Fermented Danger: Metabolic Acidosis Triggered by Kombucha Tea

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Introduction: Kombucha tea, a fermented black tea, is widely consumed because of its presumed immune boosting and anti-neoplastic properties. However, excessive fermentation can result in elevated levels of various acids, potentially leading to metabolic acidosis. We present a similar case of a woman consuming Kombucha tea, having repeated admissions to the hospital due to metabolic acidosis. Case Description: 43 year old female patient with a history of hepatic steatosis and obstructive sleep apnea was hospitalized due to nausea, vomiting and decreased appetite for 3 days. Initial labs revealed an increased anion gap metabolic acidosis. After stabilization and discharge she presented a month later with similar symptoms. On this admission her labs were significant for a pH 7.057, CO2 5.9mmol/L, Lactic acid 1.5, Anion Gap of 34 and positive urinary ketones. She required ICU level care for severe anion gap metabolic acidosis. Discussion: Kombucha, though popular for its perceived health benefits, can pose risks when consumed excessively due to its fermentation byproducts. This patient required ICU-level care with IV fluids and bicarbonate drip for severe, increased anion gap metabolic acidosis. Though initially stabilized, she was found to have persistently low bicarbonate on follow-up, prompting further investigation. Urine organic acid analysis was positive for phenyllacetic acid, acetoacid, 5 oxo-proline, 2 oxo-glutaric acid and 2 OH-glutaric acid.These findings suggest Kombucha-induced metabolic derangements, though rarely reported but important consideration. A detailed dietary history revealed that the patient had been consuming Kombucha tea over the past 6 months. This case highlights the importance of considering dietary supplements in the differential diagnosis of unexplained acidosis. Discontinuation of Kombucha led to resolution of symptoms, emphasizing the value of early recognition and intervention.

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