ABSTRACT
Hypoglycaemia rapidly produces coma in people with diabetes, compared with the slower onset of altered consciousness in diabetic ketoacidosis and hyperosmolar, hyperglycaemic state. Patients with an altered conscious level frequently present to the emergency department. Although history taking is compromised, a methodical, careful approach is essential using information from the family, friends, passers-by, the police, ambulance and previous medical records. ‘Confusion’ or delirium is a transient global disorder of cognition. It is a syndrome with multiple causes that describes a state of clouding of consciousness or disturbed awareness, which may fluctuate. Acute alcohol intoxication is causally related to all types of trauma including motor vehicle crashes, incidents in the home, deliberate self-harm, assaults, drownings, child abuse and falls in the elderly. Chronic use also predisposes to a variety of medical conditions, and sudden reduction in intake causes withdrawal problems.
