Altered mental status and

Neuroleptic malignant syndrome (NMS) A potentially fatal symptom complex sometimes referred to as NMS has been reported in association with promethazine alone or in combination with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (eg, irregular pulse or blood pressure, tachycardia, diaphoresis, cardiac dysrhythmias). 

Overdose includes symptoms of altered mental status and visual problems. 

Alkyl leads are environmentally prevalent compounds, which have been shown to produce a variety of neurological and behavioral deficits in both laboratory animals and humans. Heavy abuse of leaded gasoline resulted in an encephalopathy, cerebellar and corticospinal symptoms, dementia, mental status alterations and persistent organic psychosis. However, much of this is due to the hydrocarbons of gasoline, while the tetraethyl lead contributes to the altered mental status and is responsible for the persistent psychosis143. 

The combination of valproate and traditional neuroleptic drugs, a first-line treatment for mixed or rapid-cycling episodes or dysphoric mania with psychotic features, is associated with altered mental status and electroencepha-lographic abnormalities (641). 

A 53-year-old man developed atypical neuroleptic malignant syndrome, with fever, altered mental status, and autonomic dysfunction, but without rigidity (a usual feature of this condition) while taking olanzapine (109). 

The primary toxicities observed with procainamide are cardiovascular in nature. Initially, a tachycardia may occur due to procainamide s anticholinergic properties or as a reflex response to vasodilation. Cardiac conduction disturbances may occur. On the ECG, these may be displayed as prolongation of the QRS and/or QTc duration. Heart block, bradycardia, and asystole have been reported. Procainamide can also cause ventricular tachycardia, ventricular fibrillation, and Torsades de Pointes. Severe hypotension due to decreases in cardiac output and/or vasodilation may be seen. Altered mental status and seizure activity can occur in procainamide toxicity. 

Pressure sores are seen most frequently in chronically debilitated persons, the elderly, and persons with serious spinal cord injury. Generally, patients who are at risk for pressure sores are elderly or chronically ill young patients who are immobilized either in bed or a wheelchair and who may have altered mental status and/or incontinence. 

A 54-year-old woman was admitted to the accident and emergency department with altered mental status and decreased appetite. She was lethargic and responded poorly to questions. 

A. Chronic vitamin A toxicity is characterized by dry, peeling skin and signs of increased intracranial pressure (headache, altered mental status, and blurred vision pseudotumor cerebri). Bulging fontanelles have been described in infants. Liver injury may cause jaundice and ascites. 

B. Cyanide toxicity, manifested by altered mental status and metabolic (lactic) acidosis, may occur with rapid high-dose infusion (> 10-15 mcg/kg/min) for periods of 1 hour or longer. Patients with depleted thiosulfate stores (eg, malnourished) may have elevated cyanide levels at lower infusion rates. Continuous intravenous infusion of hydroxocobalamin, 25 mg/h (see p 453 note caution with preservative), or thiosulfate (p 505) has been used to limit cyanide toxicity. If severe cyanide toxicity occurs, discontinue the nitropmsside infusion and consider antidotal doses of thiosulfate and sodium nitrite (p 476) or high-dose hydroxocobalamin (p 453 note concentrated fona not available in the United States). 

Marked hypertension, diaphoresis, altered mental status and hypertonicity (slow forceful twisting and arching movements) occurred in one patient taking phenelzine with ecstasy. Increased muscle tension, decorticate-like posturing, fever, tachycardia and coma occurred in another patient taking phenelzine, 15 minutes after drinking juice containing ecstasy. Both patients recovered. 

A patient is comatose or has altered mental status and the risk of breathing in the stomach contents is high. 

Perez, J., and J.F. Holmes. 2005. Altered mental status and ataxia secondary to acute kava ingestion. /. Emerg. Med. 28(1) 49-51. 

Patients may present with the Charcot triad of fever and chills, jaundice, and RUQ abdominal pain, and even altered mental status and hypotension (i.e. Reynold pentad) due to ascending cholangitis. 

Other energy depletion disorders include disorders of fatty acid oxidation, ketone disorders (both synthesis and ketolysis), and disorders of glucose metabolism. These often present with a global neurologic phenotype resulting in altered mental status and/or seizures. Often these are in... 

There have been numerous cases of neurotoxicity associated with cefepime, including encephalopathy [56 ]. The first case of encephalopathy secondary to cefepime in a child was reported in a 14-year-old girl who experienced altered mental status and confusion secondary to cefepime exposure in acute renal failure A case series of nine reports of neurotoxicity related to cefepime demonstrated that cefepime accumulation, particularly in renal dysfxmction, is the main way that cefepime causes this toxicity. The authors suggest that serum and CSF monitoring of cefepime may be employed to help diagnose and manage overdoses, although this would be difficult to employ clinically... 

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