An enigmatic patient: Brewery in the stomach
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| An enigmatic patient: Brewery in the stomach |
What happens at the Oktoberfest in Munich is a lot of beer with the party guests, it happens to a US-American without any action: he is regularly drunk and claims to be stiff and firm, not to touch a drop of alcohol. His doctors do not want to believe him - a mistake.
When the 61-year-old patient lands in the office of Justin McCarthy, he has been suffering from unexplained symptoms for five years. In 2004, doctors had him operated on for a broken foot, then he got antibiotics. Then the weird symptoms started: he was drunk whenever he drank two beers.
Now you can discuss the effect of two beers. At the Munich Oktoberfest that would be well poured two liters. But the man insists that he is occasionally drunk even if he does not drink any alcohol at all. The Texan's wife is a nurse and begins to document the failures. In order to prove her subjective impression of when her husband is drunk, she creates a device for analyzing the breath alcohol content, which also uses the US police for their controls.More than three parts of alcohol in the blood
According to the machine, the patient often reaches values between 3.3 and 4 per mil alcohol in the blood. The patient and his wife have no explanation for the impressive alcohol levels. Occasionally, the man has previously eaten some alcoholic food, such as a liqueur-filled praline. However, this does not explain the values far beyond the fitness limit. From the records, however, it appears that the man was more likely to be drunk, and even if he had previously skipped a meal, exercised, or drank alcohol the night before, report Barbara Cordell from Panola College, Carthage, Texas, and the resident gastroenterologist McCarthy in the International Journal of Clinical Medicine .
The episodes of drunkenness get worse over the years. In November 2009, the man is finally admitted to the emergency room of a hospital. On this day he did not drink alcohol, the measured blood alcohol concentration is 3.7 per thousand. The doctors keep him in the hospital for 24 hours and treat him for his obvious severe alcohol intoxication. They give the protestations that he has drunk nothing, no faith and assume that he secretly drinks like many alcoholics.
Search in the gut
The following January, McCarthy finally examines the man's entire gastrointestinal tract. Apart from his specific alcohol problem, the patient has high blood pressure and high blood lipid levels. He can not remember any complaints with his stomach or intestines. Nevertheless, McCarthy suggests that the intestines may have something to do with alcohol problems if the man does not drink secretly.
Testing for problems in processing various sugars does not help. Using endoscopes - long instruments with cameras at the end - McCarthy examines the man's entire intestine. In fact, it helps to uncover samples in which it will find its way in later analysis. In the stomach of the man sits the bacterium Helicobacter pylori, which may be responsible for stomach ulcers. More exciting, however, is the finding of Saccharomyces cerevisiae in the patient's stool.
Brewer's yeast in the chair
This yeast is, as the Latin name suggests, used both for baking and for the fermentation process during beer brewing. But can the fungus in the patient's intestine be to blame for his alcohol problem?
In April 2010, the man is monitored for 24 hours in the hospital. At admission, doctors check his belongings for alcohol, and he is not allowed to receive visitors during his stay. He gets all day dextrose and sugar-rich foods because sugar would be exactly what the yeast would need to produce alcohol. At the beginning of the experiment and every two hours, the doctors determine the blood alcohol concentration, and every four hours the blood sugar level. Texan officials also check the breath alcohol content of the man. In the afternoon the blood alcohol content increases to 120 milligrams of alcohol per deciliter (mg / dL), the breath analyzer indicates 1.2 per mill.
The man brews himself
Now the treatment team is safe: You have a patient with the "Auto-Brewery Syndrome" or "Good Fermentation Syndrome" in front of him. For what sounds like a bad joke, you can actually find several dozen case reports in the medical literature. In the body of the person concerned, the excessively spreading yeast is supposed to ferment sugar from the diet into ethanol. Japanese authors reported such cases back in the early 1970s. In one case, a 13-year-old girl was affected, in another, a three-year-old girl, both suffering from malformations of the intestine.
The Texan patient is treated by his doctors with the fungicide fluconazole, followed by another antifungal, nystatin. In order to restore the intestinal flora, he gets then bacterial cultures. During the therapy, he must avoid sugar and must not drink alcohol.0.00 per thousand
Its breath alcohol content is checked daily: the device continuously displays 0.00 per thousand for ten weeks. In the subsequent chair control, the doctors no longer find yeast. Finally, the doctors still treat the gastric pylori in the stomach.
The unusual case of illness is not as good as an excuse for the drunk. After more than six years of suffering, the Texan patient could credibly prove that he was actually not dependent on alcohol. However, the case illustrates that doctors and nurses should also listen closely to patients with supposedly clear diagnoses.
When the 61-year-old patient lands in the office of Justin McCarthy, he has been suffering from unexplained symptoms for five years. In 2004, doctors had him operated on for a broken foot, then he got antibiotics. Then the weird symptoms started: he was drunk whenever he drank two beers.
Now you can discuss the effect of two beers. At the Munich Oktoberfest that would be well poured two liters. But the man insists that he is occasionally drunk even if he does not drink any alcohol at all. The Texan's wife is a nurse and begins to document the failures. In order to prove her subjective impression of when her husband is drunk, she creates a device for analyzing the breath alcohol content, which also uses the US police for their controls.More than three parts of alcohol in the blood
According to the machine, the patient often reaches values between 3.3 and 4 per mil alcohol in the blood. The patient and his wife have no explanation for the impressive alcohol levels. Occasionally, the man has previously eaten some alcoholic food, such as a liqueur-filled praline. However, this does not explain the values far beyond the fitness limit. From the records, however, it appears that the man was more likely to be drunk, and even if he had previously skipped a meal, exercised, or drank alcohol the night before, report Barbara Cordell from Panola College, Carthage, Texas, and the resident gastroenterologist McCarthy in the International Journal of Clinical Medicine .
The episodes of drunkenness get worse over the years. In November 2009, the man is finally admitted to the emergency room of a hospital. On this day he did not drink alcohol, the measured blood alcohol concentration is 3.7 per thousand. The doctors keep him in the hospital for 24 hours and treat him for his obvious severe alcohol intoxication. They give the protestations that he has drunk nothing, no faith and assume that he secretly drinks like many alcoholics.
Search in the gut
The following January, McCarthy finally examines the man's entire gastrointestinal tract. Apart from his specific alcohol problem, the patient has high blood pressure and high blood lipid levels. He can not remember any complaints with his stomach or intestines. Nevertheless, McCarthy suggests that the intestines may have something to do with alcohol problems if the man does not drink secretly.
Testing for problems in processing various sugars does not help. Using endoscopes - long instruments with cameras at the end - McCarthy examines the man's entire intestine. In fact, it helps to uncover samples in which it will find its way in later analysis. In the stomach of the man sits the bacterium Helicobacter pylori, which may be responsible for stomach ulcers. More exciting, however, is the finding of Saccharomyces cerevisiae in the patient's stool.
Brewer's yeast in the chair
This yeast is, as the Latin name suggests, used both for baking and for the fermentation process during beer brewing. But can the fungus in the patient's intestine be to blame for his alcohol problem?
In April 2010, the man is monitored for 24 hours in the hospital. At admission, doctors check his belongings for alcohol, and he is not allowed to receive visitors during his stay. He gets all day dextrose and sugar-rich foods because sugar would be exactly what the yeast would need to produce alcohol. At the beginning of the experiment and every two hours, the doctors determine the blood alcohol concentration, and every four hours the blood sugar level. Texan officials also check the breath alcohol content of the man. In the afternoon the blood alcohol content increases to 120 milligrams of alcohol per deciliter (mg / dL), the breath analyzer indicates 1.2 per mill.
The man brews himself
Now the treatment team is safe: You have a patient with the "Auto-Brewery Syndrome" or "Good Fermentation Syndrome" in front of him. For what sounds like a bad joke, you can actually find several dozen case reports in the medical literature. In the body of the person concerned, the excessively spreading yeast is supposed to ferment sugar from the diet into ethanol. Japanese authors reported such cases back in the early 1970s. In one case, a 13-year-old girl was affected, in another, a three-year-old girl, both suffering from malformations of the intestine.
The Texan patient is treated by his doctors with the fungicide fluconazole, followed by another antifungal, nystatin. In order to restore the intestinal flora, he gets then bacterial cultures. During the therapy, he must avoid sugar and must not drink alcohol.0.00 per thousand
Its breath alcohol content is checked daily: the device continuously displays 0.00 per thousand for ten weeks. In the subsequent chair control, the doctors no longer find yeast. Finally, the doctors still treat the gastric pylori in the stomach.
The unusual case of illness is not as good as an excuse for the drunk. After more than six years of suffering, the Texan patient could credibly prove that he was actually not dependent on alcohol. However, the case illustrates that doctors and nurses should also listen closely to patients with supposedly clear diagnoses.
