Advertisement

A Challenge Is Brewing: False-Positive Urine Alcohol in an Elderly Diabetic Male

      A 78-year-old man with a medical history of uncontrolled diabetes, multiple sclerosis, and neurogenic bladder with recurrent urinary infections was brought to the emergency department from a nursing home for complaints of reduced alertness. The patient’s physical examination was remarkable only for chronic bilateral lower extremity weakness. His complete blood count and basic metabolic panel were normal. Urine drug screen was positive for alcohol. Urine analysis showed persistent pyuria, hematuria, yeast, many bacteria, and glycosuria. The patient avidly denied any alcohol intake. The nursing home staff denied any possibility of him having access to alcohol. Blood alcohol level obtained shortly after admission was negative. Considering his glycosuria, as well as persistent urine yeast and bacterial colonization, his urinary alcohol was deemed to be false positive for alcohol ingestion and a by-product of local microorganism fermentation of carbohydrates. The patient was treated with oral antibiotics for a urinary tract infection, and his mentation gradually improved.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Han J.H.
        • Wilber S.T.
        Altered mental status in older patients in the emergency department.
        Clin Geriatr Med. 2013; 29: 101-136
        • Xiao H.
        Evaluation and treatment of altered mental status patients in the emergency department: life in the fast lane.
        World J Emerg Med. 2012; 3: 270-277
        • Dashko S.
        • Zhou N.
        • Compagno C.
        • Pikur J.
        Why, when, and how did yeast evolve alcoholic fermentation?.
        Fems Yeast Res. 2014; 14: 826-832
        • Helander A.
        • Olsson I.
        • Dahl H.
        Postcollection synthesis of ethyl glucuronide by bacteria in urine may cause false identification of alcohol consumption.
        Clin Chem. 2007; 53: 1855-1857
        • Hadland S.E.
        • Levy S.
        Objective testing: urine and other drug tests.
        Child Adolesc Psychiatr Clin N Am. 2016; 25: 549-565
        • Painter K.
        • Sticco K.L.
        Auto-brewery syndrome (gut fermentation).
        2019 Feb 14
        • Saady J.J.
        • Poklis A.
        • Dalton H.P.
        Production of urinary ethanol after sample collection.
        J Forensic Sci. 1993; 38: 1467-1471
        • Sulkowski H.A.
        • Wu A.H.B.
        • McCarter Y.S.
        In-vitro production of ethanol in urine by fermentation.
        J Forensic Sci. 1995; 40: 990-993