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Altered mental status

Marc L Martel, Lauren R Klein, Andrew J Lichtenheld, Allan M Kerandi, Brian E Driver, Jon B Cole
BACKGROUND: Altered mental status is a commonly evaluated problem in the ED. Ethanol intoxication is common, and prehospital history may bias emergency physicians to suspect this as the cause of altered mental status. Quantitative ethanol measurement can rapidly confirm the diagnosis, or if negative, prompt further evaluation. Our objective was to identify the etiologies of altered mental status in ED patients initially presumed to be intoxicated with ethanol but found to have negative quantitative ethanol levels...
March 12, 2018: American Journal of Emergency Medicine
Eashaa Kumar, Michael T McCurdy, Christian A Koch, Abdurrahman Hamadah, Tibor Fülöp, Kamel A Gharaibeh
Unexplained hypotension in the intensive care unit is commonly attributed to volume depletion, cardiorespiratory failure, sepsis, or relative adrenal insufficiency. In these acute conditions, thyroid hormone levels measured in blood, serum or plasma are often altered and solely attributed to critical illness. We report a series of 3 critically ill patients with prolonged respiratory failure, suppressed mental status and unexplained hypotension. Thyroid stimulating hormone levels ranged from normal to mildly elevated (2...
March 2018: American Journal of the Medical Sciences
Mark K Su, Jessica Hetherington Lopez, Aldo Crossa, Robert S Hoffman
STUDY OBJECTIVE: To assess the efficacy of 10mg intramuscular (IM) methadone in patients with opioid withdrawal syndrome (OWS). METHODS: This was a prospective observational, convenience sample of patients presenting to the ED with mild to moderate OWS. Evaluations included the Clinical Opiate Withdrawal Scale (COWS), Withdrawal Symptoms Scale (WSS), Altered Mental Status Scale (AMSS) and a physician assessment of the patient's WSS (MDWSS). After enrollment, 10mg of IM methadone was administered and patients were reassessed at 30min post-methadone administration...
March 2, 2018: American Journal of Emergency Medicine
Jamie L Fleet, Stephanie N Dixon, Paul John Kuwornu, Varun K Dev, Manuel Montero-Odasso, Jorge Burneo, Amit X Garg
Gabapentin is an effective treatment for chronic neuropathic pain but may cause dizziness, drowsiness, and confusion in some older adults. The goal of this study was to assess the association between gabapentin dosing and adverse outcomes by obtaining estimates of the 30-day risk of hospitalization with altered mental status and mortality in older adults (mean age 76 years) in Ontario, Canada initiated on high dose (>600 mg/day; n = 34,159) compared to low dose (≤600 mg/day; n = 76,025) oral gabapentin in routine outpatient care...
2018: PloS One
Ronaldo Lira-Junior, Sigvard Åkerman, Björn Klinge, Elisabeth A Boström, Anders Gustafsson
BACKGROUND: Analysis of saliva is emerging as a promising tool to diagnose and monitor diseases which makes determination of the salivary microbial profile in different scenarios essential. OBJECTIVE: To evaluate the effects of age, periodontal disease, sex, smoking, and medical conditions on the salivary microbial profile. DESIGN: A randomly selected sample of 441 individuals was enrolled (51% women; mean age 48.5±16.8). Participants answered a health questionnaire and underwent an oral examination...
2018: PloS One
Stephen Clark, Alysa Nash, Mark Shasti, Luke Brown, Julio J Jauregui, Katherine Mistretta, Eugene Koh, Kelley Banagan, Steven Ludwig, Daniel Gelb
STUDY DESIGN: Retrospective cohort study OBJECTIVE.: To assess 30-day and one-year mortality rates as well as the most common complications associated with posterior C1-2 fusion in an octogenarian cohort. SUMMARY OF BACKGROUND DATA: Treatment of unstable type II odontoid fractures in elderly patients can present challenges. Recent evidence indicates in patients older than 80 years, posterior C1-2 fusion results in improved survival as compared to other modes of treatment...
March 13, 2018: Spine
Jonathan B Imran, Robyn E Richmond, Tarik D Madni, Kimberly Roaten, Audra T Clark, Emily Huang, Ali A Mokdad, Luis R Taveras, Kareem R Abdelfattah, Michael W Cripps, Alexander L Eastman
BACKGROUND: Trauma patients may be at elevated risk for subsequent suicide; however, it is unclear whether patients at risk can be identified during their initial presentation following injury. The objective of this study was to evaluate the use of a standardized clinical decision support system for suicide risk screening developed by our hospital system and to determine the incidence of positive suicide screenings in our trauma population. METHODS: Adult trauma patient screenings were performed by nursing staff during the triage process using the Columbia Suicide Severity Rating Scale, Clinical Practice Screener, Recent (C-SSRS)...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Erum Khan, Kelli L Barr, Joveria Qais Farooqi, Dhani Prakoso, Alizae Abbas, Zain Y Khan, Shanze Ashi, Kehkashan Imtiaz, Z Aziz, Faisal Malik, John A Lednicky, Maureen T Long
Like most of the world, Pakistan has seen an increase in mosquito-transmitted diseases in recent years. The magnitude and distribution of these diseases are poorly understood as Pakistan does not have a nation-wide system for reporting disease. A cross-sectional study to determine which flaviviruses were causing of arboviral disease in Pakistan was instituted. West Nile virus (WNV) is a cause of seasonal fever with neurotropic findings in countries that share borders with Pakistan. Here, we describe the active and persistent circulation of WNV in humans in the southern region of Pakistan...
2018: Frontiers in Public Health
Matthew W Roché, Douglas J Boyle, Chia-Cherng Cheng, Jill Del Pozzo, Lindsay Cherneski, Joe Pascarella, Alicia Lukachko, Steven M Silverstein
Research has consistently demonstrated that people diagnosed with serious mental illness (SMI) are at increased risk for violent ideation and behavior (VIB) and that this is especially the case for SMI patients with comorbid substance use disorders (SUD). Despite this, what is still largely unknown is the relative prevalence of VIB across diagnostic categories, whether the rates of VIB in SMI groups exceed the rates observed in people with SUD only, and which demographic factors increase the likelihood of VIB under different circumstances for people with SMI...
March 1, 2018: Journal of Interpersonal Violence
Steven G Schauer, James A Pfaff
BACKGROUND: Heat injuries are common in the military training environment. Base policies often mandate that heat causalities require evaluation at a higher level of care, which comes at significant use of resources. Laboratory studies are often ordered routinely, but their utility is unclear at this time. METHODS: This project evaluated the use of screening laboratory studies for heat casualties brought to Bayne-Jones Army Community Hospital, Fort Polk, Louisiana...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Lei Zhang, Jian Xu
Posterior reversible encephalopathy syndrome (PRES) is a rare clinical entity associated with systemic lupus erythematosus which characterized by seizure, headache, and altered mental status. The pathophysiology involves subcortical vasogenic edema secondary to hypertension and endothelial damage. PRES is reversible with withdrawal of the offending agent, strict blood pressure control, and treating the underlying disease. We report present here a patient with lupus nephritis who developed PRES following mycophenolate administration...
2018: American Journal of Clinical and Experimental Immunology
Daniel Novick, Raina Wallace, Jody C DiGiacomo, Anand Kumar, Steven Lev, L D George Angus
BACKGROUND: The newest CT scanners provide resolution comparable to MRIs leading many to question when and whether cervical spine MRIs are warranted. METHODS: An 8 year retrospective review identified 241 patients who underwent CT scan and MRI of the cervical spine. The initial clinical examination, cervical spine CT scan, and cervical spine MRI were compared to identify cervical spine injuries that would have been missed had the MRI not been performed. RESULTS: The CT scans were normal in 153 patients, and abnormal in 88...
March 6, 2018: American Journal of Surgery
Robin A Scott, Kathleen S Oman, Kathleen Flarity, Jennifer L Comer
INTRODUCTION: Patient falls are a significant issue in hospitalized patients and financially costly to hospitals. The Joint Commission requires that patients be assessed for fall risk and interventions in place to mitigate the risk of falls. It is imperative to have a patient population/setting specific fall risk assessment tool to identify patients at risk for falling. The purpose of this study was to evaluate the reliability and validity of the 2013 Memorial ED Fall Risk Assessment tool (MEDFRAT) specifically designed for the ED population...
March 6, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Jovie Ann Alawas Decoyna, Paul McLiesh, Yvette Michelle Salamon
No abstract text is available yet for this article.
February 27, 2018: International Journal of Orthopaedic and Trauma Nursing
Manveer Garcha, Keithan Sivakumar, Mohammed El-Hunjul, Shweta Varade, Hussam A Yacoub
Posterior reversible encephalopathy syndrome (PRES) is clinically characterized by seizures, changes in vision, altered mental status, and headache, with associated radiologic changes on brain imaging. Intraparenchymal hemorrhage is a rare complication of PRES and an atypical initial presentation of this condition. In this report, we discuss two patients who presented with multifocal cerebral hemorrhages that were later attributed to PRES. We further expand on the pathophysiology, management, and prognosis on patients with hemorrhagic PRES...
March 8, 2018: Hospital Practice (Minneapolis)
Danielle Bloch, Kenya Murray, Eric Peterson, Stephanie Ngai, Inessa Rubinstein, Tanya A Halse, Ifeoma Ezeoke, Laura Miller, Lola Arakaki, Arianne Ramautar, Mike Antwi, Paula Del Rosso, Marie Dorsinville, Sandhya Clark, Megan Halbrook, Joseph Kennedy, Sarah Braunstein, Don Weiss
Backgroun: d The case fatality rate (CFR) from invasive meningococcal disease (IMD) in New York City (NYC) is greater than national figures, with higher rates among females than males across all age groups. Methods: We conducted a retrospective cohort study among 151 persons aged 15 years and older diagnosed with IMD in NYC during 2008-2016 identified through communicable disease surveillance. We examined demographic, clinical, and community-level associations with death to confirm the elevated risk of mortality among female IMD patients after adjusting for confounders and to determine factors associated with female IMD mortality...
March 2, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Israel Ugalde, Manuel Bello Segura, Sabrina Oneto, Ari Ciment
An altered mental status presents a diagnostic challenge for many clinicians. Described here is a case of primary hyperparathyroidism not initially suspected until after a thorough neurological and infectious cause were excluded. A 60-year-old woman presented with altered mental status and gait instability. Her family noticed progressive gait instability and mood swings for the past 4 months. Initial imaging and laboratory values were unable to explain her symptoms. On transfer out of the intensive care unit, her corrected calcium was found to be 13...
March 5, 2018: BMJ Case Reports
Mohamed Almuqbil, Michael J Rivkin, Masanori Takeoka, Edward Yang, Lance H Rodan
GLUT1 deficiency syndrome (GLUT1DS) is a well described neurometabolic disorder that results from impaired glucose transport into the central nervous system. GLUT1DS classically presents with infantile-onset epilepsy, progressive microcephaly, developmental delay, ataxia, dystonia, and spasticity, but a minority of patients may manifest with paroxysmal non-epileptic phenomena including hemiparesis (Wang et al., 2002). We report for the first time cerebral perfusion changes during an acute episode of hemiparesis in a 9 year old child with GLUT1DS...
February 19, 2018: European Journal of Paediatric Neurology: EJPN
Timothy B Legare, Oteni Hamilton, Sarah Dhannoon, Sayed Ali
Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic condition caused most commonly by metastatic mesenchymal tumors. A 74-year-old non-diabetic male with an eight-year history of metastatic sarcomatoid lung cancer presented with altered mental status. His previous treatment included a lobectomy and radiation. Laboratory investigations were significant for blood glucose of 28 mg/dL, confirming hypoglycemia. He was hypokalemic, a condition seen in approximately 50% of patients with NICTH, at 2...
December 20, 2017: Curēus
Ramsis F Ghaly, Armen Haroutunian, Kenneth D Candido, Nebojsa Nick Knezevic
Background: Altered mental status describes impaired mental functioning ranging from confusion to coma and indicates an illness, either metabolic or structural in nature. Metabolic causes include hypothyroidism, hyperuremia, hypo/hyperglycemia, hypo/hypernatremia, and encephalopathy. The structural causes include tumors, brain hemorrhage, infection, and stroke. To our knowledge, this is the first case in which a patient presented with altered mental status from both metabolic (myxedema coma) and structural diseases (frontal meningioma) with vasogenic edema and midline shift...
2018: Surgical Neurology International
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