Altered mental status resident survival guide
|Altered mental status Resident Survival Guide Microchapters|
Synonyms and Keywords: approach to delirium, approach to encephalopathy, encephalopathy workup, delirium workup
Altered mental status can result from a variety of factors, including alterations in the chemical environment of the brain, insufficient oxygen or blood flow in the brain, and excessive pressure within the skull. The level of consciousness may decline abruptly or slowly, or it may increase and decrease intermittently. Life threatening causes of altered mental status include malignant hypertension, myocardial infarction, rabies and sepsis. Other common causes of altered mental status include alcohol withdrawal, dehydration, electrolyte disturbance and hypoglycemia.
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated
- Carbon monoxide toxicity
- Heat stroke
- Malignant hypertension
- Myocardial infarction
- Alcohol withdrawal
- Drug withdrawal
- Electrolyte disturbance
- Epileptic seizures
- Perform an ABCDEF evaluation as a first step.
- If combative, use physical or chemical restraining.
- Take a non-contrasted CT scan of the head before contrasted when head trauma is suspected.
- Sodium imbalances should be slowly corrected to avoid a central pontine myelinolysis or a brain herniation.
- Do not administer glucose before thiamine, when alcoholism and thiamine deficiency is suspected. Administration of glucose before thiamine may lead to Wernicke encephalopathy.
- Do not assume psychiatric causes of altered mental status until the level of extent from other physical or chemical triggers is ruled out.
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