Please enable JavaScript.

Coggle requires JavaScript to display documents.

altered mental status (infectious (CNS (meningitis, encephalitis,…

- - - - DIGFAST (screen for mania), if able take comprehensive psych history both pt and family history, r/o substances (see toxins/meds)
- - - - hyperosmolar hyperglycemia
        
        neurologic deterioration is more common and occurs earlier in HHS than DKA
      - diabetic ketoacidosis
    - - presents w/ sx of increased epinephrine release (tremor, diaphoresis) followed by neurologic sx that poorly correlate with glucose concentration --> seizures, bizarre behavior, coma, focal deficits
      - management: in acute severe hypoglycemia --> 25-50g bolus dextrose IV followed by continuous dextrose infusion
  - - - most common cause of toxic metabolic encephalopathy, most commonly due to SIADH. See hypoNa schema
  - - - acute
        
        marked cerebral edema is seen in pts with acute onset hepatic failure
      - chronic
        
        pts with chronic liver disease and portosystemic shunting of blood
    - - h/o of renal failure (also consider dialysis disequilibrium syndrome --> AMS/LOC during/around dialysis due to excessive fluid shifts)
      - reversible with dialysis, although lag time of 1-2 days before mental status clears
    - - thiamine deficiency, pts with AUD, pts fasting, receiving parenteral nutrition, recovering from GI surgery, advanced cancer, undergoing hemodialysis all particularly susceptible
      - sx: confusion, ataxia, opthalmoplegia
      - prompt tx with thiamine
    - - typically obvious precipitating event such as cardiac arrest w/ prolonged resuscitation efforts