diabetes and altered mental status chapter 19. causes of altered mental status
Post on 21-Dec-2015
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Causes of AlteredCauses of AlteredMental StatusMental StatusCauses of AlteredCauses of AlteredMental StatusMental Status
Causes of Altered Mental StatusCauses of Altered Mental Status
HypoglycemiaHypoglycemia PoisoningPoisoning IntoxicationIntoxication InfectionInfection HypothermiaHypothermia HyperthermiaHyperthermia Head traumaHead trauma Decreased oxygen levelsDecreased oxygen levels
Altered mental status is
present when a patient’s
verbal or nonverbal
response shows they are
not aware of their situation.
Diabetes mellitus:Diabetes mellitus:
A disease that results from A disease that results from failure of the pancreas to failure of the pancreas to produce either enough insulin produce either enough insulin or usable insulin.or usable insulin.
Glucose:Glucose:
A basic sugar that is present in A basic sugar that is present in some form in most foods and is some form in most foods and is required by the body to required by the body to produce energy.produce energy.
Two Forms of Diabetes Two Forms of Diabetes Insulin-dependentInsulin-dependent
The pancreas no longer produces any insulinThe pancreas no longer produces any insulin
Non-insulin dependentNon-insulin dependent Some production of insulin still occursSome production of insulin still occurs
Common Diabetic Medications Common Diabetic Medications
InsulinInsulin Humulin - regular or NPHHumulin - regular or NPH
Oral medicationsOral medications DiabineseDiabinese OrinaseOrinase MicronaseMicronase
Blood Sugar Levels Blood Sugar Levels HypoglycemiaHypoglycemia
A symptomatic decrease in blood sugar concentration (may be sudden)A symptomatic decrease in blood sugar concentration (may be sudden)
HyperglycemiaHyperglycemia A symptomatic increase in blood sugar concentration (usually gradual)A symptomatic increase in blood sugar concentration (usually gradual)
Rapid-onset altered mental statusRapid-onset altered mental status Intoxicated appearance; staggering, Intoxicated appearance; staggering,
slurred speechslurred speech Elevated heart rateElevated heart rate Cold, clammy skinCold, clammy skin AnxiousAnxious HungryHungry SeizuresSeizures
Signs & Symptoms of Hypoglycemia Signs & Symptoms of Hypoglycemia
Seizure:Seizure:
A convulsive movement of the A convulsive movement of the body or an impaired mental body or an impaired mental state caused by random state caused by random discharge of the brain’s discharge of the brain’s electrical impulses.electrical impulses.
FeverFever
InfectionInfection
PoisoningPoisoning
OverdoseOverdose
IntoxicationIntoxication
HypoglycemiaHypoglycemia
Common Causes of Seizures Common Causes of Seizures
Head traumaHead trauma
Impaired cerebral oxygenationImpaired cerebral oxygenation
Epilepsy uncontrolled by medicationEpilepsy uncontrolled by medication
Brain tumorBrain tumor
No known causeNo known cause
Causes of Seizures continued Causes of Seizures continued
Other Possible Other Possible Causes of Altered Causes of Altered
Mental StatusMental Status
Other Possible Other Possible Causes of Altered Causes of Altered
Mental StatusMental Status
If the patient has an altered If the patient has an altered
mental status, but no mental status, but no
history of diabetes or history of diabetes or
seizures, consider other seizures, consider other
causes.causes.
Examine the environment for clues.
Examine the environment for clues.
Emergency Care of Emergency Care of Patients with Altered Patients with Altered Mental StatusMental Status
Emergency Care of Emergency Care of Patients with Altered Patients with Altered Mental StatusMental Status
Maintaining Airway Treatment
Maintaining Airway Treatment
The primary goal of
emergency care for a
patient with altered
mental status is
maintaining the airway.
Focused History for Altered Mental StatusFocused History for Altered Mental Status
OnsetOnset
DurationDuration
Associated symptomsAssociated symptoms
Evidence of traumaEvidence of trauma
SeizuresSeizures
FeverFever
Maintaining and Maintaining and
reassessing the airway of a reassessing the airway of a
patient with altered mental patient with altered mental
status is yourstatus is your
TOP PRIORITY!TOP PRIORITY!
Treatment for Treatment for Diabetic Diabetic
EmergenciesEmergencies
Treatment for Treatment for Diabetic Diabetic
EmergenciesEmergencies
General Diabetic TreatmentGeneral Diabetic Treatment Administer high-flow oxygenAdminister high-flow oxygen
Assist ventilations as necessaryAssist ventilations as necessary
Use C-spine precautions Use C-spine precautions (if trauma)(if trauma)
Keep warmKeep warm
TransportTransport
Oral glucose should Oral glucose should
only be administered to only be administered to
the responsive patient.the responsive patient.
It is contraindicated It is contraindicated
for patients who for patients who
cannot protect their cannot protect their
airway!airway!