This situation has been used as a DWI/DUI defense
since the early 1990s - search for “candidiasis”
in https://spaf.cerias.purdue.edu/Yucks/V1/msg00034.html .
It is good to see both a differential test procedure,
and a treatment regime.
Different laws are written, variously, from the perspective of intention (mens rea), and others are known as "strict liability."
Strict liability laws ask only whether the law was broken, and make no reference to the intent to break the law. A classic example here is statutory rape: being lied to about a partner's age is no defense, because the law asks only for the facts of the situation, not the intentions.
Is there a case where strict liability laws are a better option? It seems like a bad thing to me that leads to less just outcomes.
Case in point, whistleblowers are tried under the espionage act using strict liability. It doesn't matter why they did it, if it was harmful or beneficial, only that they did it or not.
I've heard of this syndrome a number of times. I've also heard that anyone that has fatty liver disease without being an alcoholic should at least look into the possibility that the gut is producing alcohol on its own.
I wonder if a fecal transplant would be a cure for Auto brewery syndrome?
The most common cause of non-alcoholic fatty liver disease is obesity/metabolic syndrome. If someone with a BMI > 30 came in asking for a workup for auto-brewery syndrome that would be an unreasonable work-up and a waste of limited healthcare system resources as well as the patient's, unless they provided additional signs and symptoms that were suggestive of alcohol intake.
In the absence of obesity/metabolic syndrome, I'd be pursuing a work-up of cholestatic injury, A1AT deficiency, and viral and autoimmune hepatitis before I start looking for auto-brewery syndrome, in the presence of isolated fatty-liver disease.
I doubt fecal transplant would be curative; fungi are tenacious. It might be a more effective repopulation method than the probiotics used by the folks in the article, though. Probiotics are kind of crap, no pun intended.
Imagine getting an implanted ethanol fuel cell, inducing ABS in yourself, and having a permanent source of power to charge your phone (ideally wirelessly through a subdermal Qi charger, as the alternative would be both unpleasant and unhygienic). Presumably if the fuel cell was consuming ethanol fast enough your body wouldn't take any damage from the ABS either.
“ Any patient denying alcohol ingestion but who have elevated blood alcohol levels or positive breathalyzer results should be investigated for ABS,” they concluded.
I mean in previous instances they held the patient until any previously ingested alcohol must have been processed, waited for their BAC to show a clear descent, then gave the patient sugar and watched the BAC go up at subsequent timepoints.
I don’t think even the most isolated docs would be naive enough to trust an incoming intoxicated patient about their own substance use.
I don’t think the paper suggests that this protocol be implemented in an ER to evaluate all inebriated patients. Should there be a suspicion of ABS, it would be appropriate to refer for further outpatient management. This would be the case with any other differential diagnoses. In addition, the authors are clinicians who likely have had plenty of ER experience in their training.
Well certainly one can imagine how frustrating it must be to have this condition and nobody believes you, i.e. they think you are a lying drunk.
So likely there is a happy medium between (1) being totally naive towards everyone who comes into the ER and (2) denying that ABS exists. i.e. Be aware of alternative explanations which may be rare but not non-existent.
I think it really depends on the cost of an ABS test, how common ABS is, how common patients lie about alcohol consumption, and the cost savings for dealing with ABS sooner rather than later.
If you are going to hold someone in the ER until their BAC is 0 it seems fairly cheap to give them sugar water and see if their BAC increases.
You think it should be cheap to hold someone in the ER for multiple hours just to sober them up and test for a rare condition?
Breathalyzers don't cost much at all, ER visits costs thousands of dollars. You can tell someone to go drink sugar water at home. Why would a doctor need to hold someone and give the sugar water?
They can't "hold you" in the sense of denying you the ability to leave against medical advice. "Harm to self or others" is a whole different category of hold and no one is doing it for a random drunk in the ER.
However, if you're waiting for an actual discharge from the ER, it's common to hold onto the patient until their BAC is under the legal limit, do another quick neuro exam, and then start discharge procedures.
The idea here is "the patient is almost certainly just drunk, but it's not impossible they have an underlying problem such as hepatic encephalopathy. So I'm going to wait for them to sober up enough that I can tell the difference between 'drunk' and 'underlying altered mental status' before I start discharge. The time it will take the discharge to go through will be enough to get their BAC to 0, and I will therefore not be liable if they walk out of the ER and fall and crack their head."
> However, if you're waiting for an actual discharge from the ER
To me this implies they can hold you, as I can't just walk out whenever I want? Why? I feel no compulsion to be held so that they can minimize their liability.
It's about liability you go without doctors permission and something happens it's on you. If the doctor's says you are good to go and the something happens the the doctor and hospital will face the liability.
You can walk out whenever you want against medical advice. This is different from being discharged, which is when a doctor says "you're probably ok to go home" and fills out some paperwork to that effect.
We shouldn't stop because of an edge case, because they do save lives.
It's like saying we should stop chemo because of unwanted side effect, because they don't work in some situation, or make someone worse because of an unknown variable.
Because they can cause harm in some rare situation, doesn't mean they're not valuable in many cases.
