Altered Conscious State

Suggested approach and Clinical Pearls

• Decreased conscious state can be due to:
  • Intracranial causes
    • Trauma
    • Stroke (haemorrhagic or thrombotic)
    • Seizures
    • Infection
    • Intracranial hypertension
  • Extracranial causes
    • Medication or poison related
    • Delirium
    • Metabolic (acid-base, glucose, thyroid, adrenal)
    • Circulatory shock state
    • Hypoxia
    • Hypercapnea
• Always check blood glucose in an unconscious patient
• Consider an undiagnosed intracranial cause for the patient’s behaviour, particularly if new or worsening unilateral signs
• Consider thiamine replacement 
• Consider intoxications, particularly opiate analgesics (iatrogenic)
• Consider LP, CT brain or MRI as additional investigations