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General Neurology

Altered Mental Status

Structured workup — toxic-metabolic, CNS, and systemic

Altered mental status (AMS) needs a system: glucose, vitals, oxygenation, then toxins and lytes, then CNS and systemic causes.

1.Immediate

Glucose, O2 sat, BP. Thiamine before D50 if Wernicke risk.[+]

2.Toxic-Metabolic

Lytes, renal, ammonia, LFTs. ABG. Tox screen, EtOH, medications (sedatives, anticholinergics).[+]

3.CNS

Stroke, hemorrhage, mass, infection, seizure / NCSE. CT first. MRI, LP as indicated.[+]

4.Systemic

Sepsis, hypoxia, shock. DKA, myxedema, adrenal crisis. Hepatic, uremic encephalopathy.[+]

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