Septic shock can compromise hepatic blood flow and metabolism. Sepsis can originate from hepatic or peri-hepatic infections.Ĭomorbid hepatic disease can affect drug metabolism. Altered mental status is a broad category applied to geriatric patients with a change in cognition or level of consciousness (LOC) delirium, agitation, coma. May show elevated bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma glutamyl transpeptidase More Given the vagueness of the term, it is imperative to understand its key components before considering a differential diagnosis. It is important to recognize the early signs of altered mental status, identify the underlying cause, and to provide the appropriate care to reduce patient morbidity and mortality. Our case demonstrates the importance of maintaining a wide differential for altered mental status, especially after negative initial diagnostic work-up of more common aetiologies. Altered mental status (AMS) is a general term used to describe various disorders of mental functioning ranging from slight confusion to coma. Serum electrolytes may be deranged blood urea may be elevatedĮlevated creatinine may occur in sepsis associated with renal dysfunction. Altered mental status is a common presentation. WBC count is sensitive but not specific for the diagnosis of sepsis. Tonkovi D, Adam VN, Kovacevi M, Bogovi TZ, Drvar Z, Baronica R. WBC count >12×10⁹/L (12,000/microlitre) (leukocytosis) WBC count 10% immature forms low platelets More Review Perioperative disorders of mental functions. The differential diagnosis for altered mental status is extremely broad. May be elevated levels >2 mmol/L (>18 mg/dL) associated with adverse prognosis even worse prognosis with levels >4 mmol/L (>36 mg/dL) elevated MoreĮlevated serum lactate indicates tissue hypoperfusion, and is most reliably assessed using an arterial sample. Other cultures (e.g., sputum, stool, and urine) should be taken as clinically indicated. Blood cultures should be taken immediately, and preferably before antibiotics are started, provided their sampling will not delay administration of antibiotics.
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