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  Question 1


What are the differential diagnosis for a patient with alteration of consciousness?

 
  Differential Diagnosis of Conscious change
 


The Mnemonics “TIPS from the VOWELS”
T: Trauma
I : Insulin/ Intussusception
P: Psychogenic
S:Seizures/ Stroke/ Shock/ Structural
A: Alcohols/ Abuse/ Acid-base
E: Electrolytes/ Endocrine/ Encephalopathy/
Environmental
I: Infection/ Intoxication
O: Overdose/ O2 – CO2
U: Uremia
  Flow Chart of Altered Mental Status



 
  ED workup
 


CBC/DC
BCS : Bun, Cr, GOT, Glucose, K, Na, Cl
ABG
U/A
Ethanol level
Methanol level
Brain CT
CXR
EKG
  EKG



Complete 12 leads EKG

  Imaging Study






  Lab Data
 


ABG: pH: 6.676/ pCO2: 24.5/ pO2:170
HCO3: 2.9 / BE:33.2
BCS:
Na: 133.8 K: 5.72 Cl:100.5 Glu:180
Bun: 19 Cr: 2.3 GOT:18

CBC/DC:WBC/DC 25000(S53B12)
Hb:13.8
Ethanol:107 Methanol: ?

  What is your impression?
 


1. Severe metabolic acidosis
R/O Methanol intoxication
Ethanol overdose
2. Leukocytosis, cause ?