Decreased alertness is the most severe state of reduced awareness and is a serious condition.
A coma is a state of decreased alertness from which a person cannot be awakened. A long-term coma is called a vegetative state.
Many conditions can cause decreased alertness, including:
- Chronic kidney disease
- Extreme tiredness or lack of sleep
- High blood sugar or low blood sugar
High blood sugar
High blood sugar is also called high blood glucose, or hyperglycemia. High blood sugar almost always happens in people who have diabetes. High blood...Read Article Now Book Mark Article
- 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
Low thyroid hormone levels
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....Read Article Now Book Mark Article
Brain disorders or injury, such as:
- Dementia or Alzheimer disease (advanced cases)
Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.Read Article Now Book Mark Article
- Head trauma (moderate to severe cases)
- Stroke (usually when the stroke is either massive or has destroyed certain areas of the brain such as the brainstem or thalamus)
- Infections that affect the brain, such as meningitis or encephalitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.Read Article Now Book Mark Article
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 use (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
Get medical help for any decrease in consciousness, even when it is due to alcohol intoxication, fainting, or a seizure disorder that has already been diagnosed.
Fainting is a brief loss of consciousness due to a drop in blood flow to the brain. The episode most often lasts less than a couple of minutes and y...Read Article Now Book Mark Article
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.
During a physical examination, a health care provider studies your body to determine if you do or do not have a physical problem. A physical examinat...Read Article Now Book Mark Article
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 (CBC) or blood differential
Complete blood count (CBC)
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...Read Article Now Book Mark Article
- CT scan or MRI of the head
- Oxygen level (pulseoximetry or blood gas)
- 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.
Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Berger JR, Price R. Stupor and coma. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 5.
Lei C, Smith C. Depressed consciousness and coma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 13.