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Altered Mental Status (AMS)


  • Definition: Change in a patient’s baseline cognition

    • Can be hypoactive (lethargic) or hyperactive (agitated)
  • Risk factors: Functional impairment, age > 75, dementia, depression, ETOH/substance use disorder, sensory impairment, recent surgery

Etiologies: Consider MOVE STUPID mnemonic

  • Metabolic (Hypo/hypernatremia, Hypercalcemia)

  • Oxygen (Hypoxia)

  • Vascular (CVA, Bleed, MI, CHF)

  • Endocrine (Hypoglycemia, Thyroid, Adrenal)

  • Seizure (postictal state)

  • Trauma

  • Uremia

  • Psychiatric

  • Infection

  • Drugs – intoxication, withdrawal, or medications

  • Delirium – see “Delirium” section in psychiatry


  • Consider broad toxic, metabolic, and infectious workup as appropriate

    • TSH, Vitamin B12, CBC, CMP, UA, CXR, VBG, blood Cx, glucose, UDS
  • Review of medications

    • Sedatives, anticholinergics, benzos/EtOH toxicity or withdrawal
  • Head imaging in the setting of focal neurologic findings

    • Start with head CT – note strokes take up to 24 hours to show up on CT

    • Consider MRI if high concern for stroke, inflammatory changes or infection

  • LP should be performed if there is any concern for meningitis

  • EEG is reasonable with fluctuating mental status or seizure-like activity


  • Management of underlying etiology

  • See "Delirium" in section in psychiatry for nonpharmacologic and pharmacologic management

Last update: 2022-06-23 16:58:21