scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Fat Embolism and Nonconvulsive Status Epilepticus

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yanetsy Olivera Arencibia ◽  
Mai Vo ◽  
Jennifer Kinaga ◽  
Jorge Uribe ◽  
Gloria Velasquez ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Supportive Therapy ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Nonconvulsive Status Epilepticus ◽  
Altered Level ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Wide Range

Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier. Continued neuromonitoring revealed nonconvulsive status epilepticus. Magnetic resonance imaging of the brain showed multiple bilateral acute cerebral infarcts with a specific pattern favoring the diagnosis of fat embolism syndrome. He was found to have a significant right to left intracardiac shunt on a transesophageal echocardiogram. He improved substantially over time with supportive therapy, was successfully extubated on day 6, and discharged to inpatient rehabilitation on postoperative day 15. Fat embolisms can result in a wide range of neurologic manifestations. Nonrefractory nonconvulsive status epilepticus that responds to antiepileptic drugs, sedation, and supportive therapy can have a favorable outcome. A high index of suspicion and early recognition reduces the chances of unnecessary interventions and may improve survival.

scholarly journals When the grass isn’t greener: a case series of young children with accidental marijuana ingestion

CJEM ◽  
2015 ◽  
Vol 18 (6) ◽  
pp. 480-483 ◽  
Author(s):  
Derek Murray ◽  
Joshua Olson ◽  
Ana Sofia Lopez
Keyword(s):  
Young Children ◽  
Illicit Drug ◽  
Case Series ◽  
Altered Mental Status ◽  
Altered Level ◽  
The Past ◽  
High Prevalence ◽  
Level Of Consciousness ◽  
Local Emergency Department ◽  
Marijuana Intoxication

AbstractMarijuana is the most commonly used illicit drug in Canada, with 10% of the general population admitting to its use in the past year. This high prevalence increases risk of accidental ingestion in young children.We report four pediatric cases of accidental marijuana ingestion who presented to our local emergency department with altered mental status. Three patients had extensive testing, including one patient who underwent lumbar puncture and empirical treatment for meningitis. To our knowledge, this is the first Canadian case series since McNabb et al., published over 2 decades ago.The case series aims to highlight the importance of considering acute marijuana intoxication in the differential diagnosis when assessing young children with altered level of consciousness.

scholarly journals Altered mental status is a predictor of poor outcomes in COVID-19 patients: A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258095
Author(s):  
Abdallah S. Attia ◽  
Mohammad Hussein ◽  
Mohamed A. Aboueisha ◽  
Mahmoud Omar ◽  
Mohanad R. Youssef ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Mental Status ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Altered Mental Status ◽  
Neurological Manifestations ◽  
Icu Admission ◽  
Poor Outcomes

Introduction Several studies have described typical clinical manifestations, including fever, cough, diarrhea, and fatigue with COVID-19 infection. However, there are limited data on the association between the presence of neurological manifestations on hospital admission, disease severity, and outcomes. We sought to investigate this correlation to help understand the disease burden. Methods We delivered a multi-center retrospective study of positive laboratory-confirmed COVID-19 patients. Clinical presentation, laboratory values, complications, and outcomes data were reported. Our findings of interest were Intensive Care Unit (ICU) admission, intubation, mechanical ventilation, and in-hospital mortality. Results A total of 502 patients with a mean age of 60.83 ± 15.5 years, of them 71 patients (14.14%) presented with altered mental status, these patients showed higher odds of ICU admission (OR = 2.06, 95%CI = 1.18 to 3.59, p = 0.01), mechanical ventilation (OR = 3.28, 95%CI = 1.86 to 5.78, p < 0.001), prolonged (>4 days) mechanical ventilation (OR = 4.35, 95%CI = 1.89 to 10, p = 0.001), acute kidney injury (OR = 2.18, 95%CI = 1.28 to 3.74, p = 0.004), and mortality (HR = 2.82, 95%CI = 1.49 to 5.29, p = 0.01). Conclusion This cohort study found that neurological presentations are associated with higher odds of adverse events. When examining patients with neurological manifestations, clinicians should suspect COVID-19 to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.

Neurotoxicity after high-dose melphalan.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6546-6546 ◽  
Author(s):  
Jose Eugenio Najera ◽  
Tummala Sudhakar ◽  
Qaiser Bashir ◽  
Nina Shah ◽  
Richard E. Champlin ◽  
...  
Keyword(s):  
Mental Status ◽  
Epileptiform Activity ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Cancer Center ◽  
High Dose ◽  
Loss Of Consciousness ◽  
Hematopoietic Stem ◽  
Neurologic Recovery ◽  
High Dose Melphalan

6546 Background: High dose melphalan (HDM) at 200 mg/m2 is the standard preparative regimen for patients with multiple myeloma (MM) and light-chain amyloidosis (AL) undergoing autologous hematopoietic stem cell transplantation (auto-HCT). Neurotoxicity has been seen with HDM. In this report we describe the incidence, clinical manifestations and outcome of HDM- associated neurotoxicity. Methods: We performed a chart review of all patients who received HDM and auto-HCT for MM or AL between January 2007 to December 2009 at the University of Texas MD Anderson Cancer Center (MDACC). HDM- associated encephalopathy was defined as altered mental status, seizure or unexplained loss of consciousness within 30 days of auto-HCT. Patients with documented hemorrhagic or embolic stroke, or metabolic abnormalities were excluded. Results: 451 patients were included. Median age at auto-HCT was 59 years (range: 35-80). Thirty patients (6.6%) had AL and 61 patients (13.5%) had a pre-transplant serum creatinine of > 1.5 mg/dl. Nine patients (2.0%) developed HDM-associated encephalopathy with a median of 13 days (range 4-22) from auto-HCT. Among patients with encephalopathy, 8 (89%) developed changes in mental status ranging from drowsiness and confusion to loss of consciousness, while one patient had tonic-clonic seizures (11%). Of the affected patients there were 6 (66%) females, 8 patients (89%) > 59 years of age and only 2 patients (22%) had a creatinine clearance of < 60 ml/min. One patient was dialysis-dependent. A CT scan or MRI was obtained in all 9 patients. Only one patient had imaging abnormalities reported as posterior reversible encephalopathy syndrome (PRES). Electroencephalogram (EEG) was performed on 6 patients. Epileptiform activity was seen in one patient with clinical seizures. Mild generalized slowing was noted in 2 other patients with mental status changes. Cerebrospinal fluid was obtained in 2 patients and did not show any abnormalities. Complete resolution of neurologic symptoms was seen in all patients prior to hospital discharge, and there were no deaths. Conclusions: HDM-induced encephalopathy was seen in only 2% patients, and it is associated with complete neurologic recovery without any increase in transplant-related 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.

scholarly journals Postoperative cognitive dysfunction: A case report and literature review

2017 ◽  
Vol 4 (4) ◽  
pp. 37
Author(s):  
Gurpreet Singh ◽  
Margaret M Cinicola ◽  
Naveen R Parva ◽  
John T Cinicola ◽  
Venkat G Muvva ◽  
...  
Keyword(s):  
Cognitive Dysfunction ◽  
Mental Status ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Cognitive Dysfunction ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Major Surgery ◽  
Postoperative Cognitive Decline ◽  
Prolonged Hospital

Background: Postoperative cognitive dysfunction (POCD) is loss of cognition especially in memory and executive function that can extend from a few days to a few weeks after surgery. It is more common in older adult patients. We present a case featuring a typical progression of POCD along with its associated preoperative risk factors.Case report: A 65-year-old male patient with an extensive past medical history including generalized anxiety disorder, hypertension and hyperlipidemia initially presented to the emergency department for chest pain. Coronary artery bypass graft (CABG) was performed under general anesthesia with Propofol, Fentanyl, Rocuronium and Midazolam. The patient tolerated the procedure well. After the procedure, his stay was complicated by delirium and altered mental status. All reversible causes were investigated and eliminated as likely causes. Later, the patient was sent home after a prolonged hospital stay. Following discharge, he had multiple admissions to the hospital for altered mental status, and his mental status has not reached baseline again. Family has been confident that the patient’s psychological and cognitive symptoms began following the CABG.Conclusion: We present this case to highlight the heightened incidence of postoperative cognitive decline in patients over sixty undergoing major surgery. We also present a comprehensive review of the current literature on the risk factors, clinical manifestations, and pathogenesis of POCD.

scholarly journals Delirium Associated with Salicylate and Acetaminophen Overdose in a Patient with COVID-19: A Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 517-520
Author(s):  
Tyler Wen ◽  
Jason Chu ◽  
Danielle Allenspach ◽  
David Van
Keyword(s):  
Emergency Department ◽  
Central Nervous System ◽  
Nervous System ◽  
Case Report ◽  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Psychosocial Stressors ◽  
Acetaminophen Overdose ◽  
Wide Range

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created numerous clinical challenges for physicians, in part due to its wide range of clinical manifestations and associated complications. Case Report: Here we present the case of a 69-year-old man who was admitted to the emergency department with fever, dyspnea, and altered mental status. We believe the patient’s condition was precipitated by a COVID-19 infection-induced delirium, a setting in which he ingested aspirin and acetaminophen in overdose that required lifesaving interventions. Conclusion: This case illustrates the potential for neuropsychiatric effects in COVID-19 patients due to both direct viral central nervous system pathology and pandemic-related psychosocial stressors.

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.

Management of patients with spontaneous intracranial hypotension causing altered level of consciousness: Report of two cases and review of literature

Cephalalgia ◽  
2012 ◽  
Vol 33 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Amer A Ghavanini ◽  
Courtney A Scott ◽  
David K Chan ◽  
David F Tang-Wai
Keyword(s):  
Intracranial Hypotension ◽  
Autologous Blood ◽  
Spontaneous Intracranial Hypotension ◽  
Time Interval ◽  
Altered Level ◽  
Sustained Improvement ◽  
Uncommon Presentation ◽  
Blood Patch ◽  
Level Of Consciousness ◽  
Collective Experience

Background Decreased level of consciousness is a rare neurological manifestation of spontaneous intracranial hypotension (SIH), which typically presents with orthostatic headache. The optimal management of this uncommon presentation remains uncertain. Methods We analyzed the presentation, management and outcome of two patients in our institution and reviewed 22 patients reported in the literature with SIH and decreased level of consciousness, defined as any decrease in the patient’s Glasgow Coma Scale score. Results There were 20 male and four female patients (M:F ratio of 5:1) with an average age of 52 years (range 37 to 68 years). There was a variable time interval of up to many months between the initial presentation of SIH and changes in the level of consciousness. An epidural autologous blood patch was eventually successful in 79% of the patients, although up to three trials were necessary in seven of these patients. Intrathecal saline infusion used as a temporizing measure resulted in excellent response within hours in five out of six patients who received this treatment. Drainage of the subdural collection either did not result in any sustained improvement or resulted in clinical deterioration in 12 out of 12 patients who received this treatment. Conclusions In the absence of a clinical trial because of the rarity of this entity, the treatment of SIH complicated by decreased level of consciousness remained controversial in the past. However, current collective experience supports early treatment of patients with SIH and decreased level of consciousness with one or more epidural blood patches. Fibrin glue and surgical duroplasty are the next steps in the management of patients in whom epidural blood patches fail. Drainage of the subdural collections may be detrimental.

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