Altered mental status causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]

Causes

Life Threatening Causes

Altered mental status is a life-threatening condition and must be treated as such irrespective of the causes.

Common Causes

• Acute systemic infection
• Acute psychosis
• Alcohol withdrawal
• Alcohol toxicity
• Congestive heart failure
• CVA
• Dehydration (volume depletion)
• Dementia
• Delirium
• Depression
• Drug toxicity
• Drug withdrawal
• Head injury

• Hepatic encephalopathy
• Hip fracture
• Hypercarbia
• Hyperglycemia
• Hypoglycemia
• Hypernatremia
• Hyponatremia
• Hypothermia
• Hypoxia
• Myocardial infarction
• Pulmonary embolism
• Seizures
• Uremia
• Ventricular arrhythmia

Causes by Organ System

Cardiovascular	Malignant hypertension, Heart failure, Myocardial infarction, Congestive heart failure, Ventricular arrhythmia
Chemical/Poisoning	Withdrawal states from ethanol, benzodiazepines,Water hemlock poisoning, Toxic mushrooms -- Monomethylhydrazine ,Toluene, Texas Mescalbean poisoning,Poison hemlock, Organic solvent, Methanol , Marijuana, Lead, Jimson weed, Hyperbaric sickness, Hydrogen sulfide , Heroin ,Hallucinogens, Ethylene glycol, Ethanol, Daphne poisoning, Cyanide, Carbon tetrachloride, Carbon monoxide toxicity, Alcohol withdrawal, Thallium Sulfate poisoning,Phencyclidine poisoning, Nickel, Carbonyl poisoning
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Valproic acid, Muscle relaxants, Serotonin syndrome, Quinolones, Lithium, Drug withdrawal, Drug overdose,Cabergoline, Antipsychotics, Antihistamines
Ear Nose Throat	No underlying causes
Endocrine	Pituitary apoplexy, Phaeochromocytoma, Hypothyroidism, Hypopituitarism, Hypoglycemia, Hyperthyroidism,Hyperosmolar non-ketotic diabetic coma, Hyperglycemia, Hyperthyroidism, Elevated or depressed pituitary function ,Elevated or depressed adrenal function, Diabetic ketoacidosis, Diabetic hypoglycemia, Cushing syndrome, Adrenal cortex insufficiency , Thyrotoxicosis, Myxedema coma, Pituitary apoplexy
Environmental	Hypothermia, Hyperthermia, Heat stroke, Electric shock, Decompression sickness, Acute Altitude sickness
Gastroenterologic	Elevated or depressed pancreas function, Chronic Liver failure, Acute Liver failure, Mesenteric ischemia, Appendicitis, Acute diverticulitis, Constipation
Genetic	No underlying causes
Hematologic	Thrombocytosis, Polycythemia, Leukemic blast cell crisis, Hypereosinophilia
Iatrogenic	Postoperative stress
Infectious Disease	Viral hemorrhagic fever, Vancomycin resistant enterococcal bacteremia, Urinary tract infection, Typhoid fever, systemic inflammatory response syndrome, Systemic infection, Wound#infectionSurgical wound infection, Subdural empyema, Sleeping sickness (West African), Sleeping sickness (East African), Sepsis, Rickettsiae, Rabies , Pyelonephritis, acute, Plague , Neurocysticercosis,Malaria, Intraspinal abscess / granuloma, Intracranial abscess / granuloma, Gangrene , Chest infection, Cerebral malaria,Brain or epidural abscess, Brain infection
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	Venous sinus thrombosis, Raised intracranial pressure, Postictal state, Nonconvulsive status epilepticus,Meningoencephalitis, Meningitis, Intracranial bleeding, Hypertensive encephalopathy, Epileptic seizures, Epidural haemorrhage,Encephalitis, Encephalitis, Cerebrovascular accident, Cerebral oedema, Cerebral infarction, Brain tumor, Brain abscess, Subdural hematoma, Epidural hematoma
Nutritional/Metabolic	Wilson's disease, Wernicke's encephalopathy, Vitamin B12 deficiency, Thiamine (Vitamin B1) deficiency, Niacin deficiencies, Folate deficiency, Acute intermittent porphyria
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Schizoaffective disorder
Pulmonary	Respiratory failure, Hypoxemia, Hypercarbia
Renal/Electrolyte	Hypophosphatemia, hypoosmolar states, Hyponatremia, Hypocalcemia, Hyperosmolar states, Hypernatremia, Hypermagnesemia, Hypercalcemia, Hypomagnesemia, Hyperphosphatemia, Chronic Renal failure, Acute Renal failure, Uremia
Rheumatology/Immunology/Allergy	Vasculitis
Sexual	No underlying causes
Trauma	Trauma, Skull fracture, Head injury
Urologic	No underlying causes
Miscellaneous	Coproporphyria, Burns

Causes in Alphabetical Order

Acute diverticulitis Acute intermittent porphyria Appendicitis Acute Liver failure Acute Renal failure Adrenal cortex insufficiency Alcohol withdrawal Acute altitude sickness Antihistamines Antipsychotics Brain abscess Brain infection Brain or epidural abscess Brain tumor Burns Cabergoline Carbon monoxide toxicity Carbon tetrachloride Cardiac failure Cerebral infarction Cerebral malaria Cerebral oedema Cerebrovascular accident Congestive heart failure Constipation Chest infection Chronic Liver failure Chronic Renal failure Coproporphyria, hereditary Cushing syndrome Cyanide Daphne poisoning Decompression sickness Diabetic hypoglycemia Diabetic ketoacidosis Drug overdose Drug withdrawal Electric shock Elevated or depressed adrenal function Elevated or depressed pancreas function Elevated or depressed pituitary function Encephalitis Encephalitis Epidural hematoma Epidural haemorrhage Epileptic seizures Ethanol Ethylene glycol Fat embolism Folate deficiency Gangrene Hallucinogens Head injury Heart failure

Heat stroke Heroin Hperthyroidism Hpherphosphatemia Hydrogen sulfide Hyomagnesemia Hyperbaric sickness Hypercalcemia Hypercarbia Hypereosinophilia Hyperglycemia Hypermagnesia Hypernatremia Hyperosmolar non-ketotic diabetic coma Hyperosmolar states Hypertensive encephalopathy Hyperthermia Hyperthyroid Hypocalcemia Hypoglycemia Hyponatremia hypoosmolar states Hypophosphatemia Hypopituitarism Hypothermia Hypothyroidism Hypoxemia Hypoxia Infections Intracranial abscess / granuloma Intracranial bleeding Intraspinal abscess / granuloma Jimson weed Lead Leukemic blast cell crisis Lithium Liver failure Malaria Malignant hypertension Marijuana Meningitis Meningoencephalitis Mesenteric ischemia Methanol Muscle relaxant Myocardial infarction Myxedema coma Neurocysticercosis Niacin deficiencies Nickel poisoning Nonconvulsive status epilepticus

Organic solvent Pituitary apoplexy Phaeochromocytoma Phencyclidine Pituitary apoplexy Plague Poison hemlock Polycythemia Porphyria Postictal state Postoperative stress Pyelonephritis, acute Quinolones Rabies Raised intracranial pressure Renal failure, acute Renal failure, chronic Respiratory failure Rickettsiae Schizoaffective disorder Sepsis Serotonin syndrome Skull fracture Sleeping sickness (East African) Sleeping sickness (West African) Subdural empyema Subdural hematoma Wound#infectionSurgical wound infection Systemic infection systemic inflammatory response syndrome Systemic organ failure Texas Mescalbean poisoning Thiamine (Vitamin B1) deficiency Thallium Sulfate poisoning Thrombocytosis Thyrotoxicosis Toluene Toxic mushrooms -- Monomethylhydrazine Trauma Typhoid fever Uremia Urinary tract infection Valproic acid Vancomycin resistant enterococcal bacteremia Vasculitis Venous sinus thrombosis Ventricular arrhythmia Viral hemorrhagic fever Vitamin B12 deficiency Water hemlock poisoning Wernicke's encephalopathy Wilson's disease Withdrawal states e.g. ethanol, benzodiazepines

References