Altered mental status resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D.

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

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated

• 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

Diagnosis

Shown below is an algorithm summarizing the diagnosis of altered mental status according to the the American Academy of Neurology guidelines.

Patient with amnesia (Amnesia, confusion, loss of alertness, disorientation, disruption of judgement, behavior and perception)

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Evaluate ABCDEF • Airway • Breathing • Circulation • Disability (Glasgow coma scale) • Exposure (Rapid head to toe revision) • Fingerstick blood glucose

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Do's

• Perform an ABCDEF evaluation as a first step.
• If combative, use physical or chemical restraining.
• Take a non-contrasted CT scan of the head before contrasted when head trauma is suspected.
• Sodium imbalances should be slowly corrected to avoid a central pontine myelinolysis or a brain herniation.

Don'ts

• Do not administer glucose before thiamine, when Wernicke encephalopathy is suspected.