Initial management of the patient with altered mental status

Primary care physicians may encounter patients with altered mental status or neurologic deficit. Because the differential diagnosis for altered mental status includes conditions with significant morbidity and mortality, care of these patients must be rapid and thorough. The resources required to ensure and maintain cardiopulmonary stabilization and to perform the initial workup are often unavailable in the primary care office setting. Therefore, these patients often require immediate referral to an emergency department. Proper evaluation and initial management include evaluation of metabolic factors, assessment for toxic ingestions and a thorough neurologic assessment.