Altered mental status differential full#

See also “ Approach to the poisoned patient.”.

See also “ Overview of substance intoxication and withdrawal.”.

Adverse drug events: e.g., anticholinergic overdose, salicylate toxicity, serotonin syndrome, NMS.

Withdrawal: e.g., alcohol withdrawal, opioid withdrawal.

Intoxication: e,g., CNS stimulants, CNS depressants.

Adrenal dysfunction: e.g., Cushing syndrome, adrenal insufficiency.

Thyroid disorders: e.g., thyroid storm, myxedema coma.

Acid-base disorders: e.g., metabolic acidosis.

Anoxic brain injury: e.g., after cardiac arrest.

Elevated intracranial pressure, e.g., acute hydrocephalus, IIH.

Posterior reversible encephalopathy syndrome ( PRES).

Seizure (e.g., NCSE) or postictal state.

Malignancy: primary or metastatic brain tumors.

Autoimmune disease: e.g., vasculitis, ADEM.

Infections: e.g., meningitis, encephalitis, CNS abscess.

Vascular insult: e.g., ischemic stroke, SAH, TTP.

EtiologyĬauses of altered mental status and coma Treatment is focused on the management of the underlying etiology in addition to providing supportive care and preventing complications.

Altered mental status differential full#

Once stabilized, a full diagnostic evaluation should be performed based on the suspected underlying etiology this may include basic laboratory studies, ECG, head imaging, and lumbar puncture. Coma scores are used to assess and monitor the level of neurological dysfunction. Initial management includes stabilization (e.g., definitive airway management) and screening for life-threatening acutely reversible causes (e.g., hypoglycemia, opioid overdose). There are many potential causes of altered mental status, including primary CNS processes, general medical conditions, substance use, and psychiatric illness. Altered mental status (AMS) is an acute change in cognitive function, psychological function, and/or level of consciousness and can manifest with confusion, behavioral changes, and changes in alertness ranging from hyperalertness to somnolence or even coma.