Primary care physicians may encounter patients with altered mental sta
tus or neurologic deficit. Because the differential diagnosis for alte
red mental status includes conditions with significant morbidity and m
ortality care of these patients must be rapid and thorough. The resour
ces required to ensure and maintain cardiopulmonary stabilization and
to perform the initial workup are often unavailable in the primary car
e office setting. Therefore, these patients often require immediate re
ferral to an emergency department. Proper evaluation and initial manag
ement include evaluation of metabolic factors, assessment for toxic in
gestions and a thorough neurologic assessment.