#alteredloa

Topic: Why do patients become altered?

Here is an explanation of each point. The acronym to remember when ruling out why your patient may be altered it “AEIOU TIPS”.

Alcohol; Alcohol directly effects the brains chemistry by effecting the neurotransmitters (chemical messengers that transmit signals throughout the body which control emotion, behaviour and thought process) Alcohol effects both excitatory and inhibitory neurotransmitters. Excitatory neurotransmitters are those that increase brain activity and energy levels which means if they are supressed by alcohol it results in a sllloooowwww down. Inhibitory neurotransmitters do the opposite and calm everything down alcohol works on these by amplifying there effects.

Epilepsy (seizures); It is still being research why patients who experience seizures are altered during the post ictal state but there are many theories. The first is the neurotransmitters are being used faster than they can be synthesized. There is no evidence that neurotransmitters become depleted during the seizure activity. Second researcher’s believe that the opioid receptors in the brain become depleted during the seizure which results in the depression state, some researchers have even tested if naloxone can reverse these effects and found that the depressed post ictal phase didn’t last as long. Lastly a decrease in blood flow to the brain may be the reason that not only does the tissue use up a large amount of glucose during the seizure and therefore there is limited blood glucose levels reaching the brain but there is a limited blood flow which decreases brain function.

Insulin; Both hyperglycemia (too much glucose in the blood that is not being taken up by the tissues) and hypoglycemia (lack of glucose in the blood to provide nutrients to tissues) can cause an altered mental state. Having plenty of glucose in the blood but no way to get it to the tissues causes it to become useless, insulin is the only way to open the gates to allow glucose to pass over. The brain is very reliant on glucose because it gives it energy which it needs lots of. The brain feels drowsy and slow when it doesn’t have enough, kind of like myself when I don’t get my coffee! Now it is the same way if the body has plenty of insulin available waiting for the glucose but not enough glucose is there to replenish the tissues and brain.

Overdose; Now there are many types of substances patients can take to cause them to overdose. Some may do it intentionally other by mistake. One important one is opioid overdose. In the brain there are many opioid receptors and when a patient takes an opioid drug such as heroin, fentanyl and many more, these receptors grab on to the opioid and do as they are supposed to. When a patient takes too much, these opioids cause there system to slow down so much to dangerous levels. This results in an altered state of mind.

Uremia; The kidneys do wonderful things and one very important job it has it to eliminate waste products from the body through urine. If the kidneys are not doing this job the body can become backed up with waste products and toxins that should not be present. This is mostly the case when individuals have issues urinating, have an infection, or disease not allowing them to urinate normally. These patients can become very altered when the brain is introduce to toxins it isn't used to. 

Trauma; The body can undergo a wide variety of trauma, from head injury to large blood loss all not good and all could be the reason for an altered level of consciousness.

Infection; Infections can vary from a small cut to a full body infection also known as sepsis. This topic correlates similarly to uremia as the body is being introduced to toxins its not used to and should be there. Its very important when performing assessments to go in depth about a possible infection.

Psychiatric or poisons; It is very important when assessing a psychiatric patient to confirm with an individual who is familiar with the patient to confirm if there behaviour is normal to there every day. These patients already have a mental disorder that inhibits the brain to function properly and they may seem altered to begin with but that may actually be there norm. Poisons follows similarly with overdose and alcohol as it affects the brain function substantially. The brain is not a place for toxins or chemicals to be hanging around.

Stroke; Strokes are either ischemic or hemorrhagic. Ischemic- lack of blood flow to a certain area. Hemorrhagic-  brain bleeding. If the brain is depleted of blood it is not receiving the amount of glucose and nutrients it needs to function properly. As well if the brain is losing the blood it is receiving it again cant function properly and the pressure that the blood entering the cranial space is restricting the brain.

I hope you enjoy this review if I have any errors I apologize. Busy day today and wanted to get this out of the way this morning!

http://www.forbes.com/sites/daviddisalvo/2012/10/16/what-alcohol-really-does-to-your-brain/#1fe13a96413b