- The causes of confusion or altered LOC in a middle aged diabetic male are numerous.
- Most causes could be delineated by a thorough history, examination and a few simple investigations.
- Hypoglycaemia – history of hypo’s, episode in relation to taking medications, BSL.
- Diabetic ketoacidosis – history of DKA, polyuria, polydipsia, thrist, compliance with medications, type I or II diabetes, ABG, BSL, dehydration on examination.
- Hyper-osmotic hyperosmolar syndrome (HHS) – unwell with concomitant infection, severe dehydration, severe hyperglycaemia, hyperosmolality (plasma).
- Hyperglycaemia – history of control, compliance, BSL.
- Lactic acidosis – type II diabetics on metformin (biguanides) -> sepsis or renal failure.
- Cerebrovascular accident – TIA or stroke – DM is a risk factor for vascular disease, history of focal neurological symptoms, brainstem or cortical infarct/bleeding.
- Sepsis with encephalopathy – the diabetic patient is at risk of systemic infections from a number of sources.