Glucose is not always the answer: a case of Auto-Brewery Syndrome

Abstract

Background. Auto-Brewery Syndrome (ABS) is a rare metabolic disorder characterized by the endogenous production of ethanol through the fermentation of ingested carbohydrates in the gastrointestinal tract, causing intoxication-like symptoms. It is often linked to highcarb diets, antibiotics, liver issues and stress. Objective(s). ABS is clinically important because it can mimic alcohol use disorder and trigger lactic acidosis. Early, accurate diagnosis is critical to avoid misdiagnosis and ensure timely intervention. Materials and methods. On May 6, emergency services were called for a 55-year-old man for sudden somnolence and nausea. Upon the ambulance’s arrival, the patient was alert, tachycardic (100bpm), normotensive, and glucose 88 mg/dL. Despite appearing intoxicated, he denied alcohol use. The patient was known with NASH and recurrent episodes of nonhypoxic lactic acidosis. Results. The immediate treatment included fluids (isotonic saline), vitamins, particularly thiamine (B1) to prevent Wernicke’s encephalopathy, pyridoxine (B6), gastroprotection (pantoprazole), and antiemetics (metoclopramide). In-hospital care added 2500 mL saline, more B1, Aspatofort and Hepa-Mers, reducing the blood alcohol concentration. Administering glucose can exacerbate endogenous alcohol production by feeding fermenting microbes and worsen intoxication and metabolic disturbances. Definitive treatment targets the underlying gut overgrowth with antifungals, probiotics and sustained low-carbohydrate, high-protein diets. Conclusion(s). This case highlights the importance of early recognition of ABS in patients with alcohol-intoxication-like signs who deny drinking. Misdiagnosis may lead to harmful glucose use, worsening fermentation, and metabolic issues. Prompt detection guides proper care and prevents harm.