Altered Mental Status

Mnemonic: “HE STOPS AEIOU TIPS

ETIOLOGIES

  • Hypertension/Hepatic encephalopathy
  • Electrolyte derangement (Na+, Ca2+)
  • Stroke
  • Trauma
  • Opiates
  • Psychiatric (Conversion Disorder vs Psychosis)
  • Seizure
  • Acidosis
  • Endocrine (hypoglycemia, hypo/hyperthyroidism, adrenal insufficiency, Cushing’s syndrome)
  • Intoxication/wIthdrawal
  • HypOxemia/CO2 retention
  • Uremia
  • Temperature (hyper/hypothermia) or Thiamine deficiency (Wernicke-Korsakoff Syndrome)
  • Infection (especially meningitis/encephalitis or UTI in the elderly)
  • Porphyria
  • Sepsis

WORKUP

  • History and Physical (looking for symptomatology, substance use, history of liver disease or psychiatric disorders, signs of infection, difficulty breathing)
  • Labs
    • CBC (to look for infection)
    • CMP (to look for electrolyte derangements, liver disease, renal injury, acidosis)
    • UDS (to look for substance use) + EtOH level
    • ABG (to look for acid/base derangements, hypercarbia, hypoxemia)
    • EKG and Troponin level (to evaluate for ACS)
    • Consider CT of the brain to evaluate for brain bleed based on history and physical exam
    • Consider lactic acid, blood cultures, chest x-ray, UA with microscopy and urine cultures to evaluate for sepsis and infections
    • Consider B12/folate levels
    • Consider treating empirically for Wernicke Encephalopathy with high-dose IV Thiamine (500 mg q8hours)

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