Altered Mental Status (AMS) is one of the most critical presentations in emergency medicine. It refers to any change in a patient’s level of alertness, orientation, behavior, or cognitive function.
AMS is not a diagnosis—it is a symptom of an underlying medical, metabolic, neurological, psychiatric, or toxic cause.
Your chart provides a structured, easy-to-remember framework based on the AEIOU TIPS mnemonic—essential for identifying life-threatening conditions quickly.
This guide simplifies assessment, workup, and management in a beginner-friendly academic tone.
What Is Altered Mental Status (AMS)?
AMS is a broad term that includes:
- Confusion
- Delirium
- Disorientation
- Decreased responsiveness
- Agitation
- Lethargy
- Stupor or coma
Any sudden change in mental status is considered a medical emergency.
.jpg "Altered Mental Status (AMS) - Causes, AEIOU TIPS, Diagnosis & Emergency Management")
First 60 Seconds: Immediate Actions (From Chart)
When a patient presents with AMS, immediate stabilization is the priority.
Immediate Actions
1. Check Fingerstick Glucose (FS)
If low → Give D50
2. Suspected opioid overdose
Give Naloxone
3. Uncooperative or violent patient
Sedate + restrain (safely and ethically)
These steps must be done before detailed history or physical exam.
The AEIOU TIPS Mnemonic (Differential Diagnosis)
AEIOU TIPS is a classic tool used to quickly determine why a patient is altered.
Below is the chart’s content rewritten into a clear learning format.
A – Alcohol & Withdrawal
1. Alcohol intoxication
Clues:
- Smell of alcohol
- Altered sensorium
Workup: Clinical, ethanol level
Treatment: Observe
2. Alcohol withdrawal
Clues:
- Anxiety
- Tremors
- Sweating
- High BP
- Seizures (delirium tremens risk)
Treatment:
- Anxiolytics
- IV fluids
- Admit if CIWA > 10
E – Electrolytes & Encephalopathy
1. Electrolyte abnormalities
Common offenders:
- Sodium abnormalities (Na⁺)
- Potassium abnormalities
- Calcium abnormalities
Workup: BMP, EKG
Treatment: Correct specific electrolyte
2. Hepatic encephalopathy
Clues:
- Jaundice
- Cirrhotic patient
- Confusion
Workup: LFTs, ammonia
Treatment: Lactulose, neomycin
3. Hypertensive encephalopathy
Clues:
- Diastolic BP > 120
- Headache
- Visual disturbances
Workup: Evaluate end-organ damage
Treatment:
- Controlled BP lowering
- Target: MAP ↓ ≤ 25%
I – Insulin (Hypo/Hyperglycemia)
1. Hypoglycemia
Clues:
- Diabetic patient
- Low blood sugar
Workup: FSBG
Treatment: D50
O – Opiates
Opiate overdose
Clues:
- Pinpoint pupils
- Respiratory depression
Workup: Clinical
Treatment:
- Naloxone
- Observation
U – Uremia
Renal failure / dialysis patient
Clues:
- History of CKD
- AV fistula
- Confusion, nausea
Workup: BUN/Creatinine
Treatment:
- Dialysis
- Nephrology consult
T – Trauma, Toxins, Tumor, Thyrotoxicosis
1. Trauma
Clues:
- Head injury
- Blood loss
- Unequal pupils
Workup: CT head
Treatment:
- Neurosurgery consult
- IV fluids
2. Toxins
Examples: Aspirin, acetaminophen, drugs, chemicals.
Clues: Pupils, skin signs, reflex changes
Workup: ASA level, APAP level, urine toxicology
Treatment: Poison control consult
3. Tumor
Clues:
- Insidious onset
- Focal deficits
Workup: CT head
Treatment: Neurosurgery consult
4. Thyrotoxicosis
Clues:
- Tremors
- Tachycardia
- Heat intolerance
- Nausea/vomiting
Workup: TSH
Treatment: IV fluids, propranolol
I – Infection
Serious infections causing AMS
- UTI in elderly
- Pneumonia
- Meningitis
- Sepsis
- Encephalitis
Workup:
- UA/CXR
- Blood cultures
- +/– LP
Treatment:
- IV fluids
- Antibiotics
- Treat source
P – Polypharmacy & Psychiatric Causes
1. Polypharmacy
Clues:
- New or changed medications
- Drug interactions
Workup: Toxicology screen
Treatment: Adjust medications
2. Psychiatric illness
Diagnosis of exclusion.
Treatment: Psychiatric consult
S – Seizures & Stroke
1. Post-ictal state
Clues:
- Tongue biting
- Confusion
- Hx of seizures
Workup: Lactate, CT head
Treatment:
- Neurology consult
- Monitor
2. Stroke
Clues:
- Focal neurological signs
- Sudden onset
Workup: CT head
Treatment:
- Neurology consult
- Consider tPA (if eligible)
- Aspirin (if not hemorrhagic)
Diagnostic Strategy for AMS
A. History (if possible)
Ask family, EMS, or nursing staff about:
- Baseline mental state
- Timeline of change
- Recent illnesses
- Medications
- Trauma history
- Alcohol/drug use
B. Physical Exam
Check:
- Vital signs
- Pupils
- Skin signs (track marks, rash)
- Neurological deficits
- Evidence of trauma
C. Essential Labs
- Glucose
- BMP
- CBC
- LFTs / ammonia
- TSH
- ABG/VBG
- Toxicology (ASA, APAP, UTox)
D. Imaging
- CT head (trauma, stroke, unclear cause)
E. Additional Tests
- Lumbar puncture (infection suspicion)
- ECG (electrolyte abnormality, overdose)
Management Principles for AMS
1. Stabilize first
Airway → Breathing → Circulation
2. Reverse reversible causes
- Hypoglycemia → D50
- Opioids → Naloxone
- Wernicke’s → Thiamine (if alcohol dependence)
- Hypercapnia → Ventilation support
3. Treat underlying cause
4. Prevent complications
- Protect airway
- Avoid aspiration
- Control agitation safely
5. Monitor
- Serial neurological exams
- Vital signs
- Response to interventions
Pearls & Pitfalls (Based on Chart)
- Difficult patients: search for EMS sheets, old records, contact family
- Always compare with baseline mental status
- Alcohol on breath does NOT exclude serious causes
- Elderly: infections and metabolic issues are common
- Intoxicated patients may have hidden trauma
- Stroke is a “do not miss” diagnosis
Documentation Essentials
According to the chart:
General
- LOC
- Nausea/vomiting
- Seizure activity
- Elderly?
- Alcohol smell?
Head
- Signs of trauma
- Pupils
- TM examination
- Nasal septum
- Lacerations/abrasions
Neuro
- Document exam as completely as possible
- Include GCS if needed
FAQs About Altered Mental Status (AMS)
1. Is AMS always an emergency?
Yes—because it may indicate stroke, infection, overdose, or metabolic failure.
2. Why is glucose checked first?
Hypoglycemia is a quickly reversible and common cause of AMS.
3. Do all AMS patients need CT scans?
Not all, but any patient with trauma, focal deficits, or unclear cause requires imaging.
4. What is the danger of assuming “it’s just alcohol”?
Serious conditions like subdural hematoma can coexist with intoxication.
5. Which infections commonly cause AMS?
UTI (especially in elderly), pneumonia, meningitis, sepsis.
6. What medication side effects cause AMS?
Benzodiazepines, opioids, anticholinergics, antidepressants, and polypharmacy in elderly.
7. When should you suspect stroke?
Sudden focal deficits, slurred speech, asymmetry, or acute neurological deterioration.
