Altered mental status

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This page is for adult altered mental status. See altered mental status (peds) for the pediatric page.

Background

  • Alteration of arousal or content of consciousness or both
  • Both cerebral cortices or brainstem must be affected
  • Delirium vs dementia vs psych
  • 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

Primary CNS disease or trauma

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

References