Causes of Altered Mental Status (AMS) - Workup and ...

Causes of Altered Mental Status (AMS) - Workup and Differential Diagnosis

Causes of AMS: Major buckets 1) Metabolic, 2) Infectious, 3) Drugs/Toxins/Medications, 4) Primary CNS, 5) Delirium

 • Pathophysiology: Diffuse neuronal dysfunction (due to metabolic/structural factors) causing dysfunction of ascending reticular activating system which connects midbrain/pons to cortex and controls arousal/attention.

 • Acute (min-hr): trauma, vascular, ↑ICP, meds/toxins, metabolic; Subacute (hr-day): infectious, AI, neoplastic, metabolic

 • AEIOU TIPS: Alcohol (intox, HE, withdrawal, DTs, Wernicke’s)/Arrythmia, Electrolyte/Endocrine (gluc, thyroid, adrenal), Infection, Oxygen (hypoxia, hypercarbia)/Overdose (opiate), Uremia/Urine retention, Trauma/Tumor/TTP/Temp, Iatrogenic (meds - anticholinergics, bzs, anti/dopaminergics, etc), Psych/Poison, Seizure (incl. post-ictal)/Stroke/Syncope

Approach to Acute AMS:

 • ABCs & Vitals

 • Bedside Exam

 • STAT Orders

 • Primary/Acute AMS Work-Up

 • Secondary/Subacute AMS Work-Up

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