What is the first metabolic derangement to consider in patients with altered mental status?

Hypoglycemia is the first metabolic derangement to consider in patients with altered mental status due to its prevalence and immediate effects on brain function. The brain relies heavily on glucose as its primary energy source, and a significant drop in blood sugar levels can lead to confusion, lethargy, seizures, or even loss of consciousness. The symptoms of hypoglycemia can develop rapidly, and recognizing this condition promptly can be crucial for preventing serious neurological damage or death.

In many clinical settings, especially in emergency medicine, it is standard practice to check blood glucose levels in any patient presenting with altered mental status. This proactive approach allows for quick intervention, such as administering glucose, which can rapidly reverse the symptoms and stabilize the patient. Other metabolic disturbances, while significant, often present with a wider variety of symptoms or require more specific clinical signs to be identified initially, making hypoglycemia the most urgent consideration.