Altered Level of Consciousness

What is altered level of consciousness?

Altered level of consciousness (ALOC) means that you are not as awake, alert, or able to understand or react as you are normally. Causes of ALOC include:

• A head injury
• Medicines
• Alcohol or drugs
• Dehydration
• Infection
• Fever
• Dangerously low body temperature (hypothermia)
• Diseases such as diabetes and thyroid disease

Different levels of ALOC include:

• Lethargic, which means you are drowsy and less aware or less interested in your surroundings
• Somnolent, which means you are sleeping unless someone or something wakes you up. You can usually talk and follow directions, but you may have trouble staying awake.
• Stupor, which means you are in a deep sleep unless something loud or painful wakes you up. You may not be able to talk or follow directions well, and you will fall back to sleep when left alone.
• Coma, which looks as if you are asleep, but you can’t be awakened at all
• Confusion, which means you are easily distracted and may be slow to respond. You may not know who or where you are or the time of day or year.
• Delirium, which means you have severe confusion and disorientation and may have delusions (belief in things that are not real) or hallucinations (sensing things that are not real). The degree of confusion may get better or worse over time.

What can I expect in the hospital?

All episodes of ALOC require careful observation, especially in the first 24 hours. You will need to stay in the hospital for testing and treatment because you experienced ALOC.

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring:

• You will be checked often by the hospital staff.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• A heart (cardiac) monitor may be used to keep track of your heartbeat.
• Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.

Testing:

Testing may include:

• Blood tests to check your blood sugar level and oxygen level, or for dehydration, infections, drugs, or alcohol.
• Blood, urine, or other tests to monitor how well your organs are functioning.
• Neurologic examination: Testing to check your strength, sensation, balance, reflexes, thinking, and memory. Some parts of this test may be repeated many times a day while you are in the hospital.
• Computed tomography (CT) scan: A series of X-rays is taken from different angles and arranged by a computer to show thin cross sections of the inside of your head to check for a brain injury or diseases of the brain.
• Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin cross sections of your head to check for a brain injury or diseases of the brain.
• X-rays: Energy called radiation is used to make of pictures of your bones, tissues, and organs to check for infection.
• EEG (electroencephalography): A test measures and records the electrical activity in your brain to check for seizures.
• Lumbar puncture: A sample of fluid is taken from the area around your spinal cord to check for meningitis.

Treatment:

The treatment for ALOC depends on its cause, your symptoms, your overall health, and any complications you may have.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood system and to give you fluids, if needed.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face. In very severe cases, you may need a tube put into your lungs that is attached to a machine to help you breathe.
• Your provider may prescribe medicine to:
  • Treat or prevent an infection
  • Reduce swelling in and around your brain and spinal cord
  • Control your blood glucose (sugar)
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.

What can I do to help?

• You or your caregivers will need to tell your healthcare team if you have new or worsening:
  • Seizures or convulsions
  • Bleeding from your ears or nose
  • Slurred speech
  • Trouble with muscle movements, such as swallowing, moving arms and legs
  • Dizziness or lightheadedness
  • Change in vision, such as double vision, blurred vision, or trouble seeing out of one or both eyes
  • Restlessness or irritability
  • Trouble staying awake or alert
  • Vomiting
  • Headache that will not go away after treatment
  • Tiredness
  • Loss of balance or coordination
  • Loss of memory
  • Confusion
  • Unusual behavior
• Ask questions about any medicine, treatment, or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many things, such as your general health, why you are in the hospital, the treatment you need, and how well you recover. Talk with your provider about how long your stay may be.