Altered Mental Status for DUMMIES – Part I “The Differential”

 

For inexperienced providers in the emergency department, the evaluation of the altered patient can be difficult. These patient are often unable to provide an accurate history and one must often rely on the information obtained from family, friends, pre-hospital care providers or nursing home staff. The approach to altered mental status can seem overwhelming when one considers the hundreds of potential causes.

In an attempt to provide some helpful tips for those new to emergency medicine, I will be breaking down the approach to altered mental status into multiple, “bite-size” 60-Second posts.

 

For some, mnemonics can be a helpful way to remember lists of items. No ‘one’ mnemonic is all inclusive, or better than another. Use whatever helps you remember and learn the basics.

Here are some mnemonics commonly used to often systematically break-down the possible causes for Altered Mental Status :

 

 

 

 

 

“AEIOU TIPS“

Alcohol/Acidosis (metabolic disorders)/Arrhythmia (any cardiac cause)

Endocrine/Electrolytes/Encephalopathy

Infection

Oxygen (hypoxia/hypercarbia)/Overdose/Opiates

Uremia

 

Trauma/Temperature (hyperthermia/hypothermia)/Thiamine (Wernicke)

Insulin (hypoglycemia/hyperglycemia)

Poisoning (any medication)/Psychiatric

Stroke/Seizure (or post-octal state)/Syncope/Space occupying lesion/Shunt (VP) Malfunction

 

 

 

 

 

 

 

 

 

“MOVE STUPID“

Metabolic

Oxygen (hypoxia/hypercarbia)

Vascular

Electrolytes/Endocrine

 

Seizures

Tumor/Trauma/Temperature/Toxins

Uremia

Psychiatric/Porphyria

Infection

Drugs/Drug withdra

 

 

 

 

 

 

 

 

 

 

“DIPPS“

Drug Intoxication or Withdrawal: Opiates, Benzos, illicit drugs, Ethanol intoxication or withdrawal

Infection:  either Primary CNS (meningitis/encephalitis) or systemic infection (pneumonia, UTI)

Primary Neurologic:  (Stroke, Seizure intracranial hemorrhage)

Psychiatric:  diagnosis of exclusion

Systemic Disease:  Cardiovascular (hypotension, low cardiac output), Pulmonary (hypoxia), Renal (uremia, hypo/hypernatremia, hypercalcemia), Liver (hepatic encephalopathy), Endocrine (hypo/hyperglycemia, thyroid dysfunction)

 

 

 

Or you can try to separate common causes into containers of ‘like items’…..  

 

Brain:  Glucose, Oxygen, Blood

Metabolic:  Electrolytes, Ammonia

Toxins:  Ethanol, Opiates, Cocaine

Infectious:  Peripheral vs. Central

Structural:  CNS lesion (blood, tumor)

 

 

Hopefully some of you will find some of these mnemonics helpful in your initial approach in considering the most common causes of altered mental status.  

 

Watch for Altered Mental Status for DUMMIES – Part II  – coming soon