Evaluation of altered mental status

Last reviewed: 10 Nov 2024
Last updated: 24 Sep 2024

Summary

Differentials

Common

  • Stroke and transient ischemic attack
  • Head injury
  • Dementia
  • Delirium
  • Seizures with possible postictal state
  • Myocardial infarction
  • Congestive heart failure
  • Ventricular arrhythmias
  • Depression
  • Hyperglycemia
  • Hypoglycemia
  • Hypernatremia
  • Hyponatremia
  • Dehydration (volume depletion)
  • Hypothermia
  • Hypoxia
  • Hypercapnia
  • Hepatic encephalopathy
  • Uremia
  • Severe systemic infection
  • Bipolar disorder
  • Brief psychotic disorder
  • Alcohol withdrawal
  • Alcohol toxicity
  • Drug toxicity
  • Drug withdrawal
  • Hip fracture
  • Pulmonary embolism
Full details

Uncommon

  • Subdural hematoma
  • Epidural hematoma
  • Subarachnoid hemorrhage
  • Brain tumor
  • Nonconvulsive status epilepticus
  • Hypertensive encephalopathy
  • Wernicke encephalopathy (thiamine deficiency)
  • Hypercalcemia
  • Hypocalcemia
  • Carbon monoxide poisoning
  • Hyperthermia
  • Adrenal insufficiency
  • Thyrotoxicosis
  • Myxedema coma
  • Pituitary apoplexy
  • Meningitis
  • Encephalitis
  • Neurosyphilis
  • Brain abscess
  • Mesenteric ischemia
  • Appendicitis
  • Acute diverticulitis
  • Constipation
Full details

Contributors

Authors

Gary Blanchard, MD

Assistant Professor of Medicine

University of Massachusetts Medical School

Worcester

MA

Disclosures

GB declares that he has no competing interests.

Acknowledgements

Dr Gary Blanchard would like to gratefully acknowledge Dr David Dosa, a previous contributor to this topic.

Disclosures

DD declares that he has no competing interests.

Peer reviewers

Timothy Collins, MD

Assistant Clinical Professor of Medicine

Division of Neurology

Duke University Medical Center

Durham

NC

Disclosures

TC has worked as a paid speaker for GlaxoSmithKline and Pfizer in 2008 and 2009.

Kunle Ashaye, MD

Consultant in Old Age Psychiatry

Mental Health Unit

Lister Hospital

Stevenage

UK

Disclosures

KA declares that he has no competing interests.

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