Introduction | Altered Level Conciousness

<< Altered Level of Consciousness: Evidence-Based Management in the Emergency Department (Pharmacology CME)


The term altered level of consciousness (ALOC) can be used to describe a spectrum of disorders that includes clouding of consciousness, confusion, lethargy, obtundation, stupor, or coma.1,2 In young children, ALOC may manifest as fussiness or irritability. Due to the varying degrees of altered consciousness, it is important for the emergency clinician to be familiar with the various terms that can be used to describe a patient’s clinical status, and to recognize that there is much similarity among them.

  • Clouding of consciousness can include a very mild form of ALOC in which there is inattention, decreased alertness, and reduced wakefulness.
  • Confusion involves a state of disorientation, along with bewilderment and difficulty following commands.
  • Lethargy describes severe drowsiness, though the patient can still be aroused with moderate stimuli.
  • Obtundation is similar to lethargy but with slowed responses to stimulation and decreased periods of time spent in wakefulness.

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