1. Can changes in mental status be minimal?: Answer - YES mental status is a spectrum. Changes in mental status do not go from one extremeto another, it can be as subtle as restlessness and confusion 2. Acute mental status change: Answer - when a patient has a change from their usualbaseline many causes from many systems - neuro: infection, tumor, trauma, CVA, psychiatric - CV/pulm: MI, PE, hypotension - systemic (changes in fluid and electrolytes): hypoglycemia, hyponatremia, ammonia 3. AEIOUTIPS for altered mental status: Answer - A: ALCOHOL - E: ELECTROLYTE, ENDOCRINE, EPILEPSY, ECP. hypernatremia is the most common electrolyte abnormality causing AMS.Hypo or hyperthyroidism.Addisoniancrisis. Hypo/hyperglycemia (DKA and HHS). metabolic or toxic encephalopathy. Epilepsy - I:INFECTION.particularly sepsis,severe sepsis, and septic shock situations.CNS infections (meningitis, encephalitis) are also common - O: OVERDOSE, OPIOID, OXYGEN. drug overdoses such as benzos, TCA, SSRI, OPIOID are common causes. hypoxemia causes agitation. hypercapnia causes drowsiness - U: UREMIA.there are three significant components of serum osmolarity that affect mental status. urea is one of them. any increase of a component in calculated osmolality results in high osmolarity which causes disequilibrium which results in AMS - T:TRAUMA,TEMPERATURE,TOXICITY.For toxicity, look "O".Trauma to the head may cause a concussion, bleeding or DAI. But, hypovolemic shock and obstructiveshock (e.g. tension pneumothorax) should also be considered. Hyperthermia and hypothermia affect mental status, esp in extreme ages. - I: INSULIN. insulin is a drug that can affect mental status in patients with diabetestype I and cases presented with a suicidal attempt - P:PSYCHOSIS.we should eliminate any pathology caused by various disease anddrugs