title: High urine ethanol and negative blood and vitreous ethanol in a diabetic woman: a case report, retrospective case survey, and review of the literature.
abstract: Several studies have shown that ethanol can be produced in urine infected with yeast or bacteria in vitro. We present the unusual case of a diabetic woman in whom ethanol was produced in her urine in vivo. The decedent was a 19-year-old woman who was noncompliant with her diabetes treatment. She presented to a local hospital in severe diabetic ketoacidosis and died shortly thereafter. Upon arrival at the hospital, a blood glucose of 553 mg/dL was detected. A urinalysis was positive for ketones (> 80 mg/dL), glucose (> 1000 mg/dL), and large budding yeast forms. A drug screen performed on the urine was positive for ethanol. At the coroner/medical examiner office, an autopsy was negative for significant anatomic findings. Toxicology analysis revealed a urine ethanol level 0.32 g/dL, although no ethanol was detected in blood or vitreous samples. A urine gram stain and culture identified Candida glabrata. A retrospective case review of all deaths related to diabetes examined at the coroner/medical examiner office from 1986 to 2003 did not reveal other cases with similar findings. This case of a noncompliant, juvenile-diabetic woman illustrates a rare finding of apparent in vivo glucose fermentation by C. glabrata to form ethanol in the urine. This case also highlights a potential difficulty in toxicologic analysis and interpretation using urine only.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. amygrusz@hotmail.com
authors.forename: Amy C
authors.initials: AC
authors.lastname: Gruszecki
authors.forename: C Andrew
authors.initials: CA
authors.lastname: Robinson
authors.forename: Susan
authors.initials: S
authors.lastname: Kloda
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brissie
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D001344:Autopsy; D003922:Diabetes Mellitus, Type 1; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology / Q000652:urine; D003937:Diagnosis, Differential; D000431:Ethanol / Q000652:urine; D005260:Female; D006801:Humans; D008499:Medical Records; D012189:Retrospective Studies; D014822:Vitreous Body / Q000378:metabolism; D015003:Yeasts / Q000378:metabolism
chemical_list: D000431:Ethanol