Check CBG to rule out hypoglycemia 

 Pulse oximetry, supplemental oxygen as needed (Target SpO2>88%) Send BMP, CBC, Mg, Ph, LFT's EKG and Cardiac enzymes  ABG, CXR, UA Keep NPO until safe to swallow, start on gentle IV hydration (NS@ 75 mL/hr) Give IV thiamine (in alcoholics, malnourished, ESRD and cancer patients) TSH, B12, Folate, Cortisol, Ammonia level, Urine drug screen if indicated Blood cultures, Lactic acid, PCT if an infectious etiology is suspected. CT Head if persistent confusion, patient lethargic or unable to follow commands. MRI brain in selected cases with high suspicion of central causes Minimize narcotics and other drugs that could potentially cause worsening of mental status. Lumbar Puncture and EEG, if above work up is negative. Olanzapine/ Ativan PRN for severe agitation. Orientation protocols - provision of clocks, calendars, windows with outside views, frequent reassurance, touch, and verbal orientation especially from familiar persons.