Approach to Acute Altered Mental Status and Seizures (DRAFT)

2018 ◽  
Author(s):  
Jody Manners ◽  
Kiruba Dharaneeswaran ◽  
Ruchira Jha
Keyword(s):  
Mental Status ◽  
Altered Mental Status ◽  
Hospitalized Patients ◽  
Morbidity And Mortality ◽  
Rapid Evaluation ◽  
Metabolic Derangement ◽  
Medical Comorbidities ◽  
Life Threatening

Altered mental status (AMS) is a common presenting symptom or complication in hospitalized patients. The etiology of AMS includes potential primary neurologic entities as well as systemic disturbances such as infection, intoxication, or metabolic derangement. A systematic and rapid evaluation of potentially life threatening conditions is necessary to guide appropriate management. Seizures (particularly non-convulsive episodes) are an important cause of AMS frequently encountered in acutely ill patients with multiple medical comorbidities and need to be recognized and treated early to minimize morbidity and mortality. This chapter outlines an approach to the evaluation of acute altered mental status with an emphasis on seizure management.

Altered Mental Status in the Emergency Department

2019 ◽  
Vol 39 (01) ◽  
pp. 005-019 ◽  
Author(s):  
Austin Smith ◽  
Jin Han
Keyword(s):  
Emergency Department ◽  
Mental Status ◽  
Altered Mental Status ◽  
Detailed History ◽  
Radiographic Testing ◽  
Life Threatening ◽  
Secondary Survey ◽  
Acute Changes ◽  
Department Evaluation ◽  
The Brain

AbstractAltered mental status is an umbrella term that covers a broad spectrum of disease processes that vary greatly in chronicity and severity. Causes can be a primary neurologic insult or a result of a systemic illness resulting in end-organ dysfunction of the brain. Acute changes in mental status are more likely than chronic changes to be immediately life-threatening and are therefore the focus of this review. Given the potential time-sensitive nature, acute changes in mental status must be addressed immediately and with urgency. We recommend a primary survey followed by a secondary survey with special attention to immediate life-threatening reversible causes. We then recommend a systems-based approach searching for any other life-threatening or reversible causes. Because the differential for altered mental status is broad, a comprehensive emergency department evaluation including a detailed history and physical exam as well as laboratory and radiographic testing is needed.

scholarly journals Myxedema Coma: Improving Outcomes With Prompt Recognition and Therapy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A943-A943
Author(s):  
Aisha Parihar
Keyword(s):  
Mental Status ◽  
Vital Signs ◽  
Altered Mental Status ◽  
Morbidity And Mortality ◽  
Free T4 ◽  
Early Improvement ◽  
Delay In Diagnosis ◽  
Myxedema Coma ◽  
Artery Disease ◽  
Work Up

Abstract Background: Myxedema coma, a misnomer for severe hypothyroidism, is a rare endocrine emergency with an incidence of 1.08 cases per million people per year and a high mortality rate ranging from 30-50%. A delay in diagnosis and treatment worsens the prognosis and increases morbidity and mortality. Delayed management often leads to decompensation, presenting as uncontrolled persistent hypothermia, severe electrolyte derangements, and a potential for ventilator requirement needing ICU care. We present a patient in hypothyroid crisis who was promptly managed in a non-ICU setting who demonstrated a relatively early improvement in vital signs, thyroid lab values, and return to baseline mental status. Clinical Case: A 75 year old female with past medical history of hypothyroidism, atrial fibrillation, hypertension, coronary artery disease, depression, tardive dyskinesia, and dementia presented to the hospital in the month of December due to confusion after a mechanical fall that resulted in a head laceration requiring multiple stitches. Trauma work up included a CT scan of the head that was negative. On presentation, patient was also hypothermic, bradycardic, hypotensive, and lethargic with an altered mental status. Sepsis work up was negative. TSH was checked on day of admission and found to be significantly elevated to > 100 mcIU/mL, consistent with severe hypothyroidism. Free T4 and total T3 levels were low. Patient was immediately given intravenous levothyroxine 300 mcg followed by oral levothyroxine 125 mcg daily. In addition, intravenous hydrocortisone 100 mg every 8 hours was started until adrenal insufficiency was ruled out with a normal cortisol level. Upon discussion with family, it was learned that patient had not been taking her home medications indicating non-compliance to thyroid replacement therapy as the etiology for her hypothyroid crisis. Within a day of initiating therapy, TSH levels drastically improved with a reduction by 50%. Bradycardia, hypotension, and hypothermia resolved as well. In three days, patient’s mentation improved back to baseline and TSH, free T4, and total T3 continued to normalize. Conclusion: This case demonstrates how prompt recognition of hypothyroid crisis and immediate therapy can lead to early improvement in outcomes such as reversibility of mental status, normalization of vital signs and lab values, prevention of escalation of care to an ICU setting, and overall morbidity and mortality.

Altered Mental Status: An Exploration of Definitions and Descriptors in the Literature

2020 ◽  
Vol 14 (2) ◽  
pp. 97-111
Author(s):  
Yuko Ikematsu ◽  
Elizabeth Papathanassoglou
Keyword(s):  
Mental Status ◽  
Case Reports ◽  
English Literature ◽  
Altered Mental Status ◽  
Eligibility Criteria ◽  
Accurate Definition ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Valid Assessment ◽  
Universal Definition

ObjectivesTo examine the use of “altered mental status” in studies addressing states of shock, by reviewing published English literature. We explored how the term is defined and described in the literature, and alternative words/phrases used.BackgroundAssessment of mental status is crucial for patients in shock and life-threatening conditions. The term “altered mental status” is being used inconsistently, and varied means of assessment have been reported, which may have implications for critical care nurses' training and implementation of clinical practice guidelines.MethodsA systemized literature review based on targeted searches in CINAHL and MEDLINE, with predefined eligibility criteria. Primary studies, reviews and case studies were included.ResultsBased on eligibility criteria, 92 articles were included (48 primary studies, 32 case reports, 12 review articles). Glasgow Coma Scale (GCS) was most frequently used to define “altered mental status” followed by the terms “unconsciousness”, “confusion” “coma” and “disorientation”. Changes in consciousness were described in a variety of expressions, i.e. decreased level of consciousness, change in awareness, and GCS.ConclusionThere is no universal definition for altered mental status. More work is needed towards an accurate definition standardization of use of related terms, and consensus on the most valid assessment methods in order to identify patients with high risk for deterioration.

Thiamine supplementation in hospitalized patients with altered mental status: does it help?

2021 ◽  
Author(s):  
Daniel J. Zhou ◽  
Kaeli K. Samson ◽  
Navya Joseph ◽  
Ismail Fahad ◽  
Matthew V. Purbaugh ◽  
...  
Keyword(s):  
Mental Status ◽  
Altered Mental Status ◽  
Hospitalized Patients

Successful clozapine rechallenge following clozapine-induced neuroleptic malignant syndrome

2015 ◽  
Vol 5 (2) ◽  
pp. 88-90 ◽  
Author(s):  
Clint Ross
Keyword(s):  
Adverse Effect ◽  
Neuroleptic Malignant Syndrome ◽  
Mental Status ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Treatment Resistant ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Potential Risks

Abstract Neuroleptic malignant syndrome (NMS) is a potential life-threatening adverse effect of antipsychotics. Characteristic signs and symptoms of NMS include hyperthermia, muscle rigidity, altered mental status, and autonomic instability. Treatment of NMS includes discontinuation of any antipsychotic or other potentially offending agents. This report describes the details of a patient diagnosed with NMS induced by clozapine with subsequent successful rechallenge. Given limited therapeutic options for patients with treatment-resistant schizophrenia, clinicians should be cognizant of potential risks but aware of the possibility of successful rechallenge with clozapine.

scholarly journals 466. Symptom Profile of Hospitalized, Adult Patients with COVID-19 – Findings From COVID-Net Database

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S335-S335
Author(s):  
Chun T Siu ◽  
Amogh Joshi
Keyword(s):  
Retrospective Analysis ◽  
Mental Status ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Hospitalized Patients ◽  
Shortness Of Breath ◽  
Neurologic Manifestation ◽  
Symptom Profile ◽  
Patient Reported ◽  
Control And Prevention

Abstract Background According to the Center for Disease Control and Prevention (CDC), there is a disproportional number of COVID-19 deaths in hospitalized patients that increases based on age. Among COVID-19 related deaths in hospitalized patients, 8 of 10 patients are age 65 years and older. By looking at the latest data, the objective of this retrospective analysis is to evaluate the symptom profile in patients hospitalized with COVID-19 and determine if certain symptoms are seen more in older patients. Methods We performed a retrospective analysis using the COVID-Net database. This database contains information involving COVID-19 laboratory-confirmed hospitalization across 14 states. Medical history, signs, and symptoms at admission were collected by COVID-NET surveillance officers and reported during the period of March 1st to May 31st. For our analysis, we only included adults patients age 18 and above. Further descriptive statistics were stratified by age into two groups: age 18-64, and age ≥ 65. Results We identified 60,363 patients age 18 and above with COVID-19 confirmed hospitalizations. Cough, shortness of breath, and fevers/chills were the most common symptoms at respectively 67%, 66%, and 65%. Patients age ≥ 65, when compared to patients age 18-64, were less likely to have cough (56.7% vs 73.8%), shortness of breath (58.1% vs 72.1%), fever/chills (54.7% vs 71.%), dysgeusia (2.3% vs 7%), and anosmia (1.2% vs 6%). The only presentation that was more common in patients age 65+, than in patients age 18-64, was altered mental status (26.9% vs 5.2%). Overall inpatient mortality was higher in the age ≥ 65 group (8.9% vs 2%). Among the 2,922 COVID-19 decedents, 75.3% were age ≥65. Conclusion Published in April 2020, preliminary data from COVID-Net on approximately 180 patient reported that only 8.2% of patients age ≥ 65 had altered mental status2. Since then, our analysis noted that altered mental status is more commonly seen in the age group ≥ 65 than previously reported. The percentage of decedents age ≥ 65 in this analysis is similar to the 74.8% (N= 10,647) reported in a large study that focused specifically on COVID-19-related deaths3. Our analysis highlights that altered mental status is a common neurologic manifestation in elderly patients hospitalized with COVID-19. Disclosures All Authors: No reported disclosures

Altered Mental Status

2018 ◽  
pp. 463-466
Author(s):  
James Burke
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Hospitalized Patients

This chapter guides the reader on the general principles, clinical manifestations, and management of altered mental status in hospitalized patients.

scholarly journals Inappropriate Testing for Urinary Tract Infection in Hospitalized Patients: An Opportunity for Improvement

2013 ◽  
Vol 34 (11) ◽  
pp. 1204-1207 ◽  
Author(s):  
Sarah Hartley ◽  
Staci Valley ◽  
Latoya Kuhn ◽  
Laraine L. Washer ◽  
Tejal Gandhi ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Mental Status ◽  
Urinary Catheter ◽  
Altered Mental Status ◽  
Hospitalized Patients ◽  
Orthopedic Procedures ◽  
Clinical Scenarios ◽  
Current Guidelines

Urine cultures are frequently obtained for hospitalized patients. We reviewed documented indications for culture and compared these with professional society guidelines. Lack of documentation and important clinical scenarios (before orthopedic procedures and when the patient has altered mental status without a urinary catheter) are highlighted as areas of use outside of current guidelines.

Diagnosis, assessment, and management of hyperthermic crises

2016 ◽  
Author(s):  
Kevin Thornton ◽  
Michael Gropper
Keyword(s):  
Intensive Care Unit ◽  
Mental Status ◽  
Serotonin Syndrome ◽  
Tricyclic Antidepressants ◽  
Respiratory Acidosis ◽  
Altered Mental Status ◽  
Co2 Production ◽  
Volatile Anaesthetics ◽  
Antipsychotic Medications ◽  
Life Threatening

Malignant hyperthermia, the neuroleptic malignant syndrome (NMS), and the serotonin syndrome are the principal disorders associated with life-threatening hyperthermia in the intensive care unit. While each is a clinically unique entity, all can progress to multisystem organ dysfunction with acidosis, shock, and death. MH usually results from exposure to halogenated volatile anaesthetics and/or succinylcholine and symptoms of increased CO2 production and respiratory acidosis progress rapidly without prompt intervention, including the administration of dantrolene. NMS is a syndrome of rigidity and altered mental status seen most commonly in patients being treated with antipsychotic medications. The serotonin syndrome is seen in patients treated with serotonergic agents including selective serotonin reuptake or monoamine oxidase inhibitors and tricyclic antidepressants. The salient clinical finding is clonus, but agitation, altered mental status and autonomic dysfunction are common. Recognizing the non-specific features of these syndromes presents a challenge as they are life-threatening if not treated promptly and correctly with specific therapies.

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