The article is from WeChat public account: Nutshell (ID: Guokr42) , author: Hazel
Bladder brewing-it sounds too absurd.
But a recent case showed that a patient had a large amount of alcohol in her urine, and the “brewery” could be her bladder.
Don’t get me wrong, this is beer | Pixabay
Liar Alcoholics?
This is a 61-year-old female patient from Pennsylvania in the United States who has cirrhosis and needs to join the waiting list for a liver transplant. But things didn’t go well. The test found that the patient’s urine alcohol content was nine times higher than ordinary people. Although she claimed that she did not drink alcohol, according to the test results, the doctor believed that she not only had a problem with alcoholism, but also concealed it. The patient must abstain from drinking, otherwise he is not eligible for a liver donation.
Unfortunately, the patient had to go to another hospital for help. At the Presbyterian Hospital of the Pittsburgh Medical Center, urine test results still showed that her alcohol content was high; however, after a detailed analysis of the patient’s urine and body fluids, the doctor discovered some strange phenomena.
In general, after ingestion of alcohol, some metabolites of ethanol such as ethyl glucuronide and ethyl sulfate are detected in urine. However, although the patient’s urine was high, the two metabolites were low. At the same time, the patient’s blood alcohol level was also very low, and the patient did not show symptoms of alcoholism. This shows that the patient may not really lie, and the high alcohol content in her urine is not caused by alcoholism.
Is the patient drinking and needs further testing | Pixabay
The doctor was surprised, so he started a new experiment. They put freshly collected patient urine into several test tubes, which were placed at a low temperature of 4 ° C, normal temperature of 25 ° C, and body temperature of 37 ° C, and 1% fluorine was added to some test tubes. Sodium sulphate, a chemical agent capable of inhibiting fermentation.
Before the experiment, the doctor smelled the alcohol in a 37 ° C test tube without adding a fermentation inhibitor. After one day of incubation, there is not much alcohol produced in the urine at 4 ° C, and the alcohol in the test tube added with the fermentation inhibitor is very small; but there is no inhibitor and it is also placed in the urine at 37 ° C. Alcohol was produced at a concentration of 800 mg / 100 mL. It can be seen that the alcohol in the patient’s urine is likely to be produced by fermentation in an organ in the body, and this alcohol does not enter the blood-doctors speculate that the bladder is likely to be the “location of the incident.”
The bladder is likely to be a “brewery” | Pixabay
The so-called brewing is actually the process by which yeasts ferment carbohydrates into alcohol. But how did the yeast and carbohydrates come from the patient’s bladder? The doctor analyzed her urine in more detail and found that the culprit was Candida albicans (Candida glabrata) .
This is a relative of Saccharomyces cerevisiae. It is actually part of the normal human flora, but it should not appear in the urine. As for the carbohydrates needed for winemaking—unfortunately, the patient also had diabetes and was not well controlled, so she had a lot of sugar in her urine. These sugars provided sufficient ingredients for the yeasts to ferment, turning her bladder into a veritable “brewery.”
After solving the puzzle, the doctor recently published this case in the (Annals of Internal Medicine) .
Automatic brewing syndrome
Coincidentally, similar things have happened to other patients. However, the “brewery” of these patients is not in the bladder, but in the digestive system. This medical problem is aptly named “span class =” text-remarks “label =” Remarks “> (ABS) “.
The patient with “bladder brewing” does not have alcohol in his blood; but for patients with ABS, after the consumption of carbohydrates into alcohol, their digestive system will absorb the alcohol And let it enter the blood circulation, making people dizzy, as if drinking too much.
Some patients are still drinking, so they have received a “drink driving” ticket and have nowhere to complain. What’s more frightening is that if you don’t control the intake of carbohydrates, the blood alcohol content of patients sometimes even soars to life-threatening values, causing irreversible consequences.
The “automatic brewing” that occurs in the function of the digestive system will make people feel drunk | Pixabay
A study published last September in Cell Metabolism (Cell Metabolism) also showed that in addition to “Saccharomyces cerevisiae” A kind of bacteria in the digestive tract can cause similar symptoms. Researchers found the bacterium in patients’ feces and transferred it to mice; as a result, the mice also produced a lot of alcohol.
Because the causes of ABS are not the same, different patients have different treatment methods. Some people are suitable for antibiotic treatment, some people respond well to antifungal drugs, and some people have significantly reduced symptoms when supplemented with probiotics. However, for patients with ABS, reducing carbohydrates seems like a good idea.
ABS patients usually need to reduce carbohydrate intake | Pixabay
For the protagonist of this article, because her “brewery” is only in the bladder, alcohol does not enter the blood circulation, and it has no obvious impact on her life. Doctors tried to treat her with antifungal drugs,But did not see good results. But it doesn’t seem to matter, because after she was sure she was not drinking, she has successfully returned to the list and can wait for a liver transplant.
As the first reported case, there is no official name for this type of automatic brewing symptom that occurs in the bladder. Her doctor made two suggestions-“urinary organ brewing syndrome” and “bladder fermentation syndrome”, which one do you think is better?
References
[1] KM Kruckenberg, JA Rymer, AW Pasculle and K Tamama. Urinary Auto-brewery Syndrome: A Case Report. Ann Intern Med. 2020. DOI: 10.7326 / L19- 0661
[2] J Yuan, C Chen, et al. Fatty Liver Disease Caused by High-Alcohol-Producing Klebsiella pneumoniae. 2019, 30 (4): 675-688. < / span>
[3] K Painter, BJ Cordell and KL Sticco. Auto-brewery Syndrome (Gut Fermentation). In: StatPearls [Internet]. https: //www.ncbi.nlm .nih.gov / books / NBK513346 /
The article is from WeChat public account: husk (ID: Guokr42) , Author: Hazel