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.
From the *Department of Pathology and Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and the †Jefferson County Coroner/Medical Examiner Office, Birmingham, Alabama.
Manuscript received October 1, 2004; accepted December 13, 2004.
Reprints: Amy C. Gruszecki, MSFS, DO, Jefferson County Coroner/Medical Examiner Office, 1515 6th Avenue South, Suite 611, Birmingham, AL 35233. E-mail: email@example.com.
This research was presented in part to the National Association of Medical Examiners Annual Meeting 2004, Nashville, TN.