Altered Mental Status

Diabetic Reaction




  • Known diabetic; medical alert tag
  • Report of illicit drug use or toxic ingestion
  • Past medical history
  • Medications
  • History of trauma
  • Change in condition
  • Changes in feeding or sleeping habits


Significant Findings:


  • Decreased mental status or lethargy
  • Change in baseline mental status
  • Bizarre behavior
  • Hypoglycemia (cool, diaphoretic skin)
  • Hyperglycemia (warm, dry skin, fruity breath, Kussmaul respirations; rapid, deep breathing, signs of dehydration)
  • Irritability




  • Head trauma
  • CNS (stroke/tumor/seizure/ infection)
  • Cardiac (MI/CHF)
  • Hypothermia/hyperthermia
  • nfection (CNS and other)
  • Thyroid (hyper/hypo)
  • Shock
  • Diabetes (hyper/hypoglycemia)
  • Toxic ingestion
  • Acidosis/alkalosis
  • Environmental exposure
  • Pulmonary (hypoxia)
  • Electrolyte abnormality
  • Psychiatric disorder




  • Oxygen
  • Initiate IV
  • Obtain BGL



Glucose < 60 with signs of hypoglycemia ?


  • Yes


    • Consider Oral Glucose 1-2 tubes if awake and no risk for aspiration.
    • 10% Dextrose (D10) 250 mL IV



Glucose > 60 with altered mental status ?


  • Yes


See appropriate protocol :



Glucose > 250 with signs of poor perfusion and/or dehydration ?


  • Yes


    • 12-Lead EKG
    • Normal Saline up to 1,000 mL IV


    • Notify receiving facility or contact Medical Control




  • Low glucose (less than 60)
  • Normal glucose (60-120)
  • High glucose (greater than 250)
  • Pay careful attention to the head exam for signs of bruising or other injury.
  • While infusing 10% Dextrose (D10) solution, monitor the patient for changes in level of consciousness and signs/symptoms of CHF/pulmonary edema.
  • It is safer to assume hypoglycemia than hyperglycemia if doubt exists.  Re-check blood glucose after administration of Dextrose or Glucagon (GlucaGen).
  • Be aware of altered mental status as a presenting sign of an environmental toxin or Haz-Mat exposure and protect personal safety.
  • Do not let alcohol confuse the clinical picture. Alcoholics frequently develop hypoglycemia and may have unrecognized injuries.
  • Consider restraints if necessary for patient's and/or personnel's protection per the Behavioral Emergencies/Chemical Restraint Protocol.
  • 50% Dextrose (D50) can be given on a case-by-case basis per Paramedic discretion.