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Neuroscience
45-Minute Session

My Patient Won't Wake Up, Now What? An Approach to Altered Mental Status in the ICU

Tuesday, February 25, 2025
8:00am – 8:45am Eastern Time
Location: W311A
CE: 0.75

Failed heuristics are common when caring for critically ill patients with neurologic disease and altered mental status. This session will explain why a diagnostic framework and systematic approach, involving knowledge of expected and unexpected common encephalopathy syndromes such as septic encephalopathy, is critical for patients who present with altered mental status. Speakers will discuss evaluation of patients who are altered beyond what is expected based on their critical illness, emphasizing reversible pathologies. Speakers will discuss the common problem of hyperammonemia in critically ill patients. While often insignificant, an approach is needed to determine whether it is a cause of altered mental status. An algorithm for the workup and treatment of non-acute liver failure hyperammonemia will be discussed.

Learning Objectives:

  • Appreciate why labeling patients as delirious or as having toxic-metabolic encephalopathy may lead to delayed diagnosis and impair treatment
  • Develop a framework for uncovering reversible etiologies of altered mental status that are common in ICU patients
  • Examine how hyperammonemia can be both a cause of altered mental status and a biomarker for reversible pathology beyond acute liver failure

Presentations:

  • 8:00am – 8:45am Eastern Time
    Differentiating Undifferentiated Altered Mental Status: Why It Matters and How to Do It

    Brandon Oto, PA-C, FCCM – Bridgeport Hospital Yale-New Haven Health System

  • 8:00am – 8:45am Eastern Time
    Dot Your I's and Cross Your T's: The DOTT Approach to Undifferentiated AMS

    Casey Albin, MD – Emory University

  • 8:00am – 8:45am Eastern Time
    Innocent Bystander or Encephalopathic Killer: Hyperammonemia in the Non-Acute Liver Failure Patient

    Prem Kandiah, MD – Emory University Hospital