Altered mental status is a challenging clinical syndrome that often confronts the emergency physician and represents up to 10% of all Emergency Department visits. Like a modern day Sherlock Holmes, the emergency provider is tasked with ascertaining whether the change in mental status is secondary to delirium, dementia, or psychosis. Failure to properly investigate and diagnose delirium results in worse outcomes. A good history, including obtaining collateral information, is essential in

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... who present with altered mental status. Initial evaluation should include an assessment of the patient's airway, breathing and circulatory status, in addition to a blood glucose measurement. Hypoglycemia is one of the most easily recognized and reversible cause of delirium. Additional laboratory testing and imaging should be tailored by the history and physical examination.