511 ALTERED MENTAL STATUS

1. Begin Basic Life Support Altered Mental Status procedures.

2. Draw a tube of blood for glucose level determination.

3. Begin an IV infusion of Dextrose 5% in water (D5W), to keep vein open.

4. Administer Dextrose 25 gm (50 ml of a 50% solution), IV bolus.

5. Administer Thiamine 100 mg, IV bolus.

6. In patients with diabetic histories where an IV route is unavailable, administer Glucagon 1.0 mg, IM. (Thiamine need not be administered to these patients.)

7. If there is no change in mental status, administer Naloxone up to 2.0 mg, IV bolus. (Restraints may be applied if appropriate.) If IV access has not been established, administer Naloxone 2.0 mg, IM.
   • NOTE:
     IF AN OVERDOSE IS STRONGLY SUSPECTED, ADMINISTER NALOXONE PRIOR TO DEXTROSE AND THIAMINE.

8. If the patient's mental status fails to improve significantly, repeat Dextrose 25 gm (50 ml of a 50% solution), IV bolus.

9. If the patient's respiratory status fails to improve significantly, repeat Naloxone 2.0 mg, IV bolus.

10. Transportation decision.

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