Altered Mental Status

doi:10.1017/9781009500760.030

Chapter 30 - Altered Mental Status

Published online by Cambridge University Press: 24 April 2026

Heather Jones and

Evan Vance

Edited by

Angela Bray Lindsay and

Monica Kathleen Wattana

Show author details

Angela Bray Lindsay: Affiliation:
Virginia Commonwealth University
Monica Kathleen Wattana: Affiliation:
University of Texas, MD Anderson Cancer Center

Book contents

Get access

Summary

1. After assessing and securing airway, breathing, and circulation, hypercalcemia treatment begins with IV fluid resuscitation. Patients should receive IV fluid bolus(es) followed by high volume maintenance fluid.

2. Treatment of hypercalcemia should be started regardless of etiology or symptoms if calcium is greater than 14 mg/dL.

3. Initial treatment for hypercalcemia includes volume repletion with normal saline, discontinuation of any calcium or vitamin D supplementation and initiation of medications that block bone resorption (most commonly bisphosphonates).

4. Loop diuretics should not be given routinely, instead it should be used as a method of maintaining appropriate volume resuscitation.

5. Hemodialysis is an appropriate method of calcium removal, but is often used only in cases of very severe mental status changes or inability to give saline, such as extreme volume overload.

Keywords

Hypercalcemia Hypercalcemia of malignancy Calcitonin Zoledronic Acid Denosumab Parathyroid hormone Parathyroid related protein Vitamin D Furosemide Hemodialysis

Information

Type: Chapter
Information: Oncologic Emergency Medicine
Clinical Cases Illustrating Key Concepts
, pp. 153 - 157
DOI: https://doi.org/10.1017/9781009500760.030 [Opens in a new window]
Publisher: Cambridge University Press
Print publication year: 2026

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Accessibility standard: WCAG 2.1 AA

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

The HTML of this chapter complies with version 2.1 of the Web Content Accessibility Guidelines (WCAG), covering newer accessibility requirements and improved user experiences and achieves the intermediate (AA) level of WCAG compliance, covering a wider range of accessibility requirements.

Content Navigation

Table of contents navigation
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.

Index navigation
Provides an interactive index, letting you go straight to where a term or subject appears in the text without manual searching.

Reading Order & Textual Equivalents

Single logical reading order
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.

Short alternative textual descriptions
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.

Full alternative textual descriptions
You get more than just short alt text: you have comprehensive text equivalents, transcripts, captions, or audio descriptions for substantial non‐text content, which is especially helpful for complex visuals or multimedia.

Visual Accessibility

Use of colour is not sole means of conveying information
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.

Structural and Technical Features

ARIA roles provided
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.