Altered mental status due to pruno intoxication.

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. CASE REPORT: 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.

Atrial fibrillation with rapid ventricular response resulting from low-voltage electrical injury.

BACKGROUND: Cardiac dysrhythmias after electrical injury have been reported previously, however, atrial fibrillation after low-voltage electrical injury is extremely rare. We present a case of atrial fibrillation with rapid ventricular response resulting from a low-voltage electrical injury. CASE REPORT: A 24-year-old active duty Navy sailor presented to the emergency department after an electrical shock from a 440-V furnace. He experienced severe pain in both hands and a racing sensation in his chest. He denied other symptoms. An electrocardiogram was performed demonstrating atrial fibrillation with a rapid ventricular response (132 beats/min). After analgesia and sedation, synchronized cardioversion (100 J) was performed with complete resolution of cardiac symptoms and restoration of normal sinus rhythm (75 beats/min). Cutaneous wounds were bandaged and the patient was discharged with cardiology follow-up. At follow-up, the patient reported no symptoms and an echocardiogram revealed no structural abnormalities. CONCLUSIONS: Atrial fibrillation in the setting of electrical injury is rarely reported in the published medical literature. In patients without history suggestive of cardiac structural abnormalities, synchronized cardioversion is a potential option for restoration of normal sinus rhythm and resolution of symptoms after electrical injury-induced atrial fibrillation with rapid ventricular response.

Complete ventricular asystole in a patient with altered mental status.

Patients who present with recurrent syncope are at risk for having underlying conduction disease, which may worsen if not promptly recognized and treated. We describe a patient who initially presented to a Mexican clinic with recurrent syncope and an electrocardiogram that showed complete heart block. After being transferred to our emergency department, he deteriorated into complete ventricular asystole with preserved atrial function and required placement of a transvenous cardiac pacemaker.