II. Causes: Pitfalls - critical diagnoses that are easily missed

  1. Toxicologic Pitfalls
    1. Carbon Monoxide Poisoning
    2. Toxic Alcohol ingestion or Alcohol Withdrawal Syndrome
    3. Chronic Salicylate Toxicity
    4. Anticholinergic drug toxicity
    5. Neuroleptic Malignant Syndrome or Serotonin Syndrome
    6. Envenomation
    7. Opioid Overdose
    8. Benzodiazepine Overdose
  2. Endocrine Pitfalls
    1. Thyroid emergencies (Myxedema Coma, Thyroid Storm)
    2. Addisonian Crisis (Adrenal Insufficiency)
    3. Wernicke's Encephalopathy
  3. Infectious Pitfalls
    1. Cerebral Malaria
    2. Herpes Encephalitis
  4. Organ Failure Related Pitfalls
    1. Hypercarbia (CO2 Narcosis in COPD)
    2. Hepatic Encephalopathy
    3. Uremic encephalopathy
  5. Miscellaneous Pitfalls
    1. Non-convulsive Status Epilepticus
    2. Occult Trauma
    3. Thrombotic Thrombocytopenic Purpura

III. Causes: Mnemonics

  1. Mnemonic: AEIOU TIPS
    1. Alcohol (or toxic Alcohols) or Abdominal Aortic Aneurysm
    2. Epilepsy (Status Epilepticus), Electrolytes, Hepatic Encephalopathy (or PRESS), endocrine problems
    3. Insulin (Hypoglycemia), Intussusception or Inborn Errors of Metabolism
    4. Opiates or Overdose
    5. Uremia
    6. Trauma (Closed Head Injury), Temperature (Hypothermia, hyperthermia), or Toxemia, Brain Tumor
    7. Infections (Sepsis, Meningitis, Encephalitis)
    8. Psychogenic, Pulmonary Embolism, Poisoning (Toxin Ingestion)
    9. Space occupying lesions, Stroke (including Intracranial Pressure), Shock, Seizure, shunt (ventriculoperitoneal)
  2. Mnemonic: I WATCH DEATH
    1. Infection
    2. Withdrawal
    3. Acute metabolic causes
    4. Trauma
    5. CNS Causes
    6. Hypoxia
    7. Deficiencies (Nutritional)
    8. Endocrinopathies (Adrenal Insufficiency, Myxedema, Hyperthyroidism)
    9. Acute Vascular Causes
    10. Toxins or Drugs
    11. Heavy Metals
  3. Mnemonic: SMASHED
    1. Sepsis or Substrates (abnormal Glucose, Thiamine deficiency)
    2. Meningitis or Mental Illness (acute Psychosis)
    3. Accident (Head Trauma, CVA) or Alcohol Intoxication or withdrawal
    4. Seizing or Stimulants
    5. Hypertension, Hyperthyroidism, Hypercarbia or Hypotension, Hypothyroidism, Hypoxia
    6. Electrolytes (Sodium, Hypercalcemia) or Encephalopathy
    7. Drugs (Drug Withdrawal, Carbon Monoxide, Lithium, steroids, Salicylates...)

V. Causes: Neurologic - Infratentorial

  1. Basilar Artery Occlusion
  2. Brainstem tumor
  3. Cerebellar Hemorrhage
  4. Pontine Hemorrhage
  5. Traumatic posterior fossa Hemorrhage

VII. Causes: Cardiopulmonary

VIII. Causes: Gastrointestinal and Renal

  1. Hepatic Encephalopathy
  2. Wernicke's Encephalopathy
  3. Uremic encephalopathy
  4. Electrolyte disturbance
  5. Peritonitis

X. Causes: Infectious

XII. References

  1. Herbert et al. in Herbert (2014) EM:Rap 14(11): 10-12

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