Altered Mental Status (AMS)¶
Background¶
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Definition: Change in a patient’s baseline cognition
- Can be hypoactive (lethargic) or hyperactive (agitated)
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Risk factors: Functional impairment, age > 75, dementia, depression, ETOH/substance use disorder, sensory impairment, recent surgery
Etiologies: Consider MOVE STUPID mnemonic¶
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Metabolic (Hypo/hypernatremia, Hypercalcemia)
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Oxygen (Hypoxia)
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Vascular (CVA, Bleed, MI, CHF)
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Endocrine (Hypoglycemia, Thyroid, Adrenal)
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Seizure (postictal state)
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Trauma
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Uremia
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Psychiatric
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Infection
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Drugs – intoxication, withdrawal, or medications
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Delirium – see “Delirium” section in psychiatry
Evaluation¶
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Consider broad toxic, metabolic, and infectious workup as appropriate
- TSH, Vitamin B12, CBC, CMP, UA, CXR, VBG, blood Cx, glucose, UDS
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Review of medications
- Sedatives, anticholinergics, benzos/EtOH toxicity or withdrawal
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Head imaging in the setting of focal neurologic findings
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Start with head CT – note strokes take up to 24 hours to show up on CT
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Consider MRI if high concern for stroke, inflammatory changes or infection
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LP should be performed if there is any concern for meningitis
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EEG is reasonable with fluctuating mental status or seizure-like activity
Management¶
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Management of underlying etiology
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See "Delirium" in section in psychiatry for nonpharmacologic and pharmacologic management