Alertness - decreasedStuporous; 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 person cannot be awakened. A long-term coma is called a vegetative state.
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 blood sugar
Milk-alkali syndrome is a condition in which there is a high level of calcium in the body (hypercalcemia). This causes a shift in the body's acid/ba...
- High or low blood sodium 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
Low thyroid hormone levels
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
Brain disorders or injury, such as:
- Dementia or Alzheimer disease
Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.
- Head trauma
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
- Lack of oxygen from any cause
- Low blood pressure
- Severe heart failure
- Severe lung diseases
- Very high blood pressure
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 medicines
- Side effect of almost any medicine, such as those used to treat seizures, depression, psychosis, and other illnesses
Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to f...
Fainting is a brief loss of consciousness due to a drop in blood flow to the brain. The episode most often lasts less than a couple of minutes and y...
Epilepsy is a brain disorder in which a person has repeated seizures over time. Seizures are episodes of uncontrolled and abnormal firing of brain c...
See the article on seizures for tips on how to care for a person who is having a seizure.
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. The term "seizure...
People with epilepsy or other seizure disorders should wear a medical ID bracelet or necklace 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 health care provider will perform a physical examination. The exam will include a detailed look at the heart, breathing, and nervous system.
During a physical examination, a health care provider studies your body to determine if you do or do not have a physical problem. A physical examinat...
The health care team will ask questions about the person's medical history and symptoms, including:
- 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?
- 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?
- What medicines 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
Complete blood count
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...
- CT scan or MRI of the head
- Electrocardiogram (ECG)
- Electroencephalogram (EEG)
- Electrolyte panel and liver function tests
- Toxicology panel and alcohol level
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.
Bassin BS, Cooke JL. Depressed consciousness and coma. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 16.
Bassin BS, Cooke JL, Barsan WG. Altered mental status and coma. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 94.
Lank PM, Kusin S. Ethanol and opioid intoxication and withdrawal. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 154.
Lennihan L. Delirium and Confusion. In: Rowland LP, Pedley TA, eds. Merritt's Neurology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:chap 2.
MacNeill EM, Vashist S. Approach to syncope and altered mental status. Ped Clin N Am. 2013;60(5):1083-1106.
Review Date: 6/1/2015
Reviewed By: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.