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Alertness - decreased
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Alertness - decreased

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Stuporous; Mental status - decreased; Loss of alertness; Decreased consciousness; Changes in consciousness; Obtundation; Coma; Unresponsiveness

Decreased alertness is a state of reduced awareness.

A coma is a state of decreased alertness from which a patient cannot be awakened. A long-term coma is called a vegetative state.

See also:

  • Delirium
  • Dementia

I Would Like to Learn About:

  • Causes

    Many conditions can cause decreased alertness, including:

    • Chronic kidney disease
    • Extreme tiredness or lack of sleep
    • High blood sugar level or low blood sugar level
    • High or low blood sodium (body chemical, or electrolyte) concentration 
    • Infection that is severe or involves the brain
    • Liver failure
    • Thyroid conditions that cause low thyroid hormone levels or very high thyroid hormone levels

    Brain disorders or injury, such as:

    • Dementia or Alzheimer's disease
    • Head trauma
    • Seizure
    • Stroke

    Injury or accidents, such as:

    • Diving accidents and near drowning
    • Heat stroke
    • Very low body temperature (hypothermia)

    Heart or breathing problems, such as:

    • Abnormal heart rhythm (arrhythmia)
    • Lack of oxygen (hypoxia) from any cause
    • Low blood pressure (hypotension)   
    • Severe heart failure
    • Severe lung diseases
    • Very high blood pressure (hypertension)

    Toxins and drugs, such as:

    • Alcohol abuse (binge drinking or damage from long-term alcohol use)
    • Exposure to heavy metals, hydrocarbons, or toxic gases
    • Overuse of drugs such as opiates, narcotics, sedatives, and anti-anxiety or seizure medications
    • Side effect of almost any medicine, such as those used to treat seizures, depression, psychosis, and other illnesses
  • Home Care

    Get medical help for any decrease in consciousness, even when it is due to alcohol intoxication, fainting, or a seizure disorder that has already been diagnosed.

    See the article on seizures for tips on how to care for a person who is having a seizure.

    Persons with epilepsy or other seizure disorder should carry a Medic-Alert bracelet or pendant describing their condition. They should avoid situations that have triggered a seizure in the past.

  • When to Contact a Medical Professional

    Get medical help if someone has decreased alertness that cannot be explained. Call your local emergency number (such as 911) if normal alertness does not return quickly.

  • What to Expect at Your Office Visit

    Most often, a person with decreased consciousness will be evaluated in an emergency room.

    The doctor will perform a physical examination. The exam will include a detailed look at the heart, breathing, and nervous system.

    The health care team will ask questions about the person's medical history and symptoms, including:

    Time pattern

    • When did the decreased alertness happen?
    • How long did it last?
    • Has it ever happened before? If so, how many times?
    • Did the person behave the same way during past episodes?

    Medical history

    • Does the person have epilepsy or a seizure disorder?
    • Does the person have diabetes?
    • Has the person been sleeping well?
    • Has there been a recent head injury?

    Other

    • What medications does the person take?
    • Does the person use alcohol or drugs on a regular basis?
    • What other symptoms are present?

    Tests that may be done include:

    • Chest x-ray
    • Complete blood count or blood differential
    • CT scan or MRI of the head
    • Electrocardiogram (ECG)
    • Electroencephalogram (EEG)
    • Electrolyte panel and liver function tests
    • Toxicology panel and alcohol level
    • Urinalysis

    Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition. The longer the person has had decreased alertness, the worse the outcome.

Related Information

  SeizuresEpilepsy - overvie...Central nervous sy...Head injury - firs...ShockSkin discoloration...Unconsciousness - ...Alcoholism and alc...Fainting   Concussion - child...Concussion - adult...Preventing head in...   EpilepsyAlcoholism

References

Blok BK, Newman TM. Syncope. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 52.

Huff JS. Altered mental status and coma. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 259.

Kirsch TD. Head injury. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 255.

Huff JS, Martin ML. Altered mental status and coma. In: Wolfson AB, Hendey GW, Ling LJ, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 14.

Lennihan L. Delirium and Confusion.  In Rowland LP, Merritt HH, eds. Merritt's Neurology. 12th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2009:chap 2.

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Review Date: 4/5/2013  

Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

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