Fig. 3

Ethanol production by fermenting yeast in bladder fermentation syndrome. a Outline of the experiment. In this experiment, the freshly voided urine sample was immediately transported to the laboratory on ice. The specimen was centrifuged into yeast-poor and yeast-rich fractions for incubation at three temperatures (4 °C, 25 °C, and 37 °C) for 24 h. The yeast-rich fraction was also incubated in the presence of 1% sodium fluoride, a fermentation inhibitor. The ethanol level was determined using headspace gas chromatography. b The ethanol levels in the urine sample after 24 h incubation. The ethanol level increased from 9.5 mmol/L (44 mg/dL) (baseline before incubation) to 103.3 mmol/L (476 mg/dL) and 177.1 mmol/L (816 mg/dL) after 24 h incubation at 25 °C and 37 °C, respectively. In contrast, minimal ethanol production was observed in the yeast-poor fraction and sodium fluoride and 4 °C conditions. No ethanol production was observed after 24 h incubation at 37 °C in the negative control urine (data not shown). The figure and legend reproduced with permission from Authors [2]. Urinary Auto-brewery Syndrome: A Case Report. Annals of Internal Medicine. 2020; 172: pp.702–704. https://www.acpjournals.org/doi/10.7326/L19-0661 ©American College of Physicians