Alertness - decreased
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.
Stuporous; Mental status - decreased; Loss of alertness; Decreased consciousness; Changes in consciousness; Obtundation; Coma; Unresponsiveness
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 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
Brain disorders or injury, such as:
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
See the article on seizures for tips on how to care for a person who is having a 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.
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
- 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.
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.