Very rare, also known as gut fermentation syndrome. 

A few cases have been described in children with a short bowell. This is a poorly documented intestinal disease characterized by endogenous alcohol production due to excessive fermentation of carbohydrates in the digestive system, caused by the presence of large quantities of Saccharomyces cerevisiae ("brewer's yeast "), Saccharomyces boulardii or Candida albicans. This production can cause drunkenness after a meal rich in carbohydrates. In the majority of cases, another anomaly of the digestive tract is associated: short bowell, pseudo-occlusion of the small intestine, diabetes, ileojejunal bypass, liver dysfunction. In some cases, prior exposure to broad-spectrum antibiotics is the cause of a change in the intestinal flora favoring the proliferation of these yeasts.

Symptoms: episodes of drunkenness without alcohol intake, frequent feeling of "hangover" despite the absence of any alcohol intake.

Anesthetic implications:

evaluation of the consequences of chronic alcohol exposure: liver enzymes (SGPT, gamma GT), liver function (albumin, coagulation). Avoid carbohydrate-rich meals the day before surgery, as well as the intake of clear carbohydrate-rich liquids. In theory, there is no problem with IV glucose.
Anesthetic requirements are often increased following enzyme induction secondary to chronic alcohol exposure. Increased risk of nausea and vomiting. If possible, avoid broad-spectrum antibiotics.

References:

-          Jansson-Nettelbladt E, Meurling S, Petrini B, Sjölin J.
Endogenous ethanol fermentation in a child with short bowel syndrome. 
Acta Paediat. 2006;95:502–4. 

-        Dahshan A, Donovan K.
Auto-brewery syndrome in a child with short gut syndrome: Case report and review of the literature. 
J Pediatr  Gastroenterol Nut. 2001;33:214–5. 

-        Key B, Sawicki CM, Cornelius B, Ness G, Herlich A,Wade SD.
Auto-Brewery Syndrome and general anesthesia: a case report.
A&A Practice  2023;17:e01708

Updated: April 2024