Diabetes and Altered Mental Status CHAPTER 19. Causes of Altered Mental Status.

Diabetes and Diabetes and Altered Mental Altered Mental StatusStatus

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Causes of AlteredCauses of AlteredMental StatusMental StatusCauses of AlteredCauses of AlteredMental StatusMental Status

Causes of Altered Mental StatusCauses of Altered Mental Status

HypoglycemiaHypoglycemia PoisoningPoisoning IntoxicationIntoxication InfectionInfection HypothermiaHypothermia HyperthermiaHyperthermia Head traumaHead trauma Decreased oxygen levelsDecreased oxygen levels

Altered mental status is

present when a patient’s

verbal or nonverbal

response shows they are

not aware of their situation.

Diabetic Diabetic EmergenciesEmergencies

Diabetic Diabetic EmergenciesEmergencies

Diabetes mellitus:Diabetes mellitus:

A disease that results from A disease that results from failure of the pancreas to failure of the pancreas to produce either enough insulin produce either enough insulin or usable insulin.or usable insulin.

Glucose:Glucose:

A basic sugar that is present in A basic sugar that is present in some form in most foods and is some form in most foods and is required by the body to required by the body to produce energy.produce energy.

Two Forms of Diabetes Two Forms of Diabetes Insulin-dependentInsulin-dependent

The pancreas no longer produces any insulinThe pancreas no longer produces any insulin

Non-insulin dependentNon-insulin dependent Some production of insulin still occursSome production of insulin still occurs

Common Diabetic Medications Common Diabetic Medications

InsulinInsulin Humulin - regular or NPHHumulin - regular or NPH

Oral medicationsOral medications DiabineseDiabinese OrinaseOrinase MicronaseMicronase

Blood Sugar Levels Blood Sugar Levels HypoglycemiaHypoglycemia

A symptomatic decrease in blood sugar concentration (may be sudden)A symptomatic decrease in blood sugar concentration (may be sudden)

HyperglycemiaHyperglycemia A symptomatic increase in blood sugar concentration (usually gradual)A symptomatic increase in blood sugar concentration (usually gradual)

Rapid-onset altered mental statusRapid-onset altered mental status Intoxicated appearance; staggering, Intoxicated appearance; staggering,

slurred speechslurred speech Elevated heart rateElevated heart rate Cold, clammy skinCold, clammy skin AnxiousAnxious HungryHungry SeizuresSeizures

Signs & Symptoms of Hypoglycemia Signs & Symptoms of Hypoglycemia

SeizuresSeizuresSeizuresSeizures

Seizure:Seizure:

A convulsive movement of the A convulsive movement of the body or an impaired mental body or an impaired mental state caused by random state caused by random discharge of the brain’s discharge of the brain’s electrical impulses.electrical impulses.

FeverFever

InfectionInfection

PoisoningPoisoning

OverdoseOverdose

IntoxicationIntoxication

HypoglycemiaHypoglycemia

Common Causes of Seizures Common Causes of Seizures

Head traumaHead trauma

Impaired cerebral oxygenationImpaired cerebral oxygenation

Epilepsy uncontrolled by medicationEpilepsy uncontrolled by medication

Brain tumorBrain tumor

No known causeNo known cause

Causes of Seizures continued Causes of Seizures continued

Other Possible Other Possible Causes of Altered Causes of Altered

Mental StatusMental Status

Other Possible Other Possible Causes of Altered Causes of Altered

Mental StatusMental Status

If the patient has an altered If the patient has an altered

mental status, but no mental status, but no

history of diabetes or history of diabetes or

seizures, consider other seizures, consider other

causes.causes.

Examine the environment for clues.

Examine the environment for clues.

Emergency Care of Emergency Care of Patients with Altered Patients with Altered Mental StatusMental Status

Emergency Care of Emergency Care of Patients with Altered Patients with Altered Mental StatusMental Status

Maintaining Airway Treatment

Maintaining Airway Treatment

The primary goal of

emergency care for a

patient with altered

mental status is

maintaining the airway.

AssessmentAssessmentAssessmentAssessment

Focused History for Altered Mental StatusFocused History for Altered Mental Status

OnsetOnset

DurationDuration

Associated symptomsAssociated symptoms

Evidence of traumaEvidence of trauma

SeizuresSeizures

FeverFever

Examining the Examining the

unconscious unconscious

patient.patient.

Airway Airway ManagementManagement

Airway Airway ManagementManagement

Maintaining and Maintaining and

reassessing the airway of a reassessing the airway of a

patient with altered mental patient with altered mental

status is yourstatus is your

TOP PRIORITY!TOP PRIORITY!

Treatment for Treatment for Diabetic Diabetic

EmergenciesEmergencies

Treatment for Treatment for Diabetic Diabetic

EmergenciesEmergencies

General Diabetic TreatmentGeneral Diabetic Treatment Administer high-flow oxygenAdminister high-flow oxygen

Assist ventilations as necessaryAssist ventilations as necessary

Use C-spine precautions Use C-spine precautions (if trauma)(if trauma)

Keep warmKeep warm

TransportTransport

Oral GlucoseOral Glucose

Administration of Oral Administration of Oral GlucoseGlucose

Administration of Oral Glucose Administration of Oral Glucose continuedcontinued

Oral glucose should Oral glucose should

only be administered to only be administered to

the responsive patient.the responsive patient.

It is contraindicated It is contraindicated

for patients who for patients who

cannot protect their cannot protect their

airway!airway!

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Emergency Care of Patients Emergency Care of Patients with Altered Mental Statuswith Altered Mental Status