When dealing with a patient who’s Altered, the differential can be remembered by the mnemonic “VOWEL TIPS” (A-E-I-O-U T-I-P-S):
A – Alcohol: intoxication or withdrawal (DTs vs. rum fits)- Hepatic encephalopathy
- Wernicke’s encephalopathy
E – Epilepsy
I – Infection: sepsis, meningitis, encephalitis
O – Opiates (& other substances / medications)
U – Uremia & Other Metabolic States:- Liver, Thyroid, Adrenal, Hyper-/Hypo- Na+, -K+, -Ca++…
T – Trauma, Tumor: space-occupying lesions, incl. hydrocephalus
I – Insulin: Hypo- / Hyperglycemia
P – Psychiatric
S – Shock, Stroke, Syncope, Suffocation: Cerebral Hypoxia
Work-Up is obviously complex, including Physical Exam & Tests such as:- Fingerstick glucose
- CBC
- Metabolic Panel
- Toxicology Screen
- Chest X-ray
- EKG
- Head CT
- Lumbar Puncture
.
DiagnosisDude 