В Словении доказали, что сахар в желудке подростка с ДЦП вызвал ложное содержание алкоголя в крови

When toxicology came back on a 16-year-old boy who had died at home, it showed a blood alcohol level of 0.75 grams per liter. He had severe cerebral palsy, could swallow only pureed and liquid food, and had no history of drinking. Forensic pathologists in Slovakia traced the alcohol to his own stomach, publishing the case in Forensic Science, Medicine and Pathology. Honey, Apple Juice and a Reading That Did Not Fit The boy had congenital brain malformations, spastic quadriplegia, severe intellectual disability, scoliosis and epilepsy diagnosed at three months. Six months before his death, a COVID-19 infection cost him 12 kilograms, roughly a third of his body weight. He had been treated repeatedly for pneumonia since, most recently a week before he died. His parents found him struggling to breathe, and resuscitation failed. What his parents told investigators afterward supplied the missing piece. Alongside his usual meals, about six hours before his death he had taken a teaspoon of honey and at least 100 milliliters of apple juice, carrying at least 20 grams of sugar. The pathologists concluded that this quantity of sugar could account for the alcohol measured in his blood, produced by fermentation inside his digestive tract. Urine alcohol was 0.01 grams per liter, and there were no putrefactive products, meaning decomposition was not the explanation. What the Autopsy Found in His Stomach The body was extremely wasted, with a body mass index of 8.2. The stomach held about 15 milliliters of dark brown fluid. In its lower portion were three separate ulcers with dark brown edges. Under the microscope, fungi had penetrated the surface layer of the stomach lining and reached the tissue beneath, sitting at the base of the ulcers. Those ulcers were themselves unexpected. He had shown no signs of gastrointestinal bleeding during his life and had never been prescribed immunosuppressants, acid suppressants or anti-inflammatory painkillers, the usual suspects behind stomach ulcers. The identification came from an unlikely direction. Because fungus in the stomach was not initially suspected, stomach tissue was never sent for culture. The lungs were, because they looked strange at autopsy, and testing there identified the yeast Pichia kudriavzevii, better known in medicine as Candida krusei, alongside two bacteria, Klebsiella pneumoniae and Enterobacter hormaechei. The organisms in the lungs matched the appearance of the fungi in the stomach, and the authors concluded they had almost certainly been carried there when he inhaled stomach contents as he was dying. Death was attributed to pneumonia against a background of depleted body reserves. Auto-brewery syndrome is the name for what happens when microbes in the gut ferment dietary carbohydrate into ethanol. It has been linked to short bowel syndrome, gastric surgery, Crohn disease, antibiotic courses and high sugar intake. Yeasts including Saccharomyces cerevisiae and several Candida species can do it, and so can some strains of Klebsiella pneumoniae. Candida krusei is not an exotic organism, but it is a serious one. It sits among the pathogens of concern in a review informing the WHO fungal priority list, partly because it is naturally resistant to fluconazole, a first-line antifungal. The Medicolegal Trap the Authors Wanted to Flag This is where the case stops being a curiosity. Picture the same finding without the microbiology. A severely disabled teenager dies at home. His blood contains alcohol. His parents insist he never drank. The obvious inference, and a devastating one, is that someone gave it to him. The authors are explicit that failing to test stomach and intestinal contents can produce exactly that misreading, and that misinterpreting ethanol in the blood of a child, particularly a child with severe disabilities, can carry serious medical, social and legal consequences. Their clinical advice is aimed at the living. Signs of intoxication such as poor coordination, slurred speech or impaired vision, together with alcohol on the breath and no history of drinking, should prompt clinicians to consider auto-brewery syndrome in a disabled patient on a high-sugar diet. Confirming it involves diet and medication history, blood alcohol testing, microbial cultures and a glucose challenge test. One detail underscores the difficulty. Because of his communication limitations, his parents had never noticed any behavioral change. How Rare This Is and Who May Be Vulnerable Very rare, and this remains a single autopsy case. The paper does not establish how often endogenous fermentation goes undetected, and it does not show that the syndrome caused this boy's death. What it does describe is a plausible combination of vulnerabilities stacking up: severe malnutrition, weight loss after COVID-19, repeated antibiotic courses that disturbed his gut flora, ulcers that gave yeast a foothold, and a diet reliant on sweetened liquids because he could not manage solid food. The blood alcohol here was modest. A level as high as 3.5 grams per liter has been reported in a child with short gut syndrome. Families of medically fragile children should not read this as a reason to change feeding routines on their own. Sugar-containing liquids are often the only practical way to deliver calories to a child with swallowing difficulty. Any concern about intoxication-like symptoms without alcohol exposure belongs with the treating clinician. Key Questions Answered What is auto-brewery syndrome? A rare condition in which yeast or bacteria in the digestive tract ferment dietary carbohydrate into ethanol, producing measurable blood alcohol without any drinking. Did the syndrome kill this teenager? No. Death was attributed to pneumonia in the setting of severe wasting. The fermentation explained the alcohol finding, not the death. Why does the alcohol reading matter so much? Without microbiological testing, alcohol in a disabled child's blood could easily be read as evidence that someone gave it to him, with serious legal and social consequences. What organism was responsible? Candida krusei, also called Pichia kudriavzevii, found invading the lining of his stomach. Two gut bacteria capable of producing ethanol were also identified. Who is most at risk? People with malnutrition, gut surgery, short bowel syndrome, repeated antibiotic use or high sugar intake. It remains rare in every group. How is it diagnosed? Through diet and medication history, blood alcohol testing, drug screening, microbial cultures, and a glucose challenge test showing blood ethanol rising afterward. Published by Medicaldaily.com