“Vowel TIPS” (mnemonic for Coma, etc.)

This is a mnemonic for diagnosing the different causes of acute coma, seizure, or confusion (a.k.a. Altered Mental Status). It’s useful when caring for patients in an E.R. setting.ย  The mnemonic stands for A โ€“ E โ€“ I โ€“ O โ€“ U โ€“ T โ€“ I โ€“ P โ€“ S (the 5 Vowels, plus TIPS).

A  โ€“  Alcohol:  intoxication or withdrawal

  • Withdrawal can cause mild seizures on Days 2-3, or life-threatening Delirium Tremens (โ€œDTโ€™sโ€) on Days 4-5
  • Mnemonic โ€œAโ€ also includes brain damage from alcohol, or from liver Cirrhosis

E  โ€“  Epilepsy  (i.e. Seizures, of any cause)

I   โ€“  Infection:   Sepsis; Brain Infections (Meningitis, etc.)

O  โ€“  Opiates  (i.e. also other drugs / medications)

U  โ€“  Uremia (Kidney Failure) & Other Metabolic States

  • mnemonic here sort of cheats, because it includes many possibilities:
  • Liver, Thyroid, or Adrenal failure
  • High / Low blood levels of sodium, potassium, calcium, etcโ€ฆ.

T  โ€“  Trauma, Tumor

  • Brain masses, including bleeding, hydrocephalus (spinal fluid overload)

I   โ€“  Insulin:  i.e. related to Diabetes

  • Hypoglycemia from medication
  • Diabetic coma (severe Hyperglycemia)
  • Diabetic Ketoacidosis

P  โ€“  Psychiatric  (Conversion Reaction)

S  โ€“  Shock, Stroke, Syncope, Suffocation

  • Lack of oxygen in the brain, various causes

Diagnostic Work-Up is obviously complex, including obtaining History from friends, family, & witnesses as possible (this is most important); Physical Exam; Tests such as:

  • Rapid Fingerstick for glucose (rule-out Hypoglycemia)
  • Complete Blood Count (CBC)
  • Comprehensive Metabolic Panel (CMP)
  • Urinalysis
  • Toxicology Screen (urine & blood, for drugs)
  • Blood gas analysis (levels of oxygen & acids)
  • Chest X-ray
  • EKG
  • CT scan of brain
  • Spinal Tap
  • Many more

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