![]() Delirium can be thought of as acute brain failure and is the final common pathway of multiple mechanisms. 2 Deliriumĭelirium, also known as an acute confusional state, is a transient disorder characterized by impaired attention, perception, thinking, memory, and cognition. 1 Altered mental status has many definitions, but fundamentally it involves changes in a person’s alertness, attention, memory, and/or awareness. When a patient presents to the emergency department (ED) with altered mental status, three broad categories of diagnosis should be considered: delirium, coma, and dementia. Mental status, simply put, is how well one’s brain and body are working in sync. The term “mental status” has a complex definition that involves the interplay between emotional and intellectual functioning. Even with a good history, the underlying cause may not be determined for several days and, in some cases, may never be found. However, these are not always available in the ED, and it may take some detective work to establish a diagnosis. A thorough history and physical examination are necessary to establish the cause of the altered mental state.Patients can be treated with benzodiazepines. Some patients, especially the elderly and those who live alone, may be able to hide their addiction. ![]() Alcohol withdrawal can be seen in patients with known chronic alcoholism.However, dementia is a fixed deficit resulting from changes in the brain, such as those seen with Alzheimer’s disease. When the underlying cause is treated, delirium may be reversible. Delirium is a transient alteration of sensorium that often waxes and wanes.The role of the ED provider is to stabilize the patient, treat causes that are rapidly reversible (hypoglycemia, hyperthermia/hypothermia) and initiate diagnostic testing and treatment for life-threatening causes (trauma, intracranial lesions, sepsis). There are many causes of altered mental status, and often the exact cause is not apparent in the ED. Altered mental status is a common presentation in the emergency department (ED).
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