Woman brews alcohol in bladder
Trouble started brewing a few years ago for a Pennsylvania woman who was denied a liver transplant due to the vast amounts of alcohol in her urine.
Doctors suspected the 61-year-old woman, who swore she didn't drink, was hiding an alcohol abuse disorder. It turns out they were right — in manner of speaking — as extensive testing would eventually reveal that microbes within the woman's bladder were fermenting sugar into alcohol. The frustrated patient was initially denied a place on a liver-transplant list and told by doctors to seek treatment for her addiction, according to LiveScience. But as doctors dug deeper, they began to suspect their patient may actually be under the influence of a previously unknown condition.
When she arrived at the University of Pittsburgh Medical Center (UPMC) Presbyterian hospital, the woman was found to have cirrhosis — or scarring of the liver — and high sugar levels from a case of uncontrolled diabetes. But while her urine tested positive for high levels of yeast and ethanol, two metabolites of alcohol — ethyl glucuronide and ethyl sulphate — were absent. At least one of the two metabolites should be present in someone who had recently consumed alcohol, said Kenichi Tamama, the medical director of UPMC's Clinical Toxicology Laboratory and senior author of the woman's case study. “This was the first clue,” he said.
When the patient's blood tests came back negative for ethanol, Tamama began to suspect that microbes in her bladder may be turning the high levels of sugar in her body into alcohol. “As I went over the medical record and learned the situation of the patient, I started feeling obliged to do something because she might have been falsely mislabelled as an alcohol abuser,” he said.
Doctors were aware of a similar condition called auto-brewery syndrome (ABS), in which microbes located in the gastrointestinal tract transform carbohydrates into alcohol. For people with ABS, simply eating carbs can be an intoxicating experience — literally. In this case, fermentation was occurring in the bladder, meaning the alcohol did not have access to the bloodstream and the woman did not feel its effects.
The newly discovered condition was so rare it was unnamed at the time, although her doctors helpfully suggested “urinary auto-brewery syndrome” or “bladder fermentation syndrome.”
The discovery allowed the woman to be reconsidered for a liver transplant and prompted doctors to stress “the importance of recognizing urinary auto-brewery syndrome when it is present.”