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.
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