Sepsis: This is often the most common cause of altered mental status combined with hypotension, especially in elderly or immunocompromised patients. Sepsis can lead to hypotension due to vasodilation and decreased vascular resistance, and altered mental status can result from the systemic inflammatory response affecting the brain.

Hypovolemic Shock: Significant blood or fluid loss can lead to hypotension and decreased perfusion of the brain, resulting in altered mental status.
Cardiogenic Shock: Conditions like myocardial infarction or severe heart failure can cause hypotension due to inadequate cardiac output, leading to reduced cerebral perfusion and altered mental status.
Toxic or Medication-Induced Causes: Various substances, including prescription medications, drugs of abuse, and toxins, can cause both hypotension and altered mental status through different mechanisms, such as vasodilation, depression of the central nervous system, or interference with neurotransmitter function.
Adrenal Insufficiency: This condition, including Addisonian crisis, can present with hypotension and altered mental status due to the lack of cortisol and aldosterone, which are crucial for maintaining blood pressure and electrolyte balance.

Myocardial Infarction: Although included under cardiogenic shock, it's crucial to specifically consider myocardial infarction as it requires immediate intervention.
Pulmonary Embolism: A large pulmonary embolism can cause hypotension and altered mental status due to the sudden increase in pulmonary vascular resistance and subsequent decrease in cardiac output.
Intracranial Hemorrhage: Although it might not directly cause hypotension, the increased intracranial pressure can lead to Cushing's reflex, which includes hypertension initially, but in late stages or with significant brainstem involvement, hypotension can occur.
Anaphylaxis: This severe allergic reaction can cause hypotension due to massive vasodilation and increased vascular permeability, along with altered mental status from the systemic effects.

Pheochromocytoma Crisis: A rare tumor of the adrenal gland that can cause episodic or sustained hypertension, but in crisis situations, it can lead to hypotension and altered mental status due to catecholamine-induced vasospasm and subsequent cardiac dysfunction.
Neuroleptic Malignant Syndrome: A life-threatening neurological disorder caused by an adverse reaction to neuroleptic or antipsychotic medication, characterized by fever, altered mental status, and muscle rigidity, which can be associated with hypotension.
Meningitis or Encephalitis: Infections of the meninges or brain can cause altered mental status and, in severe cases, hypotension due to the systemic inflammatory response or direct effects on the brainstem.
Thyroid Storm: A rare but life-threatening complication of untreated or undertreated hyperthyroidism, which can cause hypotension and altered mental status among other symptoms.