The most important part of the work-up will be the history and physical (of which the vital signs are of critical importance). The initial approach to patient with acute alteration in mental status should be systematic and focus on stabilizing the patient. The Glasgow Coma Scale can be an easy assessment tool initially to gauge a patient’s alertness. In a patient presenting with altered mental status and decreased alertness, one should rule out medical causes such as systemic illness, infection, intoxication, acute drug reactions, or trauma. Both cognition and behavior will be affected greatly by one’s level of alertness. Behavior refers to one’s reactions to one’s environment. Cognition refers to one’s ability to understand his or her environment, being able to integrate and process information. Any evaluation of mental status should consider the patient’s cognition, behavior, and alertness. Patients may present as hyper-vigilent and confused, or they may simply be forgetful, or obtunded and completely unresponsive. Therefore, in working up the patient with acute mental status changes, one should have a broad differential, but initially focus on problems that are easily correctible, or most life-threatening.īecause the degree of altered mental status can be so varied, there may be a wide range of clinical features. Approximately 85% of patients who present to an emergency room with acute altered mental status have either a metabolic or systemic cause.Ī patient’s mental status can be affected by virtually any organ system: cardiac, circulatory, pulmonary, metabolic, endocrine, immunologic, allergic, and neurologic or psychiatric. ![]() However, a decreased level of alertness is not typical, even in patients with primary psychiatric illnesses, and this usually points to a medical cause. ![]() In many patients, particularly the elderly, there may exist some degree of chronic, ongoing, cognitive impairment, psychiatric illness, or dementia. Acute altered mental status is a very broad topic, and can encompass any number of states, from mild agitation to delirium, or from sleepy to coma.
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