title: Altered mental status due to pruno intoxication.
abstract: BACKGROUND
  The diagnosis of alcohol intoxication might not be considered in patients coming from locations where access to alcohol is severely restricted or not permitted.
  
  
  OBJECTIVE
  We present a case of alcohol intoxication in a patient presenting from a military prison. The patient ingested an alcoholic beverage made in his prison cell with produce stolen from the prison cafeteria. We also discuss potential complications of "prison-brewed" alcoholic beverages.
  
  
  METHODS
  A 22-year-old male presented to the emergency department after being found in his cell with a depressed level of consciousness and next to a mouthwash bottle filled with a foul-smelling liquid. Physical examination revealed a heart rate of 111 beats/min, a Glasgow Coma Scale score of 11, no signs of injury or track marks on the skin, and intermittent agitation alternating with somnolence. Laboratory evaluation was significant for a serum ethanol level of 279 mg/dL. After a period of observation, mental status returned to normal and the patient admitted to making "pruno."
  
  
  CONCLUSIONS
  Alcohol intoxication might be unexpected or not considered in patients that should have no access to common sources of ethanol. Awareness of methods of novel fermentation, even in incarcerated individuals, can assist in the differential diagnosis of patients presenting with altered mental status.
authors.affiliation: Department of Emergency Medicine, Navy Medical Center San Diego, San Diego, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Zanoni
authors.affiliation: Department of Emergency Medicine, Navy Medical Center San Diego, San Diego, California.
authors.forename: Shaun
authors.initials: S
authors.lastname: Carstairs
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of California, San Francisco, Fresno, California.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Darracq
mesh_terms: D000434:Alcoholic Beverages / Q000009:adverse effects*; D000435:Alcoholic Intoxication / Q000097:blood / Q000209:etiology*; D003244:Consciousness Disorders / Q000139:chemically induced*; D000431:Ethanol / Q000009:adverse effects* / Q000097:blood; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D011330:Prisons; D055815:Young Adult
chemical_list: D000431:Ethanol
keywords: alcohol intoxication; alcohol poisoning; ethanol; hooch; prison wine; pruno