The Approach to Altered Mental Status in the Intensive Care Unit.

Area of Science:

• Critical Care Medicine
• Neuroscience
• Internal Medicine

Background:

• Altered mental status (AMS) is a common and burdensome syndrome in the intensive care unit (ICU).
• Patients with AMS are frequently diagnosed with non-specific labels such as toxic-metabolic encephalopathy (TME) or delirium.
• There is a critical need for identifying specific, treatable etiologies of AMS in critically ill patients.

Purpose of the Study:

• To provide a structured approach for identifying specific causes of AMS in critically ill patients.
• To offer practical guidance on bedside assessment in the ICU environment.
• To review the utility of neurodiagnostic procedures for diagnosing AMS in unstable patients.

Main Methods:

• Review of literature on causes and diagnosis of AMS in the ICU.
• Discussion of bedside assessment techniques and neurodiagnostic procedures.
• Focus on high-yield toxicologic, neurologic, and infectious etiologies of AMS.

Main Results:

• A structured approach can increase the identification of specific causes of AMS.
• Bedside assessment and specialized neurodiagnostic modalities are valuable in the ICU.
• Specific etiologies, including uremic and septic encephalopathies, and other high-yield causes, require deliberate consideration.

Conclusions:

• Systematic evaluation for specific etiologies is crucial for managing AMS in the ICU.
• Clinicians should move beyond non-specific diagnoses to ensure appropriate treatment.
• This review provides a framework for diagnosing and managing AMS in critically ill patients.