Altered mental status

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

Primary CNS disease or trauma

Psychiatric

Evaluation

AMS Workup

Common Orders

  • Point of care glucose
  • CBC
  • Chemistry
  • LFTs
  • UA
  • CXR
  • Utox
  • ECG
  • Head CT
  • CAM score

Consider Based on Clinical Situation

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

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References

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