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 (โDTโsโ) on Days 4-5
- Mnemonic โAโ 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, etcโฆ.
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