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Patients with hypoglycemia may present with confusion, agitation, or focal neurologic findings.
Central nervous system injury from ischemia, hemorrhage, or trauma can present with altered mental status.
Get full access to all EB Medicine articles published 3 years (or more) ago, including evidence-based, peer-reviewed diagnosis and treatment recommendations. Common causes include pneumonia, pneumothorax, and pulmonary embolism as well as acute exacerbations of underlying illnesses, such as asthma and chronic obstructive pulmonary disease (COPD). Severe hypercalcemia from malignancy, hyperparathyroidism, or renal failure can present with agitation and confusion. Infections of the central nervous system (CNS) are always a concern in patients with altered mental status. Other drugs, including sympathomimetics and hallucinogens, may also present with delirium and the diagnosis is often made by recognizing the related toxidrome. Severe vitamin B deficiency presenting with altered mental status (Wernicke's encephalopathy) can be treated with thiamine if properly identified.

With the nationwide availability of stroke and trauma centers, timely recognition of injury must occur at the prehospital level and proper triage to the appropriate centers made. The underlying etiology must be identified and treated in order to attain resolution as soon as possible and, thus, decrease mortality.
Patients with COPD may have baseline elevations in pCO2, but an acute rise can lead to lethargy and coma.
Alcohol dependent patients with a sudden cessation can present with a severe form of withdrawal known as delirium tremens. At times, as in the case of sepsis, therapeutic interventions may be initiated even before a specific underlying etiology is identified. In this subset of patients, as well as in asthmatics, bedside capnography is a useful tool. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia state (HHS) can present with altered mental status, lethargy, and coma. Associated symptoms include nausea, vomiting, abdominal pain, joint pain, polyuria, and constipation.

Risk factors from this study included an immunocompromised host, recent neurosurgical procedure, and sinusitis. Examples of reversible, immediately life threatening causes of delirium include hypoxia, hypoglycemia, and hypotension. Sepsis can present with delirium or coma and management must focus on prompt antibiotic administration. Vital signs are consistent with severe sympathetic hyperactivity (hypertension, hyperthermia, and tachycardia).
By history, the last drink is typically more than 48 hours before presentation, with a range from one to five days.

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