inpateint / neurology

Altered Mental Status

Last Updated: 1/5/2023

# Altered Mental Status

-- ABCs: 
protecting airway (intubate), RR (narcan)
-- Chart Check: *** med list, prior infection, seizure, stroke
-- HPI Intake: *** last known normal, baseline mental status, medications and adherence, drug use, complaining of localizing sxs (SOB, dysuria, frequency, wounds),
-- Can't Miss: sepsis, stroke, hypoglycemia, opioid overdose, hyponatremia, hepatic encephalopathy,
-- Admission Orders: CBC, BMP, coags, VBG, lactate, TSH, UDS, cortisol, ammonia, thiamine/B12, UA/UCx, BCx, CXR, consider CT head
-- Initial Treatment to Consider: 

-- History: *** h/o dementia, med-list, ingestions, prior infections, seizure, stroke RFs, use of AC, cirrhosis, COPD/asthma, diabetes or insulin use
-- Clinical/Exam: *** focal neuro deficit, fever, diaphoresis, withdrawal sxs
-- Data: *** infectious w/u, CBC, BMP, coags, VBG, lactate, TSH, UDS, thiamine/B12; CT Head
-- Etiology/DDx: *** metabolic (glucose, lyte, hypercarbia, thyroid, hepatic), infection (UTI, PNA, bacteremia meningitis/encephalitis), Structural (stroke, seizure/post-ictal, tumor), Toxin (opioids, EtOH/benzo, iatrogenic), Delirium/Dementia/Depression; Rarer (HIV, lyme, nutritional, HTN, PRES

The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.

-- Labs: CBC, BMP, coags, VBG, lactate, TSH, UDS, cortisol, ammonia, thiamine/B12
-- Infectious Workup: UA/UCx, bladder scan, CXR, BCx, consider LP
-- Imaging: Consider CT head vs stroke alert imaging
-- EEG if c/f underlying seizure

-- Precautions: remove offending meds (anticholinergic, antihistamine, benzo, anti-dopamine), promote sleep-wake cycles

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