Altered Mental Status / Coma / Seizure

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

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