Altered Mental Status

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					                                  Altered Mental Status

This is a very common reason to present to the ER and/or get admitted to the
hospital. It is also a common cross cover call at night! Altered mental status can
include both benign and catastrophic causes. A comprehensive approach is
needed…I like the “top down” memory tool (as opposed to a lengthy
pneumonic.) Draw the stick man and you won’t miss anything, even when you
are on call, tired, and not thinking straight.

Once you have ruled out these more serious etiologies, on the inpatient side you
are probably dealing with medication effects or sundowning. Many elderly
patients with mild dementia (perhaps even undetected) worsen in the evening in
an unfamiliar setting such as the hospital. Having family members or a sitter
stay with them will help. Haloperidol is the medication of choice;
benzodiazepines second line.

   Head: primary CNS events
          --stroke
          --seizure
          --meningitis/encephalitis
          --increased ICP (cerebral edema;
          bleed)

   Mouth: think ingestions
          --sedatives, sleep agents
          --polypharmacy
          --alcohol, illicits
          --withdrawal states

   Neck: thyroid disease

   Chest: Cardiac
          --tachy/bradyarrythmias with cerebral
          hypoperfusion
          --PFO
          Pulmonary
          --hypercarbia or hypoxemia
   Belly:
          --hepatic encephalopathy
          --gut infection/infarction/perforation (if
          septic, hypotensive)
          --UTI

   Periphery: think bloodstream
           --hypo/hypernatremia
           --hypercalcemia
           --hypo/hyperglycemia
           --bacteremia, early sepsis

				
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posted:5/2/2013
language:English
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