TREATMENT AND PROGNOSIS :
Airway: consider intubation if the airway appears compromised especially if the glassgow coma scale is less than 8.
Breathing: consider intubation.
Circulation: check the vitals signs.
Assess the nedd for intravenous access and fluids and oxygen and also monitors the electrocardiographic monitoring.
Rule out easily reversible conditions:
Thiamine: 100 mg IV is usually given to rule out the wernicke’s psychosis.
50% dextrose (D50) can be given if severe hypoglycaemia occurs.
It should be suggested if an opiate overdose id detected. Rapid improvement in mental status with the administration of the naloxone is both diagnostic and therapeutic for opioid overdose.
If severe complications such as tumour, bleeding or abscess is present then neuroimaging followed by neurosurgery is indicated. Mannitol, steroids or intubation with hyperventilation can be indiacted if increase in the intracranial pressure is detected.
Meningitis: if meningitis is suspected then antibiotics should be prescribed.
Status encephalopathy: Benzodiazepines are the first choic of drug. IV lorazepam, diazepam are the first line options. If seizure activity is not subsided then valproic acid or fosphenytoin can be administered.
Nitroprusside is often administered to reduce the systemic pressure.
To treat the delirium both Non pharmacological and pharmacological causes can be used.
Non pharmacological: Reorient the patients, maintain normal sleep wake cycle to the patients.
Pharmacological measures: Low doses of antipsychotics such as haloperidol, rispridone, planzapine and quietipine are preffered.
Benzodiazepines, Fomepizole can be used for alcohol withdrawal cases.