STUDY OF SODIUM PLASMA LEVEL IN ALTERED MENTAL STATUS ADULT PATIENTS

Background: Altered mental state is a frequent and clinically relevant presentation in the emergency department, including a wide range of neurological dysfunction, from confusion and disorientation to stupor and coma. Objectives: To evaluate serum sodium levels in adult patients presenting with altered mental status to the emergency department of Al-Jamhory Teaching Hospital in Mosul. Methods: The present study included prospective study of 45 adult patients who presented to emergency department in Al-Jamhory Teaching Hospital with altered mental status during the period from February 2025 to July 2025. The study excluded patients admitted with altered mental state secondary to trauma. the questionnaire included the demographic and clinical data (age, sex, occupation, address, chief complaint, with it is duration, medical history, drug history). In addition to full clinical examination of each patient (blood pressure, plus rate, body temperature) as well as complete neurological examination including (consciences, orientation, Glasgow coma scale assessment). Results: The study included 45 patients. Of them 26 (57.77%) males and 19 (42.23%) females with male: female ratio of 1.368:1. 21 (46.67%) patients had Na+ level of more than 145 mmol/l (hypernatremia) while normal plasma Na + level was present in 16 (35.56%) and hyponatremia in 8 (17.77%) patients. the majority of patients with each of hypernatremia, normal sodium level and hyponatremia had Glascow coma scale of 9-13. Moreover, the majority of patients of random blood sugar of more than 250 mg/dl with each of hypernatremia and hyponatremia had Glascow coma scale of 9-13. While the majority of patients with random blood sugar of more than 250 mg/dl and normal sodium level had GCS of <9. Diuretic use was prevalent among 4 (19.05%) of hypernatremia patients, while it was used by 4 (25%) and 2 (25%) patients with normal sodium level and hyponatremia. Conclusion: Both dysnatremia and changed serum osmolality contributed to lower Glasgow Coma Scale scores, emphasizing the importance of electrolyte imbalance as a reversible cause of altered mental status in emergency situations. Routine serum sodium and plasma osmolality testing should be emphasized in all adult patients presenting with altered mental status in the emergency department.