Mental status, altered

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. 

In animal studies it was proved that PPD has a toxic effect on the parasympathetic nerves [14]. In humans, neurotoxicity consist of mental status alterations ranging from drowsiness to coma were reported. Also flaccid paraparesis has been published [6] [25]. Foot drop, palatopharyngeal and laryngeal paralysis were also reported (25). Rhabdomyolysis following intoxication with PPD has been reported [28-30]. Skeletal muscle biopsy of patients showed scattered coagulation necrosis and inflammatory cellular infiltration [30]. 

The symptoms of hypothyroidism and hyperthyroidism are given in Table 51-1. A severe form of hyperthyroidism, called thyrotoxicosis or tiiyroid storm, is characterized by high fever, extreme tachycardia, and altered mental status. Thyroid hormones are used to treat hypothyroidism and antithyroid... 

Although it has not been proven that acidification of the urine to increase PCP excretion alters the duration of the symptoms of psychosis, it appears appropriate to facilitate excretion of PCP from the adipose tissue in which it is stored in any PCP user (Done 1980). Maintaining the urine pH at an acid level for several weeks, even though the mental status is normal, is advised. It is important to test the pH of the urine to ensure compliance with the acidification. We have found that PCP becomes detectable in acidified urine for a time, even after being undetectable in alkaline urine, in previously intoxicated individuals. We have not found a change in mental status to result from such acidification treatment and resultant enhanced PCP excretion. 

Assess for the presence of the following clinical features ° Agitation, altered mental status, delirium, diaphoresis,... 

Utilize 3% saline for severe signs and symptoms (i.e., altered mental status, coma, and seizures)... 

TO, a 77-year-old male nursing home resident is admitted to the hospital with a 3-day history of altered mental status. The patient was unable to give a history or review of systems. On physical examination the vital signs revealed a blood pressure of 100/60 mm Hg, pulse 110 beats per minute, respirations 14/minutes, and a temperature of 101°F (38.3°C). Rales and dullness to percussion were noted at the posterior right base. The cardiac exam was significant for tachycardia. No edema was present. Laboratory studies included sodium 160 mEq/L (160 mmol/L), potassium 4.6 mEq/L (4.6 mmol/L), chloride 120 mEq/L (120 mmol/L), bicarbonate 30 mEq/L (30 mmol/L), glucose 104 mg/dL (5.77 mmol/L), BUN 34 mg/dL (12.14 mmol/L), and creatinine 2.2 mg/dL (194.5 pmol/L). The CBC was within normal limits. Chest x-ray indicated a right lower lobe pneumonia. 

Body system abnormalities (e.g., rales, altered mental status, localized inflammation, erythema, warmth, edema, pain, and pus)... 

Altered mental status (i.e., confusion, lethargy, and obtundation) (69%)... 

Predictors of an unfavorable outcome seizures, focal neurologic findings, altered mental status, papilledema, hypotension, septic shock, and pneumococcal meningitis3... 

The elderly frequently will not present with common signs and symptoms of UTI, but may present with altered mental status. 

Sepsis The systemic inflammatory response syndrome and documented infection (culture or Gram stain of blood, sputum, urine, or normally sterile body fluid positive for pathogenic microorganisms Severe sepsis Sepsis associated with organ dysfunction, hypoperfusion, or hypotension (systolic blood pressure less than 90 mm Hg). Hypoperfusion and perfusion abnormalities may include, but are not limited to, lactic acidosis, oliguria, or acute alteration in mental status. 

CDC Case Definition Arboviral infections may be asymptomatic or may result in illnesses of variable severity sometimes associated with central nervous system (CNS) involvement. When the CNS is affected, clinical syndromes ranging from febrile headache to aseptic meningitis to encephalitis may occur, and these are usually indistinguishable from similar syndromes caused by other viruses. Arboviral meningitis is characterized by fever, headache, stiff neck, and pleocytosis. Arboviral encephalitis is characterized by fever, headache, and altered mental status ranging... 

Treatment of hyponatremia involves the use of hypertonic saline. However, care is required since correction at rates in excess of 1 mEq/l/h may result in central pontine myelinolysis (CPM) [5], Symptoms of CPM include progressive weakness leading to quadriparesis, pseudobulbar palsy and altered mental status. CPM is often fatal and is characterized neuropathologically by demyelinating lesions in the central pons. 

Altered ammonia, glutamate, benzodiazepine receptor agonists, and manganese are associated with HE. However, serum ammonia levels are poorly correlated with mental status in HE. 

Sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion and perfusion abnormalities may include, but are not limited to, lactic acidosis, oliguria, or acute alteration in mental status. 

Elderly patients frequently do not experience specific urinary symptoms, but they will present with altered mental status, change in eating habits, or GI symptoms. 

Symptoms of withdrawal include depression, altered mental status, drug craving, dyssomnia, and fatigue. Duration of withdrawal from methamphetamine ranges from 3 to 24 days, but these individuals are usually not in acute distress. Occurrence of delirium suggests withdrawal from another drug (e.g., alcohol). 

Neuromuscular symptoms include altered mental status, abnormal behavior, seizures, stupor, and coma. Hypercapnia can mimic a stroke or CNS tumor by producing headache, papilledema, focal paresis, and abnormal reflexes. CNS symptoms are caused by increased cerebral blood flow and are variable, depending in part on the acuity of onset. 

Noninvasive positive-pressure ventilation (NPPV) provides ventilatory support with oxygen and pressurized airflow using a face or nasal mask with a tight seal but without endotracheal intubation. In patients with acute respiratory failure due to COPD exacerbations, NPPV was associated with lower mortality, lower intubation rates, shorter hospital stays, and greater improvements in serum pH in 1 hour compared with usual care. Use of NPPV reduces the complications that often arise with invasive mechanical ventilation. NPPV is not appropriate for patients with altered mental status, severe acidosis, respiratory arrest, or cardiovascular instability. 

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). 

Abrupt discontinuation of intrathecal baclofen, regardless of the cause, has resulted in sequelae that include high fever, altered mental status, exaggerated rebound spasticity, and muscle rigidity, which in rare cases has advanced to rhabdomyolysis, multiple organ-system failure, and death. 

Encephalopathy - Impaired cognition confusion obtundation altered mental status auditory/visual hallucinations psychosis (delirium, paranoia) mood changes (eg, mania, agitation, combativeness) diffuse hypotonus hyperreflexia myoclonus tremor asterixis involuntary movements major motor seizures lethargy/stupor/coma diffuse weakness. Approximately one-third of patients with a diagnosis of encephalopathy may have had... 

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