ethanol is produced endogenously by gut microorganisms, leading to intoxication without alcohol intake. First reported in 1952, fewer than 100 cases have been documented.<br /><br />The patient was a 47-year-old man with traumatic brain injury, seizure disorder, GERD with Barrett’s esophagus, and diabetes insipidus. He presented repeatedly over two years with slurred speech and unsteady gait. His workup for neurologic and cardiac causes was unrevealing, but blood alcohol levels during episodes were mildly elevated (5–10 mg/dL) despite no alcohol use or access. Because of suspicion for ABS, he underwent a glucose challenge test using 200 g of glucose, followed by serial blood alcohol measurements. His ethanol level rose from undetectable to 11 mg/dL, confirming the diagnosis.<br /><br />He was treated with fluconazole 200 mg daily for 14 days and placed on a low-carbohydrate diet. At six-month follow-up, he had no recurrence of symptoms, and his diet was later liberalized with use of post-meal breathalyzer monitoring.<br /><br />The discussion notes that ABS is thought to result from altered gut microbiota, especially fungal overgrowth and, more recently, bacterial colonization, which ferment carbohydrates into ethanol. Reported symptoms range from mild slurred speech to severe intoxication, seizures, withdrawal symptoms, and pancreatitis. Diagnosis requires careful history, exclusion of hidden alcohol use, and confirmation with a carbohydrate challenge test. Additional supportive tests include stool or endoscopic cultures and paired blood/breath alcohol testing. Management typically involves antifungal therapy, sometimes antibiotics, and dietary carbohydrate restriction. Probiotics and fecal microbiota transplantation have shown promise but need further study.

Asset Subtitle

Amitasha Sinha

Meta Tag

Author List Amitasha Sinha

Category Clinical Vignettes

Concept Auto-brewery Syndrome

Concept Endogenous Ethanol Production

Concept Carbohydrate Challenge Test

Concept Alcohol

Concept Intoxication-like Episode

Distinguished Non-Finalist

Presenter Organization Beth Israel Deaconess Medical Center

Presenting Author Amitasha Sinha

Track Adult

Keywords

auto-brewery syndrome

endogenous ethanol production

gut microbiota

glucose challenge test

blood alcohol levels

fluconazole treatment

low-carbohydrate diet

fungal overgrowth

slurred speech

carbohydrate fermentation

Auto-brewery Syndrome

Endogenous Ethanol Production

Carbohydrate Challenge Test

Alcohol

Intoxication-like Episode