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] Kiran Singh, M.D. [3]

Overview

Life threatening causes of altered mental status include malignant hypertension, myocardial infarction, rabies and sepsis. Other common causes of altered mental status include alcohol withdrawal, dehydration, electrolyte disturbance and hypoglycemia.

Causes

Life Threatening Causes

• Carbon monoxide toxicity
• Heat stroke
• Hypothermia
• Malignant hypertension
• Myocardial infarction
• Rabies
• Sepsis

Common Causes

• Alcohol withdrawal
• Drug withdrawal
• Dehydration
• Electrolyte disturbance
• Encephalitis
• Epileptic seizures
• Hyperglycemia
• Hypoglycemia
• Meningitis
• Sepsis

Causes by Organ System

Cardiovascular	Carotid artery stenosis, congestive heart failure, decreased cardiac output ,disseminated intravascular coagulation, heart attack, hypotension, hypoxemia, malignant hypertension, myocardial infarction, nonbacterial thrombotic endocarditis, pulmonary embolism, rheumatic fever, shock, sleep apnea, stroke, subacute bacterial endocarditis, ventricular arrhythmia
Chemical/Poisoning	Atropa belladonna extract, bromide, brown snake poisoning, carbon monoxide poisoning, carbon tetrachloride, carbonyl poisoning, coral snake poisoning, cyanide, daphne poisoning, ethanol, ethylene glycol, gamma hydroxybutyrate, hallucinogens, heroin, hydrocarbon poisoning, hydrogen sulfide, hypomagnesemia, iron compounds, Jimson weed, ketamine, lead, lithium, mandrake, manganese, marijuana, methanol, milk poisoning, nickel, organic solvent, paraldehyde, perazine, phencyclidine poisoning, poison hemlock, psilocybin, snake bite, spider bite,Texas Mescalbean poisoning, thallium sulfate poisoning, toluene, water hemlock poisoning
Dental	No underlying causes
Dermatologic	Burns, chester porphyria, decompression sickness, porphyria
Drug Side Effect	Acyclovir, alfentanil, alphaprodine, amantadine, amiloride, aminoglycosides, aminophylline, amitriptyline, amlodipineamobarbital, amphetamine, amphotericin B, analgesics, antiarrhythmics, anticholinergics, antidepressants, antiemetics, antihistamines antimalarials, antipsychotic agents, antispasmodics, apomorphine, aripiprazole, armodafinil, amobarbital, asparaginase, aspirin, atropine, baclofen, barbiturates, benzodiazepines, beta blockers, blinatumomab, bromocriptine, bupivacaine, buprenorphine, butorphanol, cabergoline, camphorated opium tincture, carbamazepine, cephalosporins, chlophedianol, chloroquine, chlorpheniramine, chlorpromazine,cholinesterase inhibitors, cinnarizine, ciprofloxacin, clomethiazole, clonazepam, clonidine, clozapine, cocaine, codeine, corticosteroids, cyclazocine, cyclobenzaprine, cycloserine, deserpidine, desipramine, dexamfetamine, dextromoramide, dezocine, diamorphine, diazepam, digoxin, dihydrocodeine, diphenhydramine, dipipanone, disulfiram, diuretics, domperidone, donepezil, dopamine agonists, dothiepin, doxylamine, drug overdose, drug withdrawal, efavirenz, eszopiclone, ethosuximide, ethotoin, ethylmorphine, fentanyl, fludarabine, fluoroquinolones, gabapentin, general anaesthesia, glutethimide, guanethidine, hallucinogens, histamine-2 receptor blocker, hydromorphone, hydroxyzine, ifosfamide, interferon, interleukin, isoniazid, ketobemidone, L-dopa, lanatoside C, lenalidomide, levetiracetam, levodopa, levomepromazine, levorphanol, lidocaine, linezolid, lithium, loperamide, lorazepam, lysergic acid diethylamide, lysuride, macrolides, marijuana, memantine, meptazinol, mescaline, methadone, methadyl acetate, methcathinone, methyldopa, methyldopate, methylenedioxymethamphetamine, methylphenidate, metronidazole, mirtazapine, monoamine oxidase inhibitors, monomethylhydrazine, morphine, muscle relaxant, mushrooms, nabilone, nalbuphine, nalidixic acid, nelarabine, nitrazepam, nonsteroidal anti-inflammatory drugs, norfloxacin, norpropoxyphene, nortriptyline, noscapine, olanzapine, opiates, opium, oxazepam, oxycodone, oxycontin, oxymorphone, papaveretum, penicillins, pentazocine, perampanel, pergolide, pethidine, phenazocine, phencyclidine, phenelzine, phenobarbital, phenoperidine, phenothiazines, phentermine, phenytoin, pholcodine, piribedil, piritramide, pizotifen, pomalidomide, pramipexole, prednisolone, primidone, prochlorperazine, propoxyphene, propranolol, psychotropics, quetiapine, quinine, quinolones, ramelteon, rasagiline, remifentanil, reserpine, retigabine, rifampin, risperidone, rivastigmine, ropinirole, salicylate, secobarbital, sedative hypnotics, sedatives, selective serotonin reuptake inhibitors, selegiline, skeletal muscle relaxant, st John's wort, steroid abuse, sufentanil, sulfonamides, thioridazine, tricyclic antidepressants, zaleplon, ziprasidone, zolpidem, zopiclone
Ear Nose Throat	Presbyacusis
Endocrine	Addisonian crisis, adrenal cortex insufficiency, carcinoid crisis, cushing syndrome, diabetic coma, diabetic hypoglycemia, diabetic ketoacidosis, elevated or depressed adrenal function, elevated or depressed pancreas function, elevated or depressed pituitary function, hyperglycemia, hyperosmolar non-ketotic diabetic coma, hyperosmolar states, hyperthyroidism, hypoglycemia, hypopituitarism, hypothyroidism, myxedema coma, phaeochromocytoma, pituitary apoplexy, thyrotoxicosis
Environmental	acute altitude sickness, decompression sickness, electric shock, heat stroke, hyperthermia, hypothermia, sick building syndrome
Gastroenterologic	Acute diverticulitis, appendicitis, carcinoid crisis, cirrhosis of liver, constipation, folate deficiency, hepatic encephalopathy, hepatic failure, mesenteric ischemia, mucormycosis, Reye's syndrome, rhinocerebral mucormycosis rhinocerebral zygomycosis
Genetic	Acute intermittent porphyria, Adrenal leukodystrophy, Chester porphyria, citrullinemia type 2, coproporphyria hereditary,
Hematologic	Chester porphyria, disseminated intravascular coagulation, fat emboli, folate deficiency, hypovolemia, internal bleeding, hypercoagulable state, hypereosinophilia, leukostasis, methemoglobinemia, polycythemia, porphyria, prothrombotic state, pulmonary embolism, severe hemorrhage
Iatrogenic	Neuroleptic malignant syndrome, serotonin syndrome
Infectious Disease	Appendicitis, bacterial meningitis, bartonella infections, brain abscess, brain infection, Brill-Zinsser disease, cat scratch disease , cerebral abscess, cerebral malaria, chest infection, Creutzfeldt-Jakob disease, disseminated intravascular coagulation, epidemic typhus, epidural abscess, human immunodeficiency virus (HIV), infectious mononucleosis, intracranial abscess, intracranial granuloma, legionella infection, listeria, Lyme disease, malaria, mucormycosis, neurocysticercosis,neurosyphilis, plague, postoperative septicemia, pyelonephritis, acute, rabies, recrudescent typhus rhinocerebral mucormycosis, Rickettsiae, sepsis, septic shock, sleeping sickness (East African), sleeping sickness (West African), streptococcal infections, subacute bacterial endocarditis, subdural empyema, surgical wound infection, syphilis, systemic infection, systemic inflammatory response syndrome, typhoid fever, urinary tract infection, vancomycin resistant enterococcal bacteremia, viral hemorrhagic fever
Musculoskeletal/Orthopedic	Fat emboli, fibromyalgia, gangrene
Neurologic	Acute altitude sickness, acute disseminated encephalomyelitis, advanced sleep phase disorder, bacterial meningitis, basilar occlusion, bilateral anterior cerebral artery occlusion, bilateral internal carotid occlusion , basal ganglia diseases, brain abscess, brain damage, brain edema, brain infection, brain tumor, brainstem hemorrhage brain stem infarction, central pontine myelinolysis, Cerebral abscess, cerebral hypoxia, cerebral infarction, cerebral malaria, cerebral oedema, cerebral vasculitis, cerebrovascular accident, Creutzfeldt-Jakob disease, decompression sickness, delayed sleep phase syndrome, dementia, dialysis encephalopathy, encephalitis, encephalopathy, epidural abscess, epidural haemorrhage, epidural hematoma, epileptic seizures, extradural hematoma, fat emboli, fungal meningitis, gangrene, head injury, hepatic encephalopathy, hydrocephalus, hyperbaric sickness, hypertensive encephalopathy, intracerebral hemorrhage, intracranial abscess, intracranial granuloma, intracranial space-occupying lesion, Korsakoff's Syndrome, leukoencephalopathy, Lewy body dementia, massive or bilateral supratentorial infarction, meningitis, meningoencephalitis, midline brainstem tumor, multifocal leukoencephalopathy, multiple sclerosis, neurocysticercosis, neurosyphilis, nonconvulsive status epilepticus, pain, panayiotopoulos syndrome, Pick's disease, pontine hemorrhage, postictal state, postinfectious encephalomyelitis, raised intracranial pressure, reversible posterior leukoencephalopathy syndrome, Reye's syndrome, sagittal sinus thrombosis, seizure, stroke, subarachnoid haemorrhage, subdural haemorrhage
Nutritional/Metabolic	Acute intermittent porphyria, adrenal leukodystrophy, citrullinemia type 2, Cope's syndrome, coproporphyria,hereditary, folate deficiency, hyperammonemia, hypercalcaemia, hyperglycemia, hypermagnesemia, hypernatremia, hypocalcaemia, hypoglycaemia, hypokalaemia, hypomagnesemia, hyponatraemia, Korsakoff's Syndrome, lipid storage disorder, niacin deficiencies, niacin deficiency, pellagra,porphobilinogen synthase deficiency, starvation, thiamine (Vitamin B1) deficiency, vitamin B12 deficiency, Wilson's disease
Obstetric/Gynecologic	Eclampsia, hyperoestrogenic states, preeclampsia
Oncologic	Brain tumor, carcinoid crisis, leukemic blast cell crisis, midline brainstem tumor, phaeochromocytoma, subependymoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Advanced sleep phase disorder, alcohol withdrawal, anxiety state, bipolar disorder, brief psychotic disorder, catatonia, chronic fatigue syndrome, delayed sleep phase syndrome, dementia, depression, drug abuse, hysteria, Korsakoff's Syndrome, Lewy body dementia,mental health, narcolepsy, neuroleptic malignant syndrome, postoperative stress, psychiatric disorders, schizoaffective disorder,schizophrenia, suicide
Pulmonary	Respiratory failure, hypoxemia, hypercarbia
Renal/Electrolyte	Electrolyte disturbance, hypercalcaemia, hypermagnesemia, hypernatremia, hyperphosphatemia, hypocalcaemia, hypoglycaemia, hypokalaemia, hypomagnesemia, hyponatraemia, Hyperosmolar states, Hypoosmolar states, hypophosphatemia , interstitial nephritis, kidney failure, lactic acidosis, membranoproliferative glomerulonephritis, pyelonephritis, acute, renal failure, acute, renal failure, chronic, respiratory acidosis, uremia, dehydration
Rheumatology/Immunology/Allergy	Vasculitis
Sexual	No underlying causes
Trauma	Trauma, skull fracture, head injury
Urologic	Burnett's syndrome, Cope's syndrome
Miscellaneous	Coproporphyria, Burns, Chronic fatigue syndrome

Causes in Alphabetical Order

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