Altered Mental Status and Its Causes: Commonest Dilemma of Residents and Emergency Physicians

Objective: To assess the frequency of the various medical conditions in patients presenting with altered mental status (AMS) in the Emergency Department of Pakistan Naval Ship (PNS) Shifa Hospital. Study Design: Prospective longitudinal study. Place and Duration of Study: Emergency Department, Pak Naval Ship Shifa Hospital, Karachi Pakistan from Feb-Jul 2021. Methodology: Adult patients who have presented with altered mental status (Glasgow coma scale score less than 15) or who have the diagnosis "AMS" written in their notes were included in the study. Patients were observed in the wards until a definitive diagnosis could be made. Results: Sixty patients presented with AMS at the Emergency Department of PNS Shifa, during the study period. The causes of AMS were sepsis (20, 33.33%), CVA (12, 20%), metabolic (hepatic/uremic) encephalopathy (8, 13.33%), diabetic complications (7, 11.66%), seizures (5, 8.33%), drug intoxication (4, 6.66%) and respiratory failure due to lung pathology (4,6.66%). The overall mortality rate was 20%. Conclusion: Sepsis is the most frequently encountered cause of altered mental state in emergency department patients,followed by CVA, metabolic encephalopathy, and diabetic complications.