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)
