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| Altered mental status
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| {{col-begin|width=80%}} | | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' |
| {{col-break|width=33%}}
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| * [[systemic infection| Acute systemic infection]]
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| * [[psychosis|Acute psychosis]]
| | | '''Chemical / poisoning''' |
| * [[Alcohol|Alcohol withdrawal]]
| | |bgcolor="Beige"| |
| * [[Alcohol|Alcohol toxicity]]
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| * [[Congestive heart failure]]
| | | '''Dermatologic''' |
| * [[CVA]]
| | |bgcolor="Beige"| |
| * [[Dehydration]] (volume depletion)
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| * [[Dementia]]
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| * [[Delirium]]
| | | '''Drug Side Effect''' |
| * [[Depression]]
| | |bgcolor="Beige"| |
| * [[Intoxication|Drug toxicity]]
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| * [[Withdrawal|Drug withdrawal]]
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| * [[Head injury]]
| | | '''Ear Nose Throat''' |
| {{col-break|width=33%}}
| | |bgcolor="Beige"|] |
| * [[Hepatic encephalopathy]]
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| * Hip fracture
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| * [[Hypercarbia]]
| | | '''Endocrine''' |
| * [[Hyperglycemia]]
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| * [[Hypoglycemia]]
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| * [[Hypernatremia]]
| | | '''Environmental''' |
| * [[Hyponatremia]]
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| * [[Hypothermia]]
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| * [[Hypoxia]]
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| * [[Myocardial infarction]]
| | | '''Gastroenterologic''' |
| * [[Pulmonary embolism]]
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| * [[Seizures]]
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| * [[Uremia]]
| | | '''Genetic''' |
| * [[Ventricular arrhythmia]]
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| {{col-end}}
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| | | |-bgcolor="LightSteelBlue" |
| | | | '''Hematologic''' |
| *[[diverticulitis|Acute diverticulitis]]
| | |bgcolor="Beige"| |
| *[[Acute intermittent porphyria]]
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| *[[Advanced sleep phase syndrome|Advanced sleep phase disorder]]
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| *[[Analgesics]]: mostly prescribed or illicit [[opiates]] such as [[oxycontin]]
| | | '''Iatrogenic''' |
| *[[Antiepileptic]]s such as [[phenytoin]], [[carbamazepine]], [[gabapentin]]
| | |bgcolor="Beige"| |
| *[[Antidepressants]]: for instance sedating [[tricyclic antidepressants]]
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| *[[Antihistamines]]: [[diphenhydramine]] and [[doxylamine]]
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| *[[Antihypertensive]] medications like [[amlodipine]]
| | | '''Infectious Disease''' |
| *[[Antipsychotics]]: [[thioridazine]], [[quetiapine]], [[olanzapine]], [[risperidone]], and [[ziprasidone]] but not [[haloperidol]]
| | |bgcolor="Beige"| |
| *[[Appendicitis]]
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| *[[Liver failure|Acute Liver failure]]
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| *[[Renal failure|Acute Renal failure]]
| | | '''Musculoskeletal / Ortho''' |
| *[[Adrenal cortex insufficiency]]
| | |bgcolor="Beige"| |
| *[[Alcohol withdrawal]]
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| *[[Altitude sickness|Acute altitude sickness]]
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| *[[Antihistamines]]
| | | '''Neurologic''' |
| *[[Antipsychotics]]
| | |bgcolor="Beige"| |
| *Benzodiazepine receptor agonists: [[Eszopiclone]], [[Zolpidem]], [[Zaleplon]]
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| *[[Brain abscess]]
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| *[[Cerebral edema|Brain edema]]
| | | '''Nutritional / Metabolic''' |
| *[[Brain infection]]
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| *[[Central nervous system infection|Brain or epidural abscess]]
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| *[[Cerebral hypoxia]]
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| *[[Chronic fatigue syndrome]]
| | | '''Obstetric/Gynecologic''' |
| *[[Dopamine agonists]] used in the treatment of [[parkinson's disease]] e.g. [[pergolide]], ropinirole and [[pramipexole]].
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| *[[Brain tumor]]
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| *[[Burns]]
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| *[[Cabergoline]]
| | | '''Oncologic''' |
| *[[Carbon monoxide toxicity]]
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| *[[Carbon tetrachloride]]
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| *[[Cardiac failure]]
| | |-bgcolor="LightSteelBlue" |
| *[[Cerebral infarction]]
| | | '''Opthalmologic''' |
| *[[Cerebral malaria]]
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| *[[Cerebral oedema]]
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| *[[Cerebrovascular accident]]
| | |-bgcolor="LightSteelBlue" |
| *[[Congestive heart failure]]
| | | '''Overdose / Toxicity''' |
| *[[Constipation]]
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| *[[Dehydration]]
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| *[[Delayed sleep phase syndrome]]
| | | '''Psychiatric''' |
| *[[Depression]]
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| *[[Dopamine agonists]] used in the treatment of [[parkinson's disease]] e.g. [[pergolide]], ropinirole and [[pramipexole]].
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| *[[Lower respiratory tract infection classification|Chest infection]]
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| *[[Liver failure|Chronic Liver failure]]
| | | '''Pulmonary''' |
| *[[Renal failure|Chronic Renal failure]]
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| *[[Coproporphyria, hereditary]]
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| *[[Cushing syndrome]]
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| *[[Cyanide]]
| | | '''Renal / Electrolyte''' |
| *[[Daphne poisoning ]]
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| *[[Decompression sickness]]
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| *[[Diabetic hypoglycemia]]
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| *[[Diabetic ketoacidosis]]
| | | '''Rheum / Immune / Allergy''' |
| *[[Drug overdose]]
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| *[[Drug withdrawal]]
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| *[[Electric shock]]
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| *[[Endocrine diseases|Elevated or depressed adrenal function]]
| | | '''Sexual''' |
| *[[Endocrine diseases|Elevated or depressed pancreas function]]
| | |bgcolor="Beige"| |
| *[[Endocrine diseases|Elevated or depressed pituitary function]]
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| *[[Encephalitis]]
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| *[[Encephalitis]]
| | | '''Trauma''' |
| *[[Epidural hematoma]]
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| *[[Epidural haemorrhage]]
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| *[[Epileptic seizures]]
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| *[[Ethanol]]
| | | '''Urologic''' |
| *[[Ethylene glycol]]
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| *[[Fat embolism]]
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| *[[Folate deficiency]]
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| *[[Gangrene ]]
| | | '''Miscellaneous''' |
| *[[Hallucinogens]]
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| *[[Head injury]]
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| *[[Heart failure]]
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| *[[Heat stroke]]
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| *[[Heroin]]
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| *[[HIV]] medications for example, [[efavirenz]]
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| *[[Hypnotics]] like [[zopiclone]], or the [[benzodiazepine]] such as [[diazepam]] or [[nitrazepam]] and the [[barbiturate]], such as [[amobarbital]] or [[secobarbital]]
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| *[[Thyroid#Diseases|Hperthyroidism]]
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| *[[Electrolyte disturbance|Hpherphosphatemia]]
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| *[[Hydrogen sulfide]]
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| *[[Electrolyte disturbance|Hyomagnesemia]]
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| *[[Fibromyalgia]]
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| *[[Hydrocephalus]]
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| *[[Hyperbaric sickness]]
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| *[[Hypercalcemia]]
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| *[[Hypercarbia]]
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| *[[Hypereosinophilia]]
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| *[[Hyperglycemia]]
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| *[[Electrolyte disturbance|Hypermagnesia]]
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| *[[Hypernatremia]]
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| *[[Hyperosmolar non-ketotic diabetic coma]]
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| *[[Hyperosmolar syndrome|Hyperosmolar states]]
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| *[[Hypertensive encephalopathy]]
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| *[[Hyperthermia]]
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| *[[Hyperthyroid]]
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| *[[Hypocalcemia]]
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| *[[Hypoglycemia]]
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| *[[Hyponatremia]]
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| *[[Hyponatremia causes|hypoosmolar states]]
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| *[[Hypophosphatemia]]
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| *[[Hypopituitarism]]
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| *[[Hypothermia]]
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| *[[Hypothyroidism]]
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| *[[Hypoxemia]]
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| *[[Hypoxia]]
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| *[[Infections]]
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| *[[Infectious mononucleosis]] (glandular fever)
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| *[[Intracranial abscess / granuloma]]
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| *[[Intracranial bleeding]]
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| *[[Central nervous system infection|Intraspinal abscess / granuloma]]
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| *[[Datura stramonium|Jimson weed]]
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| *[[Lead]]
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| *[[Acute lymphoblastic leukemia natural history, complications and prognosis|Leukemic blast cell crisis]]
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| *[[Lithium]]
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| *[[Liver failure]]
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| *[[Lyme disease]]
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| *[[Malaria]]
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| *[[Malignant hypertension]]
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| *[[Marijuana]]
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| *Melatonin receptor agonists: [[Ramelteon]]
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| *[[Meningitis]]
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| *[[Meningoencephalitis]]
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| *[[Mesenteric ischemia]]
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| *[[Methanol]]
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| *[[Muscle relaxant]]
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| *[[Myocardial infarction]]
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| *[[Myxedema coma]]
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| *[[Neurocysticercosis]]
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| *[[Neurosyphilis]]
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| *[[Niacin|Niacin deficiencies]]
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| *[[Nickel|Nickel poisoning]]
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| *[[Nonconvulsive status epilepticus]]
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| *[[Organic solvent]]
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| *[[Pituitary apoplexy]]
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| *[[Phaeochromocytoma]]
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| *[[Phencyclidine]]
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| *[[Pituitary apoplexy]]
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| *[[Plague]]
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| *[[Conium|Poison hemlock]]
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| *[[Polycythemia]]
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| *[[Porphyria]]
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| *[[Postictal state]]
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| *Postoperative [[stress]]
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| *[[Pyelonephritis, acute]]
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| *[[Quinolones]]
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| *[[Rabies]]
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| *[[Raised intracranial pressure]]
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| *[[Renal failure, acute]]
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| *[[Renal failure, chronic]]
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| *[[Respiratory failure]]
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| *[[Rickettsiae]]
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| *[[Schizoaffective disorder]]
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| *[[Sepsis]]
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| *[[Serotonin syndrome]]
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| *[[Skull fracture]]
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| *[[Sleep apnea]]
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| *[[Sleeping sickness (East African)]]
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| *[[Sleeping sickness (West African)]]
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| *[[Starvation]]
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| *[[Subdural empyema]]
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| *[[Subdural hematoma]]
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| *[[Subarachnoid hemorrhage]]
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| *[[Wound#infectionSurgical wound infection]]
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| *[[Systemic infection]]
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| *[[systemic inflammatory response syndrome]]
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| *[[Multiple organ dysfunction syndrome|Systemic organ failure]]
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| *[[Mescalbean|Texas Mescalbean poisoning]]
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| *[[Thiamine (Vitamin B1) deficiency]]
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| *[[Thallium|Thallium Sulfate poisoning]]
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| *[[Thrombocytosis]]
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| *[[Thyrotoxicosis]]
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| *[[Toluene]]
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| *[[Toxic mushrooms -- Monomethylhydrazine]]
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| *[[Trauma]]
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| *[[Typhoid fever]]
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| *[[Uremia]]
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| *[[Urinary tract infection]]
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| *[[Valproic acid]]
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| *[[Vancomycin resistant enterococcal bacteremia]]
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| *[[Vasculitis]]
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| *[[Venous sinus thrombosis]]
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| *[[Ventricular arrhythmia]]
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| *[[Viral hemorrhagic fever]]
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| *[[Vitamin B12 deficiency]]
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| *[[Conium|Water hemlock poisoning]]
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| *[[Wernicke's encephalopathy]]
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| *[[Wilson's disease]]
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| *Withdrawal states e.g. [[ethanol]], [[benzodiazepines]]
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| [[Acute altitude sickness]],
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| [[Acute disseminated encephalomyelitis]],
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| [[Advanced sleep phase disorder]],
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| [[Bacterial meningitis]],
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| [[Basilar occlusion]],
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| [[Anterior cerebral artery|Bilateral anterior cerebral artery occlusion]],
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| [[Internal carotid artery|Bilateral internal carotid occlusion]],
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| [[Basal ganglia diseases]]
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| [[Brain abscess]],
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| [[Brain damage]],
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| [[Brain edema]],
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| [[Brain infection]]
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| [[Brain tumor]],
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| [[Brainstem stroke|Brainstem hemorrhage]],
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| [[Brain stem infarction]],
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| [[Brainstem thrombencephalitis]]
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| [[Central pontine myelinolysis]],
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| [[Cerebral hypoxia]],
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| [[Cerebral infarction]],
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| [[Cerebral malaria]]
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| [[Cerebral oedema]],
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| [[Cerebral vasculitis]],
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| [[Cerebrovascular accident]],
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| [[Lower respiratory tract infection classification|Chest infection]],
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| [[Creutzfeldt-jakob disease]],
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| [[Decompression sickness]],
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| [[Delayed sleep phase syndrome]],
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| [[Dementia]],
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| [[Dialysis encephalopathy]],
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| [[Encephalitis]],
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| [[Encephalopathy]]
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| [[Epidural abscess]]
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| [[Epidural haemorrhage]],
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| [[Epidural hematoma]],
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| [[Epileptic seizures]],
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| [[Extradural hematoma]],
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| [[Fat emboli]],
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| [[Fits]],
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| [[Fungal meningitis]],
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| [[Gangrene ]],
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| [[Head injury]],
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| [[Hepatic encephalopathy]],
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| [[Hydrocephalus]],
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| [[Hyperbaric sickness]],
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| [[Hyperosmolar non-ketotic diabetic coma]],
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| [[Hypertensive encephalopathy]],
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| [[Intracerebral hemorrhage]],
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| [[Intracranial granuloma]],
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| [[Intracranial space-occupying lesion]],
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| [[Korsakoff's Syndrome]],
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| [[Leukoencephalopathy]],
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| [[Lewy body dementia]],
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| [[Lyme disease]]
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| [[Malaria]]
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| [[Massive or bilateral supratentorial infarction]],
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| [[Meningitis]],
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| [[Meningoencephalitis]],
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| [[Progressive multifocal leukoencephalopathy|Multifocal leukoencephalopathy]],
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| [[Multiple sclerosis]],
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| [[Neurocysticercosis]],
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| [[Neurosyphilis]],
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| [[Nonconvulsive status epilepticus]],
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| [[Pain]],
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| [[Panayiotopoulos syndrome]],
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| [[Pick's disease]] ,
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| [[Plague ]],
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| [[Intracranial haemorrhage|Pontine hemorrhage]] ,
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| [[Postictal state]],
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| [Encephalomyelitis[|Postinfectious encephalomyelitis]],
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| [[Pyelonephritis, acute]],
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| [[Rabies ]],
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| [[Raised intracranial pressure]],
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| [[Reversible posterior leukoencephalopathy syndrome]],
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| [[Reye's syndrome]],
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| [[Rickettsiae]],
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| [[Superior sagittal sinus thrombosis|Sagittal sinus thrombosis]],
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| [[Seizure]],
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| [[Sepsis]]
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| [[Sleeping sickness (East African)]],
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| [[Sleeping sickness (West African)]],
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| [[Stroke]],
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| [[Subarachnoid haemorrhage]],
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| [[Subdural empyema]],
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| [[Subdural haemorrhage]]
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| [[Infection|Surgical wound infection]]
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| [[Systemic infection]],
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| [[systemic inflammatory response syndrome]]
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| [[Typhoid fever]]
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| [[Urinary tract infection]]
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| [[Vancomycin resistant enterococcal bacteremia]]
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| [[Venous sinus thrombosis]]
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| [[Viral hemorrhagic fever]],
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| Neurology
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| [[Acute altitude sickness]], [[acute disseminated encephalomyelitis]], [[advanced sleep phase syndrome|advanced sleep phase disorder]], [[bacterial meningitis]], basilar occlusion, [[Anterior cerebral artery|bilateral anterior cerebral artery occlusion]], [[Internal carotid artery|bilateral internal carotid occlusion]], [[basal ganglia diseases]] [[brain abscess]], [[brain damage]], [[brain edema]], [[brain infection]], [[brain tumor]], [[brainstem stroke|brainstem hemorrhage]], [[brain stem infarction]], [[central pontine myelinolysis]], [[cerebral hypoxia]], [[cerebral infarction]], [[cerebral malaria]], [[cerebral oedema]], [[cerebral vasculitis]], [[cerebrovascular accident]], [[Lower respiratory tract infection classification|chest infection]], [[Creutzfeldt-Jakob disease]], [[decompression sickness]], [[delayed sleep phase syndrome]], [[dementia]], [[dialysis encephalopathy syndrome|dialysis encephalopathy]], [[encephalitis]], [[encephalopathy]], [[epidural abscess]], [[epidural haemorrhage]], [[epidural hematoma]], [[epileptic seizures]], [[extradural hematoma]], [[fat emboli]], [[fits]], [[fungal meningitis]], [[gangrene]], [[head injury]], [[hepatic encephalopathy]], [[hydrocephalus]], [[hyperbaric sickness]], [[hyperosmolar non-ketotic diabetic coma]], [[hypertensive encephalopathy]], [[intracerebral hemorrhage]], [[intracranial granuloma]], [[intracranial space-occupying lesion]], [[Korsakoff's Syndrome]], [[leukoencephalopathy]], [[Lewy body dementia]], [[Lyme disease]], [[malaria]], [[massive or bilateral supratentorial infarction]], [[meningitis]], [[meningoencephalitis]], [[Progressive multifocal leukoencephalopathy|multifocal leukoencephalopathy]], [[multiple sclerosis]], [[neurocysticercosis]], [[neurosyphilis]], [[nonconvulsive status epilepticus]], [[pain]], [[panayiotopoulos syndrome]], [[Pick's disease]], [[plague]], [[Intracranial haemorrhage|pontine hemorrhage]], [[postictal state]], [[Encephalomyelitis|postinfectious encephalomyelitis]], [[pyelonephritis, acute]], [[rabies]], [[raised intracranial pressure]], [[reversible posterior leukoencephalopathy syndrome]], [[Reye's syndrome]], [[superior sagittal sinus thrombosis|sagittal sinus thrombosis]], [[seizure]], [[sepsis]], [[sleeping sickness (East African)]], [[sleeping sickness (West African)]], [[stroke]], [[subarachnoid haemorrhage]], [[subdural empyema]], [[subdural haemorrhage]],[[Infection|surgical wound infection]][[venous sinus thrombosis]]
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| Altered mental status has varying time courses and degrees of severity. Acute changes in mental status are usually secondary to [[delirium]], [[stupor]], and [[coma]], which are forms of acute brain dysfunction. These changes occur over a period of hours or days and are usually precipitated by an underlying medical illness that is potentially life threatening. Chronic alterations in mental status (e.g. dementia) occur over a period of months and years and are less likely to be precipitated by a life-threatening illness. For these reasons, acute changes in mental status will be the focus of this review. Altered mental status is rarely caused by psychiatric illnesses such as [[depression]] or [[schizophrenia]], and in elder patients, these should be diagnoses of exclusion. Acute brain dysfunction ([[delirium]], [[stupor]], and [[coma]]) and their underlying etiology should be ruled out prior to considering any psychiatric diagnoses, especially in patients without a previous history of psychiatric illness.
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