Altered Mental Status Flashcards
are hallucinations common in dementia?
no
what is the delirium mnemonic
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)
what are metabolic causes of delirium?
B12, thiamine, serotonin syndrome
can hypoxia or hypercapnea cause delirium?
yes
what electrolytes and endocrine abnormalitites are common in delirium?
hypercalcemia hyper/hyponatremia hyper/hypoglycemia, hyper/hypothyroid addison's
what toxins may cause delirium?
CO, mercury, lead
Can uremia cause delirium?
yes- CKD or cirrhosis
What infections often cause delirium>
UTI
Pneumonia
abcsess
meningitis, encephalitis
What are the common drugs that cause delirium
opioids, benzos, TCA, SSRI, EtOH, barbiturates, anticholinergics!!!
remember these other delirium inducers
urinary rettention
constipation
reduced sensory input
What is the number one cause of delirium>
hypoglycemia
when should we get LP in case of altered mental status?
suspect meningitis, SAH, or autoimmune inflammation
when should we get paracentises in altered mental status?
new onset ascites, cirrhosis,
whatare the 3 components of the glascow coma score?
eye opening, best verbal response, best motor respons
What are common labs for aletered mental status
shotgun
CBC, BMP, LFT, NH3, toxin screen, TSH, B12, ABG, UA, CXR, EKG/troponin, HEAD CT, consider MRI, LP, EEG
What are the 5 common/general things used to treat altered mental status
identify cause and treat remove unecessary drugs environment medications restraints
what should we do at night, day, social for AMS?
night- sleep and avoid distractions
day- clock and calendar, stay awake, open blinds, glasses, hearing aides
social- fam, friends, photos, consistent providers
are benzos good for AMS?
no
Tf- give glucose and thiamine?
yes- thiamine first
1st agitation drug?
haloperidol- monitor Qtc
2nd line agitation drug-
atypicals- quetiapine
what are symptoms of alcohol withdrawal
anxiety, agitation, HA, confusion, nausea, vomiting, sweats, hallucinations (visual, auditory, tactile)
what are the alcohol withdrawal complicatins
seizures
delirium tremens- hyperadrenergic state, disorientation, hallucinations, tachy, hypertension, fever, sweating
alcohol withdrawal treatment?
lorazepam
thiamine then glucose
replete electrolytes
Is the diagnosis of hepatic encephalopathy made on high serum ammonia levels?
No- it is clinical
what is hepatic encephalopathy treatment
lactulose, rifaximin, sodium benzoate
