Altered Mental Status

Question 1

are hallucinations common in dementia?

Answer 1

no

Question 2

what is the delirium mnemonic

Answer 2

i. D- drugs (pay attention to prescriptions and drug-drug interaction, withdrawal, toxicology screen or therapeutic drug levels.)
ii. E- eyes/ears and other sensory
iii. L- low O2, MI, Stroke, PE
iv. I- infection (blood culture, urine analysis, lumbar puncture..especially in elderly patients with unknown etiology even in absence of fever)
v. R-retention urine or stool
vi. I- ictal state (EEG if patients are defying diagnosis and especially with prior trauma, stroke, focal brain lesions, or known seizures)
vii. U- underhydration/undernutrition
viii. M- metabolic causes- DM, post-operative, sodium (electrolytes, serum glucose, CBC, urinalysis) (maybe thyroid function tests, ammonia levels and hepatic function)
ix. S- subdural hematoma (CT, MRI if no apparent diagnostic etiology or treatment of presumptive etiology does not work)

Question 3

what are metabolic causes of delirium?

Answer 3

B12, thiamine, serotonin syndrome

Question 4

can hypoxia or hypercapnea cause delirium?

Answer 4

yes

Question 5

what electrolytes and endocrine abnormalitites are common in delirium?

Answer 5

hypercalcemia
hyper/hyponatremia
hyper/hypoglycemia,
hyper/hypothyroid
addison's

Question 6

what toxins may cause delirium?

Answer 6

CO, mercury, lead

Question 7

Can uremia cause delirium?

Answer 7

yes- CKD or cirrhosis

Question 8

What infections often cause delirium>

Answer 8

UTI
Pneumonia
abcsess
meningitis, encephalitis

Question 9

What are the common drugs that cause delirium

Answer 9

opioids, benzos, TCA, SSRI, EtOH, barbiturates, anticholinergics!!!

Question 10

remember these other delirium inducers

Answer 10

urinary rettention
constipation
reduced sensory input

Question 11

What is the number one cause of delirium>

Answer 11

hypoglycemia

Question 12

when should we get LP in case of altered mental status?

Answer 12

suspect meningitis, SAH, or autoimmune inflammation

Question 13

when should we get paracentises in altered mental status?

Answer 13

new onset ascites, cirrhosis,

Question 14

whatare the 3 components of the glascow coma score?

Answer 14

eye opening, best verbal response, best motor respons

Question 15

What are common labs for aletered mental status

Answer 15

shotgun

CBC, BMP, LFT, NH3, toxin screen, TSH, B12, ABG, UA, CXR, EKG/troponin, HEAD CT, consider MRI, LP, EEG

Question 16

What are the 5 common/general things used to treat altered mental status

Answer 16

identify cause and treat
remove unecessary drugs
environment
medications
restraints

Question 17

what should we do at night, day, social for AMS?

Answer 17

night- sleep and avoid distractions
day- clock and calendar, stay awake, open blinds, glasses, hearing aides
social- fam, friends, photos, consistent providers

Question 18

are benzos good for AMS?

Answer 18

no

Question 19

Tf- give glucose and thiamine?

Answer 19

yes- thiamine first

Question 20

1st agitation drug?

Answer 20

haloperidol- monitor Qtc

Question 21

2nd line agitation drug-

Answer 21

atypicals- quetiapine

Question 22

what are symptoms of alcohol withdrawal

Answer 22

anxiety, agitation, HA, confusion, nausea, vomiting, sweats, hallucinations (visual, auditory, tactile)

Question 23

what are the alcohol withdrawal complicatins

Answer 23

seizures

delirium tremens- hyperadrenergic state, disorientation, hallucinations, tachy, hypertension, fever, sweating

Question 24

alcohol withdrawal treatment?

Answer 24

lorazepam
thiamine then glucose
replete electrolytes

Question 25

Is the diagnosis of hepatic encephalopathy made on high serum ammonia levels?

Answer 25

No- it is clinical

Question 26

what is hepatic encephalopathy treatment

Answer 26

lactulose, rifaximin, sodium benzoate