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First of all, my apologies for this lengthy post.
Some cites - I learn something new every day. Your
experience with antabuse is interesting and would certainly
be a teaching point for one of your clients. I'll keep it
in mind but I've never had a patient on antabuse so I had
no idea of the potential for this interaction in a person
who drinks no alcohol.
Candida species are common infectious agents in those
undergoing long term or multiple antibiotic therapy or who
are immunocompromised and we treat such infections
routinely. Even so, the production of ethanol by Candida
albicans would appear to be of no relevance to critical
care medicine. The first article seems to address
"auto-brewry" syndrome as a defence for DUI. But to quote,
in the healthy individual "These concentrations are far too
low to have any forensic or medical significance."
Acetaldehyde is a toxic metabolite of the breakdown of
ethanol by the enzyme alcohol dehydrogenase in the liver.
That the chemical reaction can be driven in reverse by
various microorganisms seems to be the topic of the second
article. Again this seems to be of no clinical
significance as any ethanol produced in such a manner in a
human would quickly be metabolized back into acetaldehyde
by the liver, assuming the patient's liver is functioning
appropriately. If the liver is unable to do this then the
patient has a much more serious problem which we would be
addressing in the clinical setting. I've cared for
numerous patients who are in liver failure (never
admittedly as a result of alcoholism) as well as after
having received liver transplants and this phenomena has
never been addressed by the Hepatologists with whom I've
worked. The article seems to be addressing this as an
interesting phenomena from biochemical evolutionary
standpoint.
Are you somehow suggesting this as justification for
drinking faux alcoholic beverages? If not, then I'm not
entirely sure why you even bring it up. If so, then feel
free to do so as you wish.
I've never made any secret of my distaste for faux
alcoholic beverages which contain small quantities of
alcohol so you don't have to work very hard to glean my
viewpoint which stems from my personal experience. It's a
personal choice and if you wish to drink such beverages
then by all means do so. However, I will continue to
abstain.
https://www.ncbi.nlm.nih.gov/pubmed/10976182
Abstract
The concentration of ethanol in blood, breath or urine
constitutes important evidence for prosecuting drunk
drivers. For various reasons, the reliability of the
results of forensic alcohol analysis are often challenged
by the defence. One such argument for acquittal concerns
the notion that alcohol could be produced naturally in the
body, hence the term 'auto-brewery' syndrome. Although
yeasts such as Candida albicans readily produce ethanol
in-vitro, whether this happens to any measurable extent in
healthy ambulatory subjects is an open question. Over the
years, many determinations of endogenous ethanol have been
made, and in a few rare instances (Japanese subjects with
very serious yeast infections) an abnormally high ethanol
concentration (> 80 mg/dl) has been reported. In these
atypical individuals, endogenous ethanol appeared to have
been produced after they had eaten carbohydrate-rich foods.
A particular genetic polymorphism resulting in reduced
activity of enzymes involved in hepatic metabolism of
ethanol and a negligible first-pass metabolism might
explain ethnic differences in rates of endogenous ethanol
production and clearance. Other reports of finding
abnormally high concentrations of ethanol in body fluids
from ostensibly healthy subjects suffer from deficiencies
in study design and lack suitable control experiments or
used non-specific analytical methods. With reliable gas
chromatographic methods of analysis, the concentrations of
endogenous ethanol in peripheral venous blood of healthy
individuals, as well as those suffering from various
metabolic disorders (diabetes, hepatitis, cirrhosis) ranged
from 0-0.08 mg/dl. These concentrations are far too low to
have any forensic or medical significance. The notion that
a motorist's state of intoxication was caused by
endogenously produced ethanol lacks merit.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1148946/
Abstract
The stereochemical course of the reduction of acetaldehyde
to ethanol was investigated by evaluating, with the enzymic
system yeast alcohol dehydrogenase/diaphorase and
g.c.-m.s., the configuration of [1-2H]ethanol obtained from
[1-2H]acetaldehyde with different micro-organisms. Although
only S-[1-2H]ethanol was formed, all the micro-organisms
showed evidence of the existence of alcohol dehydrogenases
with opposite stereospecificity.