
Auto-brewery syndrome: probably an under-diagnosed medical condition - arkades
https://bmjopengastro.bmj.com/content/6/1/e000325
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dmckeon
This situation has been used as a DWI/DUI defense since the early 1990s -
search for “candidiasis” in
[https://spaf.cerias.purdue.edu/Yucks/V1/msg00034.html](https://spaf.cerias.purdue.edu/Yucks/V1/msg00034.html)
. It is good to see both a differential test procedure, and a treatment
regime.

~~~
userbinator
_the prosecutor told the judge it didn 't matter where vargas got the alcohol.
the judge agreed and found him guilty.)_

Indeed, I believe the laws only say something about "under the influence of
alcohol" and specific BAC, with nothing about where the alcohol came from.

~~~
arkades
Different laws are written, variously, from the perspective of intention (mens
rea), and others are known as "strict liability."

Strict liability laws ask only whether the law was broken, and make no
reference to the intent to break the law. A classic example here is statutory
rape: being lied to about a partner's age is no defense, because the law asks
only for the facts of the situation, not the intentions.

~~~
eloff
Is there a case where strict liability laws are a better option? It seems like
a bad thing to me that leads to less just outcomes.

Case in point, whistleblowers are tried under the espionage act using strict
liability. It doesn't matter why they did it, if it was harmful or beneficial,
only that they did it or not.

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WheelsAtLarge
I've heard of this syndrome a number of times. I've also heard that anyone
that has fatty liver disease without being an alcoholic should at least look
into the possibility that the gut is producing alcohol on its own.

I wonder if a fecal transplant would be a cure for Auto brewery syndrome?

~~~
arkades
The most common cause of non-alcoholic fatty liver disease is
obesity/metabolic syndrome. If someone with a BMI > 30 came in asking for a
workup for auto-brewery syndrome that would be an unreasonable work-up and a
waste of limited healthcare system resources as well as the patient's, unless
they provided additional signs and symptoms that were suggestive of alcohol
intake.

In the absence of obesity/metabolic syndrome, I'd be pursuing a work-up of
cholestatic injury, A1AT deficiency, and viral and autoimmune hepatitis before
I start looking for auto-brewery syndrome, in the presence of isolated fatty-
liver disease.

I doubt fecal transplant would be curative; fungi are tenacious. It might be a
more effective repopulation method than the probiotics used by the folks in
the article, though. Probiotics are kind of crap, no pun intended.

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waste_monk
Imagine getting an implanted ethanol fuel cell, inducing ABS in yourself, and
having a permanent source of power to charge your phone (ideally wirelessly
through a subdermal Qi charger, as the alternative would be both unpleasant
and unhygienic). Presumably if the fuel cell was consuming ethanol fast enough
your body wouldn't take any damage from the ABS either.

------
arkades
“ Any patient denying alcohol ingestion but who have elevated blood alcohol
levels or positive breathalyzer results should be investigated for ABS,” they
concluded.

How you know an academic has never worked the ER.

~~~
npo9
I think it really depends on the cost of an ABS test, how common ABS is, how
common patients lie about alcohol consumption, and the cost savings for
dealing with ABS sooner rather than later.

If you are going to hold someone in the ER until their BAC is 0 it seems
fairly cheap to give them sugar water and see if their BAC increases.

~~~
snagglegaggle
They can hold you for that? Why?

~~~
arkades
They can't "hold you" in the sense of denying you the ability to leave against
medical advice. "Harm to self or others" is a whole different category of hold
and no one is doing it for a random drunk in the ER.

However, if you're waiting for an actual discharge from the ER, it's common to
hold onto the patient until their BAC is under the legal limit, do another
quick neuro exam, and then start discharge procedures.

The idea here is "the patient is almost certainly just drunk, but it's not
impossible they have an underlying problem such as hepatic encephalopathy. So
I'm going to wait for them to sober up enough that I can tell the difference
between 'drunk' and 'underlying altered mental status' before I start
discharge. The time it will take the discharge to go through will be enough to
get their BAC to 0, and I will therefore not be liable if they walk out of the
ER and fall and crack their head."

~~~
snagglegaggle
> However, if you're waiting for an actual discharge from the ER

To me this implies they _can_ hold you, as I can't just walk out whenever I
want? Why? I feel no compulsion to be held so that they can minimize their
liability.

~~~
xbmcuser
It's about liability you go without doctors permission and something happens
it's on you. If the doctor's says you are good to go and the something happens
the the doctor and hospital will face the liability.

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aszantu
Ppl call me crazy when i tell them that I can't eat carbs and sugar because i
get really bad depression after about 4 days after ingestion

------
opan
This condition was just in an episode of The Good Doctor.

------
alexfromapex
We need to stop using antibiotics until we have a better understanding of the
microbiome.

~~~
m-p-3
We shouldn't stop because of an edge case, because they do save lives.

It's like saying we should stop chemo because of unwanted side effect, because
they don't work in some situation, or make someone worse because of an unknown
variable.

Because they can cause harm in some rare situation, doesn't mean they're not
valuable in many cases.

