Altered Mental Status

Question 1

Most common and most serious causes of AMS

Answer 1

1. Metabolic: hyper/hyponatremia, hyper/hypoglycemia, hypercalcemia, hyper/hypothyroidism, hypoxia/hypercapnea, B12 deficiency, hepatic encephalopathy, uremic encephalopathy, drug/alcohol intoxication/withdrawal, Wernicke’s encephalopathy
2. Structural lesions: primary or mets tumor, ICH, subdural hematoma
3. Vascular: CVA, TIA, cerebral vasculitis
4. Infectious etiologies: encephalitis, meningitis, urosepsis, endocarditis, pneumonia, cellulitis
5. Seizure/post-ictal state
6. HTN encephalopathy
7. Low perfusion states: arrhythmia, MI, shock, acute blood loss, severe dehydration
8. Misc causes: fecal impaction, postoperative state, sleep deprivation, urinary retention

Question 2

Risk factors for developing AMS

Answer 2

• Dementia
• Advanced age
• Substance abuse
• Comorbid physical problems such as sleep deprivation, immobility, dehydration, pain, and sensory impairment
• ICU admission

Question 3

Nonpharm measures to reduce agitation and aggression

Answer 3

• Avoid using physical restraints whenever possible
• Use reorientation techniques
• Assuring pt has devices to correct sensory deficits
• Promote normal sleep and day/night awareness
• Prevent dehydration and electrolyte disturbance
• Avoid medications which may worsen delirium whenever possible (anticholinergics, benzos)

Question 4

Labs to consider in AMS

Answer 4

• CBC with diff
• Electrolytes, BUN/Cr, Glucose, hepatic function panel, Ca
• ABG
• Tox screen
• VDRL
• VitB12 and thiamine
• TSH with reflex T4
• UA and UCx
• Blood Cx
• CSF analysis (color, opening pressure, chemitries, cell count, staining, cultures, cytology, cryptococcal antigen)