1. Diabetes and Altered Mental Status CHAPTER 19

2. Causes of Altered Mental Status

3.  Hypoglycemia  Poisoning  Intoxication  Infection  Hypothermia  Hyperthermia  Head trauma  Decreased oxygen levels

4. Altered mental status is present when a patient’s verbal or nonverbal response shows they are not aware of their situation.

5. Diabetic Emergencies

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

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

8. Two Forms of Diabetes  Insulin-dependent  The pancreas no longer produces any insulin  Non-insulin dependent  Some production of insulin still occurs

9. Common Diabetic Medications  Insulin  Humulin - regular or NPH  Oral medications  Diabinese  Orinase  Micronase

10. Blood Sugar Levels  Hypoglycemia  A symptomatic decrease in blood sugar concentration (may be sudden)  Hyperglycemia  A symptomatic increase in blood sugar concentration (usually gradual)

11.  Rapid-onset altered mental status  Intoxicated appearance; staggering, slurred speech  Elevated heart rate  Cold, clammy skin  Anxious  Hungry  Seizures Signs & Symptoms of Hypoglycemia

12. SeizuresSeizures

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

14.  Fever  Infection  Poisoning  Overdose  Intoxication  Hypoglycemia Common Causes of Seizures

15.  Head trauma  Impaired cerebral oxygenation  Epilepsy uncontrolled by medication  Brain tumor  No known cause Causes of Seizures continued

16. Other Possible Causes of Altered Mental Status

17. If the patient has an altered mental status, but no history of diabetes or seizures, consider other causes. Examine the environment for clues.

18. Emergency Care of Patients with Altered Mental Status Maintaining Airway Treatment

19. The primary goal of emergency care for a patient with altered mental status is maintaining the airway.

20. AssessmentAssessment

21. Focused History for Altered Mental Status  Onset  Duration  Associated symptoms  Evidence of trauma  Seizures  Fever

22. Examining the unconscious patient.

23. Airway Management

24. Maintaining and reassessing the airway of a patient with altered mental status is your TOP PRIORITY!

25. Treatment for Diabetic Emergencies

26. General Diabetic Treatment  Administer high-flow oxygen  Assist ventilations as necessary  Use C-spine precautions (if trauma)  Keep warm  Transport

27. Oral Glucose

28. Administration of Oral Glucose

29. Administration of Oral Glucose continued

30. Oral glucose should only be administered to the responsive patient. It is contraindicated for patients who cannot protect their airway!

31. SUMMARY Causes of Altered Mental Status Causes of Altered Mental Status Emergency Care of Patients with Altered Mental Status Emergency Care of Patients with Altered Mental Status