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  1. DDX Altered Mental Status:
    • Metabolic - B12, Thiamine def, hepatic encephalopathy, Wilson's Dz, niacin def
    • Oxygen - hypoxemia, hypercarbia, anemia, decreased cerebral blood flow, sepsis, CO
    • Vascular - stroke, hemorrhage, vasculitis, TTP, DIC
    • Endocrine - hyper/hypoglycemia, hyper/hypothyroidism, high/low cortisol
    • Electrolyte - low Na, hyper/hypocalcemia, hypermag, hypophos, abnl LFTs
    • Seizures - post-ictal, status epilepticus, complex partial sz
    • Structural - lesions with mass effect, hydrocephalus
    • Tumor/Trauma/Temp - fever/hypothermia
    • Uremia - also dialysis disequilibrium syndrome
    • Psychiatric - ICU psychosis, "sun-downing"
    • Infection - CNS, sepsis
    • Drugs - intoxication or withdrawal
    • Degenerative Dz - Alzheimer's, Parkinson's, Huntington's
  2. AMS workup:
    • Blood glucose
    • CBC
    • BMR, Mg, Phos
    • LFT's
    • UA, Utox
    • ABG
    • EKG, troponins
    • Blood/Urine cx
    • CXR
    • consider non-con Head CT
    • consider LP
  3. AMS initial treatment:
    • O2
    • Thiamine 100mg IV, then D50 1amp
    • Naloxone 0.4-1.2mg IV (if suspect opiod OD)

    Further treatment based on lab/test results
  4. Pseudotumor cerebri =
    Idiopathic intracranial hypertension characterized by papilledema, normal imaging studies, and elevated opening pressure on lumbar puncture with normal CSF

    Typically seen in young, obese females
  5. Pseudotumor cerebri treatment:
    • First line:
    • Acetazolamide - carbonic anhydrase inhibitor,¬†lowers intracranial pressure by reducing the production of CSF

    or Furosemide

    May resolve spontanesously, but risk of vision impairment/blindness if left untreated.

    Surgical options: optic nerve fenestration, ventricular-peritoneal shunt
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