What is altered level of consciousness?

Altered level of consciousness (ALOC) means that you are not as awake, alert, or able to understand or react as you are normally. ALOC can be caused by a head injury, medicines, alcohol or drugs, dehydration, or some diseases, such as diabetes.

Different levels of ALOC include:

• Lethargic, which means you are drowsy and less aware or less interested in your surroundings.
• Somnolent, which means you are sleeping unless someone or something wakes you up. You can usually talk and follow directions, but you may have trouble staying awake.
• Stupor, which means you are in a deep sleep unless something loud or painful wakes you up. You may not be able to talk or follow directions well, and you will fall back to sleep when left alone.
• Coma, which looks as if you are asleep, but you can’t be awakened at all.
• Confusion, which means you are easily distracted and may be slow to respond. You may not know who or where you are or the time of day or year.
• Delirium, which means you have severe confusion and disorientation and may have delusions (belief in things that are not real) or hallucinations (sensing things that are not real). The degree of confusion may get better or worse over time.

Stupor and coma are rated according to how severe the symptoms are.

What can I expect in the hospital?

All episodes of ALOC require careful observation, especially in the first 24 hours. You will need to stay in the hospital for testing and treatment because you experienced ALOC.

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring:

• You will be checked often by the hospital staff.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• A heart (cardiac) monitor may be used to keep track of your heartbeat.
• Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.
• Your strength, range of motion, and ability to feel pain may be checked regularly.

Testing:

Testing may include:

• Blood tests to check your blood sugar level and oxygen level, or for dehydration, infections, drugs, or alcohol
• Blood, urine, or other tests to monitor how well your organs are functioning
• Neurologic examination: Testing to check your strength, sensation, balance, reflexes, and memory. This will include looking at your eyes with a flashlight to see if your pupils are the same size.
• Computed tomography (CT) scan: A series of X-rays taken from different angles and arranged by a computer to show thin cross sections of the inside of your head to check for a brain injury or diseases of the brain
• Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin cross sections of your head to check for a brain injury or diseases of the brain
• X-rays: Pictures of the inside of the chest to check for lung problems

Treatment:

The treatment for ALOC depends on its cause, your symptoms, your overall health, and any complications you may have.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood system and to give you fluids, if needed.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face. In very severe cases, you may need a tube put into your lungs to help you breathe.
• Your provider may prescribe medicine to:
  • Treat or prevent an infection
  • Reduce swelling in and around your brain and spinal cord
  • Control your blood sugar

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Seizures or convulsions
  • Bleeding from your ears or nose
  • Slurred speech
  • Trouble with muscle movements, such as swallowing, moving arms and legs
  • Dizziness
  • Confusion
  • Change in vision, such as double vision, blurred vision, or trouble seeing out of one or both eyes
  • Restlessness
  • Irritability
  • Trouble staying awake or alert
  • Vomiting
  • Headache that will not go away after treatment
  • Tiredness
  • Loss of balance or coordination
  • Loss of memory
  • Unusual behavior
• Ask questions about any medicine, treatment, or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many factors. The average amount of time to stay in the hospital after ALOC is 5 to 6 days.