Diabetes and Altered Mental Status

Diabetes and Altered Mental Status

• Diabetes and altered mental status is a chapter topic.
• The overview of the topic includes causes of altered mental status, diabetic emergencies, seizures, stroke, and other possible causes.
• Emergency care of patients with altered mental status includes assessment, airway management, and treatment for diabetic emergencies.

AVPU

• AVPU stands for Alert-oriented, Alert and disoriented, Verbal response, Painful response, and Unconscious.
• These are used to assess levels of consciousness.

Causes of Altered Mental Status

• Hypoglycemia is a cause.
• Poisoning is a cause.
• Intoxication is a cause.
• Hypothermia is a cause.
• Hyperthermia is a cause.
• Head trauma is a cause.
• Infection is a cause.
• Decreasing oxygen levels (also known as hypoxia) is a cause.

Diabetic Emergencies

• Insulin is a hormone that breaks down glucose into usable energy.
• Insipidus and Mellitus are types of diabetes related to anti-diuretic hormone from the pituitary and blood glucose levels, respectively.
• Glucose is a basic sugar found in many foods.
• Diabetes mellitus is a disease where the pancreas fails to produce enough insulin.
• Two forms of diabetes include insulin-dependent (pancreas produces no insulin) and non-insulin-dependent (pancreas still produces some insulin).
• Common diabetic medications include Insulin, Humulin, Diabinese, Orinase, and Micronase.

Blood Sugar Levels

• Hypoglycemia is a symptomatic decrease in blood sugar concentration.
• Hyperglycemia is a symptomatic increase in blood sugar concentration.

Signs and Symptoms of Hypoglycemia

• Rapid onset of altered mental status.
• Intoxicated appearance.
• Elevated heart rate.
• Cold, clammy skin.
• Anxiety.
• Hunger.
• Seizures.

Seizures

• A convulsive body movement or impaired mental state caused by random brain electrical impulses.
• Common seizure causes include fever, infection, poisoning, overdose, and intoxication.
• Other causes include hypoglycemia, head trauma, hypoxia, epilepsy, brain tumor, and unknown.

Stroke

• Strokes occur when brain arteries are blocked or break.
• Most strokes (about 85%) are ischemic, caused by blood clots blocking the arteries.
• Hemorrhagic strokes (about 15%) result from bleeding inside the brain.
• Stroke signs and symptoms include sudden weakness or numbness (often on one side), confusion, trouble speaking or seeing, headache, difficulty walking.
• The Cincinnati Prehospital Stroke Scale evaluates speech, facial droop, and arm drift.
  • To assess speech, have the patient repeat "The sky is clear in Cincinnati."
  • Examine facial droop or asymmetry when smiling.
  • Assess arm drift by having the patient close their eyes and hold their arms out straight.
• Any patient suspected of having a stroke should receive oxygen and be transported immediately to the hospital.

Emergency Care of Patients with Altered Mental Status

• Diabetic emergencies: assessment, airway management, oral glucose administration.
• Scene size-up, initial assessment, focused history and physical exam (SAMPLE, OPQRST).
• Airway management (positioning, suction).
• Maintaining and reassessing the patient's airway is crucial.
• General treatment includes airway maintenance, high-flow oxygen, assisting ventilations as needed, and oral glucose administration.
• Transport the patient after all necessary actions done.

Oral Glucose

• Generic name: Oral glucose
• Trade names: Glutose, Insta-Glucose
• Indications: Patients with altered mental status and a known history of diabetes controlled by medication.
• Contraindications: Unresponsive patients, patients unable to swallow.
• Administration technique: Order from medical direction, ensure consciousness and swallowing ability, place between cheek and gum, or tongue.
• Mechanism of action: Increases blood sugar.
• Side effects: None when given properly, may be aspirated if patient doesn't have a gag reflex.
• Reassessment strategies: If patient loses consciousness or has a seizure, remove the glucose device from the mouth.

Seizure Management

• Protect the patient from the environment.
• Maintain an open airway.
• Administer high-flow oxygen.
• Transport the patient.

Stroke Management

• Maintain a comfortable position.
• Maintain and protect the airway.
• Administer high-flow oxygen.
• Transport the patient.

Summary

• Overview of causes and emergency care of altered mental status.
• Specific details on diabetic emergencies, seizures, and stroke, along with related assessments.