MiamiHerald, 3 June 2024 : For years, a Canadian mom would have an occasional glass of wine or drink around the holidays, but she maintained a mostly sober lifestyle. She eventually leaned into her religious beliefs and stopped drinking alcohol altogether. Then, she walked into an emergency room drunk. 

Beginning two years earlier, the 50-year-old woman had odd cases of sleepiness where she would get so drowsy she would fall asleep “suddenly while getting ready for work or preparing meals,” according to a June 3 case report published in the Canadian Medical Association Journal. 

She went to her primary care doctor and the emergency room multiple times while barely awake, her speech slurring and the smell of alcohol emanating from her breath, according to the case report. 

She was adamant that she was sober, and her family corroborated that no one had seen her consume any alcohol, doctors said. 

During her first visit to the emergency room, her alcohol level was a 39 when the normal level was below 2, according to the case report, but her liver enzymes remained completely normal. But by later visits, that value reached 62, more than 30 times normal levels. 

Nothing appeared abnormal on brain scans, and she was repeatedly referred to an addiction specialist and psychiatrists over seven doctors visits in two years, doctors said. 

Later, the patient told doctors about recurring urinary tract infections she had been experiencing for years. She was prescribed strong, wide-range antibiotics to stop the infection, and these seemingly drunk episodes would occur afterward, according to the case report. 

During her last emergency room visit, doctors confirmed she also had an urinary tract infection, and a diagnosis was proposed. 

Her body was brewing alcohol inside her gut. “Auto-brewery syndrome is a rare syndrome of endogenous alcohol fermentation. 

A 1948 report of a boy with a ruptured stomach whose contents smelled of alcohol was the first to describe gut fermentation,” according to the case report. 

“A 2020 systematic review identified 20 patients reported in the English medical literature since 1974.” 

The syndrome occurs when the microorganisms in the gut that are capable of fermenting carbohydrates into alcohol are able to outgrow the “good” bacteria in our gastrointestinal system, doctors said. 

When someone takes antibiotics for an infection, the drugs aren’t always able to target bad bacteria alone, and bacteria in the gut can also be affected, usually resulting in doctors recommending a probiotic or to eat yogurt while taking a round of antibiotics. 

In extreme cases, antibiotics kill so much of the good bacteria that keeps the gut balanced that the bad, fermenting-capable fungi and microorganisms flourish. 

“In our patient, we suspect her recurrent antibiotics for UTI and dexlansoprazole use (a prescription drug used to treat heartburn and reflux symptoms) led to gut dysbiosis with potential contribution of genetics, resulting in auto-brewery syndrome,” according to the case report. 

The condition can be hard to treat as the microorganisms, in this case a fungus, can live in the body naturally without any harmful effects, doctors said. 

“Auto-brewery syndrome carries substantial social, legal and medical consequences for patients and their loved ones,” doctors said. 

In previous cases, people have been accused of driving under the influence only later to find out they have auto-brewery syndrome. 

For this mother, a combination of antifungal medication, a lower carbohydrate diet and a change to her treatment for UTIs led to an end of the drunken spells, according to the case report.