医事法律视角下的极罕见自体酿酒(内源性酒精发酵)综合征。
A medicolegal approach to the very rare Auto-Brewery (endogenous alcohol fermentation) syndrome.
机构信息
Faculty of Medicine, Department of Forensic Medicine, Gaziantep University, Gaziantep, Turkey.
出版信息
Traffic Inj Prev. 2020;21(5):295-297. doi: 10.1080/15389588.2020.1740688. Epub 2020 Apr 7.
Auto-Brewery Syndrome is defined as the production of ethanol by microorganisms becoming dominant when inhabiting the gastrointestinal system or through the impairment of flora because of carbohydrate-rich nutrition, and the elevation of levels of measured ethanol. This study aimed to consider medicolegal approaches to individuals with Auto-Brewery Syndrome. A 38-year-old male patient who was involved in a traffic accident about two months ago and whose driving license was taken away due to his blood alcohol level measuring above the legal limits was referred to our department for the detection of any condition which might cause the elevation of blood alcohol levels without alcohol intake, in consequence of his objection submitted to the judicial authorities claiming that he had not drunk alcohol on the day of the event. After the informed consent of the individual was obtained, he was admitted under supervision to an inpatient unit with a visitor ban in a manner which inhibited his intake of alcohol, and during admission his blood alcohol levels were measured at intervals. His blood alcohol level was measured as 160 mg/dl at the time of admission for monitoring and as 141 mg/dl, 322 mg/dl, 208 mg/dl and 279 mg/dl after two hours, six hours, 12 hours and 20 hours, respectively. His liver function test results were high and neurological examination was normal. The individual was diagnosed with Auto-Brewery Syndrome. Various gastrointestinal system abnormalities such as through laparotomy, gastrectomy are reported in most of Auto-Brewery syndrome cases. There are cases, although rare, where gastrointestinal disorders are not detected and secondary disorders of normal intestinal flora due to frequent antibiotic use seem to be a factor. Such a condition is present in the current case. Those who are aware of this condition may falsely rely on it as a method to avoid penalties. On the other hand, genuine patients suffering from this condition may be caught by traffic control and become victims of the condition. For that reason, a meticulous and planned approach should be taken to verify the condition and to ensure that it is not overlooked.
自酿综合征是指微生物在胃肠道中占优势或由于富含碳水化合物的营养物质而损害菌群,导致乙醇水平升高,从而产生乙醇。本研究旨在探讨自酿综合征患者的法医学方法。一位 38 岁的男性患者大约两个月前发生交通事故,由于血液酒精水平超过法定限制,他的驾照被吊销,他被转介到我们部门,以检测任何可能导致血液酒精水平升高而无需摄入酒精的情况,因为他向司法当局提出异议,声称他在事件发生当天没有饮酒。在获得个人知情同意后,他被以访客禁止的方式在住院部接受监督,以抑制他的酒精摄入,在住院期间,每隔一段时间测量他的血液酒精水平。他入院时的血液酒精水平为 160mg/dl,用于监测,两小时、六小时、十二小时和二十小时后的血液酒精水平分别为 141mg/dl、322mg/dl、208mg/dl 和 279mg/dl。他的肝功能检查结果较高,神经系统检查正常。该患者被诊断为自酿综合征。大多数自酿综合征病例都有各种胃肠道系统异常,如剖腹术、胃切除术。虽然很少见,但也有胃肠道疾病未被发现的病例,由于频繁使用抗生素,正常肠道菌群的继发性紊乱似乎是一个因素。目前的情况就是如此。那些了解这种情况的人可能会错误地依赖它作为一种避免惩罚的方法。另一方面,真正患有这种疾病的患者可能会被交通管制抓住,成为这种疾病的受害者。因此,应该采取细致和有计划的方法来验证这种情况,以确保不会忽略它。