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Altered Level of Consciousness Causes
Aka: Altered Level of Consciousness Causes, Altered Mental Status Differential Diagnosis, ALOC Causes
- See Also
- Altered Level of Consciousness
- Altered Level of Consciousness in Children
- Altered Mental Status in Febrile Returning Traveler
- Drug Induced Altered Level of Consciousness Causes
- Causes: Pitfalls - critical diagnoses that are easily missed
- Toxicologic Pitfalls
- See Drug Induced Altered Level of Consciousness Causes
- Carbon Monoxide Poisoning
- Toxic Alcohol ingestion
- Alcohol Withdrawal Syndrome
- Chronic Salicylate Toxicity
- Anticholinergic drug toxicity
- Neuroleptic Malignant Syndrome or Serotonin Syndrome
- Envenomation
- Opioid Overdose
- Benzodiazepine Overdose
- Endocrine Pitfalls
- Hypoglycemia
- Thyroid emergencies (Myxedema Coma, Thyroid Storm)
- Addisonian Crisis (Adrenal Insufficiency)
- Wernicke's Encephalopathy
- Infectious Pitfalls
- Cerebral Malaria
- Herpes Encephalitis
- Organ Failure Related Pitfalls
- Hypercarbia (CO2 Narcosis in COPD)
- Hepatic Encephalopathy
- Uremic encephalopathy
- Miscellaneous Pitfalls
- Non-convulsive Status Epilepticus
- Occult Trauma
- Thrombotic Thrombocytopenic Purpura
- Causes: Mnemonics
- Mnemonic: AEIOU TIPS
- Alcohol (or toxic Alcohols) or Abdominal Aortic Aneurysm
- Epilepsy (Status Epilepticus), Electrolytes, Hepatic Encephalopathy (or PRESS), endocrine problems
- Insulin (Hypoglycemia), Intussusception or Inborn Errors of Metabolism
- Opiates or Overdose
- Uremia
- Trauma (Closed Head Injury), Temperature (Hypothermia, hyperthermia), or Toxemia, Brain Tumor
- Infections (Sepsis, Meningitis, Encephalitis)
- Psychogenic, Pulmonary Embolism, Poisoning (Toxin Ingestion)
- Space occupying lesions, Stroke (including Intracranial Pressure), Shock, Seizure, shunt (ventriculoperitoneal)
- Mnemonic: I WATCH DEATH
- Infection
- Withdrawal
- Acute metabolic causes
- Trauma
- CNS Causes
- Hypoxia
- Deficiencies (Nutritional)
- Endocrinopathies (Adrenal Insufficiency, Myxedema, Hyperthyroidism)
- Acute Vascular Causes
- Toxins or Drugs
- Heavy Metals
- Mnemonic: SMASHED
- Sepsis or Substrates (abnormal Glucose, Thiamine deficiency)
- Meningitis or Mental Illness (acute Psychosis)
- Accident (Head Trauma, CVA) or Alcohol Intoxication or withdrawal
- Seizing or Stimulants
- Hypertension, Hyperthyroidism, Hypercarbia or Hypotension, Hypothyroidism, Hypoxia
- Electrolytes (Sodium, Hypercalcemia) or Encephalopathy
- Drugs (Drug Withdrawal, Carbon Monoxide, Lithium, steroids, Salicylates...)
- Causes: Neurologic - Supratentorial
- Unilateral hemispheric disease AND Brainstem Herniation
- Closed Head Injury (Concussion or Contusion)
- Meningitis or Encephalitis
- Hypertensive Encephalopathy
- Subarachnoid Hemorrhage or other Intracranial Hemorrhage (e.g. Epidural Hematoma, Subdural Hematoma)
- Ventriculoperitoneal Shunt Malfunction
- Cerebrovascular Accident
- Parkinsonism
- Myasthenia Gravis
- Intracranial Mass
- Demyelinating Disease (e.g. Multiple Sclerosis)
- Seizure
- Post-ictal State
- Non-convulsive Status Epilepticus
- Causes: Neurologic - Infratentorial
- Basilar ArteryOcclusion
- Brainstem tumor
- Cerebellar Hemorrhage
- Pontine Hemorrhage
- Traumatic posterior fossa Hemorrhage
- Causes: Toxins
- See Toxin Induced Altered Level of Consciousness Causes (includes medication causes)
- See Unknown Ingestion
- See Date Rape Drug
- Carbon Monoxide Poisoning
- Toxic Alcohol ingestion (e.g. Ethylene Glycol, Methanol)
- Alcohol Intoxication or Alcohol Withdrawal Syndrome
- Chronic Salicylate Toxicity
- Anticholinergic drug toxicity
- Neuroleptic Malignant Syndrome
- Serotonin Syndrome
- Envenomation
- Excited Delirium (Cocaine, Methamphetamine, PCP, or other psychostimulant induced)
- Opioid Overdose
- Benzodiazepine Overdose
- Causes: Cardiopulmonary
- Hypoxia
- Hypercarbia
- Congestive Heart Failure (CHF)
- Pulmonary Embolus
- Hypertensive Encephalopathy
- Causes: Gastrointestinal and Renal
- Hepatic Encephalopathy
- Wernicke's Encephalopathy
- Uremic encephalopathy
- Peritonitis
- Causes: Electrolyte disturbance
- Hypercalcemia
- Hypermagnesemia
- Hyponatremia
- Hypernatremia
- Hypophosphatemia
- Causes: Endocrine
- Adrenal Insufficiency (Addisonian Crisis)
- Diabetes Mellitus
- Hypoglycemia
- Diabetic Ketoacidosis
- Hyperosmolar Hyperglycemic Nonketotic Coma
- Thyroid disease
- Myxedema Coma (severe Hypothyroidism)
- Thyroid Storm
- Causes: Infectious
- Meningitis or Encephalitis
- Sepsis
- Urinary Tract Infection
- Pneumonia
- Severe Viral Infection (e.g. Covid19)
- Causes: Miscellaneous
- Heat Stroke or Malignant Hyperthermia
- Hypothermia
- Vasculitis
- Hyperviscosity Syndromes (e.g. Thrombotic Thrombocytopenic Purpura)
- References
- Herbert et al. in Herbert (2014) EM:Rap 14(11): 10-12
- Veauthier (2021) Am Fam Physician 104(5): 461-70 [PubMed]