Differentiating Undifferentiated Altered Mental Status: Why It Matters and How to Do It

While many patients in the ICU are altered because of their critical illness and improve with treatment of the underlying pathology, some fail to improve and many of these patients are never definitively diagnosed. Often, these patients are incorrectly labeled as having “toxic-metabolic encephalopathy” or “delirium,” which results in obstacles to targeted therapeutics, accurate prognostication, and shared decision-making. We discuss the challenges to diagnosing the altered patient and reflect on the cognitive errors and biases that contribute to the problem.