Difference between revisions of "Altered mental status"
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''This page is for <u>adult</u> altered mental status. See [[altered mental status (peds)]] for the pediatric page.'' | ''This page is for <u>adult</u> altered mental status. See [[altered mental status (peds)]] for the pediatric page.'' | ||
==Background== | ==Background== | ||
| − | * | + | *Acute alteration in brain function |
| + | **May include alteration of arousal or awareness, thought content, memory, or attention | ||
*Both cerebral cortices or brainstem must be affected | *Both cerebral cortices or brainstem must be affected | ||
| − | *[[Delirium]] vs [[dementia]] vs | + | *[[Delirium]] vs [[dementia]] vs other organic pathology vs functional (psychiatric) |
*Must quickly determine if coma is from diffuse or focal impairment | *Must quickly determine if coma is from diffuse or focal impairment | ||
Revision as of 18:07, 21 March 2019
This page is for adult altered mental status. See altered mental status (peds) for the pediatric page.
Contents
Background
- Acute alteration in brain function
- May include alteration of arousal or awareness, thought content, memory, or attention
- Both cerebral cortices or brainstem must be affected
- Delirium vs dementia vs other organic pathology vs functional (psychiatric)
- Must quickly determine if coma is from diffuse or focal impairment
Clinical Features
- Depends on cause
- Diffuse brain dysfunction - lack of focal findings
- Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes
Differential Diagnosis
Altered mental status
Diffuse brain dysfunction
- Hypoxic encephalopathy
- Acute toxic-metabolic encephalopathy (Delirium)
- Hypoglycemia
- Hyperosmolar state (e.g., hyperglycemia)
- Electrolyte Abnormalities (hypernatremia or hyponatremia, hypercalcemia)
- Organ system failure
- Hepatic Encephalopathy
- Uremia/Renal Failure
- Endocrine (Addison's disease, Cushing syndrome, hypothyroidism, myxedema coma, thyroid storm)
- Hypoxia
- CO2 narcosis
- Hypertensive Encephalopathy
- Toxins
- TTP / Thrombotic thrombocytopenic purpura
- Alcohol withdrawal
- Drug reactions (NMS, Serotonin Syndrome)
- Environmental causes
- Deficiency state
- Wernicke encephalopathy
- Subacute Combined Degeneration of Spinal Cord (B12 deficiency)
- Vitamin D Deficiency
- Zinc Deficiency
- Sepsis
- Osmotic demyelination syndrome (central pontine myelinolysis)
- Limbic encephalitis
Primary CNS disease or trauma
- Direct CNS trauma
- Diffuse axonal injury
- Subdural/epidural hematoma
- Vascular disease
- SAH
- Stroke
- Hemispheric, brainstem
- CNS infections
- Neoplasms
- Paraneoplastic Limbic encephalitis
- Malignant Meningitis
- Pancreatic Insulinoma
- Seizures
- Nonconvulsive status epilepticus
- Postictal state
- Dementia
Psychiatric
- Acute psychosis
- Excited delirium
- Malingering
Evaluation
AMS Workup
Common Orders
Consider Based on Clinical Situation
- Blood and urine cultures
- Ammonia level
- Tylenol/Aspirin level
- LP
- Serum Osm
- Coags
- Cortisol
- ABG/VBG
- CO level
Management
- Patients with focal findings may have surgically treatable cause
- Coma cocktail
- Treat underlying cause
Disposition
- Most frequently admission, unless of a chronic and known etiology
See Also
Video