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Comment by dav_Oz | Hacker News Reader

>On her seventh ED visit, the patient presented with slurred speech, alcohol odour on her breath, and an elevated ethanol level of 62 mmol/L.

About 0.285% or 2.85‰ (!). For a 200lbs (90kg) person about 14 drinks[0] for a 120lbs (55kg) person about 11 drinks.

TL;DR: The issue was resolved with a low carb diet (about 6 months) and putting her on courses of fluconazole.

[0]1 drink = a 12-ounce (350 ml) beer or 5 ounces of wine (140 ml) http://www.clinlabnavigator.com/alcohol-ethanol-ethyl-alcoho...

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As someone who was a home brewer, the amount of fermentable sugar this woman must have consumed over the Days of fermentation to cause a BAC at that level at one point in time is astounding to the point where I’m suspicious she wasn’t drinking

I’m talking about the equivalent of consuming a pound of honey for multiple days straight, and more likely something like multiple pounds somehow turbo fermented to hit that alc%. If she didn’t have this medical problem, she would have had five others soon.

For those who don’t know, there is an upper limit of natural fermentation where if you try hard, maybe you hit 20% alc/vol. Four pints of it to hit those numbers at the low end (120 lb / 55 kg person)

> there is an upper limit of natural fermentation where if you try hard, maybe you hit 20% alc/vol

In a drink. In your stomach your blood will absorb that, meaning the yeast will just continue to make alcohol forever until you die since the yeast tolerates much higher alcohol percentages than you do.

Yeast makes sugar into about half alcohol, so 200g carbs would be enough for about 2% blood alcohol at 5l blood. 200g carbs isn't that much, you'd get it from some cake and soda at a party.

Ok that’s interesting. But at the same time her body is getting rid of 10 mL of alc an hour or so too? She’d have to get past the first ~10g of carbs, every hour? 240g base carb plus another 200g at one point to hit the mark?

Edit: 20g of carbs converted to alcohol would be removed every hour? My quick math sucks

> “Genetic predisposition for inactive aldehyde dehydrogenase enzyme and subsequent inefficient alcohol metabolism, may also play a role. In our patient, we suspect her recurrent antibiotics for UTI and dexlansoprazole use led to gut dysbiosis with potential contribution of genetics, resulting in auto-brewery syndrome.”

If the patient was genetically predisposed to have inactive ALDH, that would explain how they could reach such a high BAC without excess carbohydrate or exogenous alcohol consumption.

> About 0.285%

That's pretty high and aligns with the description of slurred speech and other signs of inebriation.

I wonder if those afflicted ever connect diet with severity of symptoms as it seems that high carbs increase ETOH production.

I also wonder if the constant exposure leads to addiction and if withdrawal complicates treatment.

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