Altered mental status: Difference between revisions
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==Background == | {{Adult top}} [[altered mental status (peds)]] | ||
* | ==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 | ||
==Clinical Features== | ==Clinical Features== | ||
*Depends on cause | *Depends on cause | ||
**Diffuse brain dysfunction - lack of focal findings | **Diffuse brain dysfunction - lack of focal findings | ||
**Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes | **[[focal neuro deficits|Focal brain dysfunction]] - hemiparesis, loss of motor tone, loss of ocular reflexes | ||
*Important to differentiate diffuse brain dysfunction from localized lesion as a patient may appear confused due to visual deficit, dysphasia, etc. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{AMS DDX}} | {{AMS DDX}} | ||
== | ==Evaluation== | ||
{{AMS workup}} | {{AMS workup}} | ||
== | ==Management== | ||
*Patients with focal findings may have surgically treatable cause | *Patients with focal findings may have surgically treatable cause | ||
*Coma cocktail | *Coma cocktail | ||
**[[Glucose]], [[thiamine]], [[naloxone]] | **[[dextrose|Glucose]], [[thiamine]], [[naloxone]] | ||
*Treat underlying cause | *Treat underlying cause | ||
| Line 27: | Line 28: | ||
*Most frequently admission, unless of a chronic and known etiology | *Most frequently admission, unless of a chronic and known etiology | ||
==See Also == | ==See Also== | ||
*[[Toxicology (Main)]] | *[[Toxicology (Main)]] | ||
*[[Glasgow Coma Scale (GCS)]] | *[[Glasgow Coma Scale (GCS)]] | ||
*[[Altered | *[[Altered mental status (peds)]] | ||
*[[AVPU Scale]] | *[[AVPU Scale]] | ||
*[[Brain Death]] | *[[Brain Death]] | ||
| Line 38: | Line 39: | ||
==References== | ==References== | ||
<references/> | |||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Symptoms]] | |||
Revision as of 22:48, 28 November 2019
This page is for adult patients. For pediatric patients, see: altered mental status (peds)
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
- Important to differentiate diffuse brain dysfunction from localized lesion as a patient may appear confused due to visual deficit, dysphasia, etc.
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
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
{{#widget:YouTube|id=Sc0ObjHa3VA}}