Altered mental status (geriatrics): Difference between revisions
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==Background== | ==Background== | ||
*Elderly patients present differently with common issues | *Elderly patients present differently with common issues | ||
*Unique aspects of elderly | *Unique aspects of elderly altered mental status | ||
*See [[ | *See [[altered mental status]] for complete differential list | ||
*Dementia should be diagnosis of exclusion | *Dementia should be diagnosis of exclusion | ||
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'''Meningitis''' | '''Meningitis''' | ||
*Usually other etiology for | *Usually other etiology for altered mental status, but if negative workup do LP | ||
*Consider [[Ampicillin]] for listeria | *Consider [[Ampicillin]] for listeria | ||
*Consider acyclovir for HSV | *Consider acyclovir for HSV | ||
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'''UTI''' | '''UTI''' | ||
*Very common etiology for | *Very common etiology for altered mental status in elderly | ||
*Straight cath UA | *Straight cath UA | ||
*Resistant organisms likely, look up old urine culture + sensetivity | *Resistant organisms likely, look up old urine culture + sensetivity | ||
Revision as of 13:02, 31 July 2016
Background
- Elderly patients present differently with common issues
- Unique aspects of elderly altered mental status
- See altered mental status for complete differential list
- Dementia should be diagnosis of exclusion
Infectious
Encephalitis
- Mental status changes - personality/behavior changes
- Unlikely to have fevers, meningismus
- High risk: same for meningitis, live near water
Meningitis
- Usually other etiology for altered mental status, but if negative workup do LP
- Consider Ampicillin for listeria
- Consider acyclovir for HSV
- High risk: HIV, DM, malignancy, s/p ceftriaxone, prior NSG, alcoholism, recent sinusitis
Pneumonia
- False negative CXR ~15-20%
- High morbidity
UTI
- Very common etiology for altered mental status in elderly
- Straight cath UA
- Resistant organisms likely, look up old urine culture + sensetivity
- High risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, history prostate cancer
Cholecystitis
- May not have RUQ pain or GI symptoms
- Ask about history of gallstones/US RUQ
Skin/Soft Tissue
- Completly undress to examine
- Often decubs present
- Old photos helpful
- Consider fistula, osteo, necrotizing
Metabolic/Toxic/Polypharmacy
Withdrawl/Overdose
- Chronic opiate/Benzo/Ambien use
- EtOH abuse - may not experience tremors in withdrawal
Polypharmacy
- NSAIDS - may be taking multiple
- Long term ASA
- Steroids
- Sedative/Psychoactives
- Anticholinergics - many OTC
- Meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, diphenhydramine
- Dietary - teas, supplements
Other
- Cardiac Ischemia - no chest pain needed
- Seizure v Post ictal
- Urinary retention - uremia
- Fecal impaction
- Occult mesenteric ischemia
- Ca/Mg/Phos
See Also
References
ACEP Academic Affairs Committee Geriatric Video lecture series SAEM Academy of Geriatric Emergency Medicine