Encephalopathic disorders: The Daily PANCE Blueprint

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Encephalopathic disorders: The Daily PANCE Blueprint

A 68-year-old hospitalized patient develops acute confusion, inattention, and fluctuating levels of alertness over 24 hours. Laboratory studies reveal severe hyponatremia. The patient is unable to follow simple commands but has no focal neurological deficits. Which of the following is the most appropriate management strategy?

A. Immediate MRI of the brain
B. Scheduled high-dose antipsychotics
C. Treat the underlying metabolic disorder
D. Lumbar puncture to rule out meningitis
E. Start long-term cholinesterase inhibitors

Answer and topic summary

The answer is C. Treat the underlying metabolic disorder

Acute toxic-metabolic encephalopathy is a condition typically seen in hospitalized patients that encompasses both confusion and delirium. It is caused by global cerebral dysfunction due to some sort of acute insult. Etiologies include: sepsis, uremia, liver failure, hypo or hypernatremia, hypoglycemia, hypoxemia, DKA/HHS. Clinical features depend but may include: inability to think straight, inattention, decreased alertness, impaired memory, disorientation, tremor, etc. Management is focused on treating the underlying cause and maintaining patient safety.

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Covered under ⇒ PANCE Blueprint Neurology ⇒ Encephalopathic disorders

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