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

Common Causes

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, 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 No underlying causes
Drug Side Effect Acyclovir, Alfentanil, Alphaprodine, Amantadine, Amiloride, Aminoglycosides, Aminophylline, Amitriptyline, AmlodipineAmobarbitalAmphetamine, Amphotericin B, AnalgesicsAntiarrhythmics, 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, 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, EszopicloneEthosuximide, Ethotoin, Ethylmorphine, Fentanyl, Fludarabine, Fluoroquinolones, gabapentinGeneral 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, Nonsteroidal anti-inflammatory drugs, Norfloxacin, Norpropoxyphene, Nortriptyline, Noscapine, olanzapine, Opiates, Opium, Nitrazepam, 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, Sulfonamidesthioridazine, tricyclic antidepressants,Zaleplon, ziprasidone zolpidem, zopiclone
Ear Nose Throat Burns, chester porphyria, decompression sickness, porphyria
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 Hypothermia, hyperthermia, heat stroke, electric shock, decompression sickness, acute Altitude sickness
Gastroenterologic Acute diverticulitis, Acute Liver failure, Appendicitis, carcinoid crisis , Chronic liver failure, Chronic Liver failure, Cirrhosis of liver, Constipation Elevated or depressed pancreas function, 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, 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 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, Infectious mononucleosis (glandular fever), Lyme disease
Musculoskeletal/Orthopedic Fibromyalgia
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 Urinary Track Infection
Miscellaneous Coproporphyria, Burns, Chronic fatigue syndrome

Causes in Alphabetical Order

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