Altered mental status (peds): Difference between revisions
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| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Electrolyte abnormalities]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Electrolyte abnormalities]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Moyamoya malformation | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Moyamoya]] malformation | ||
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| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [Na<sup>+</sup>], [Ca<sup>2+</sup>], [Mg<sup>2+</sup>], PO<sub>4</sub><br> | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [Na<sup>+</sup>], [Ca<sup>2+</sup>], [Mg<sup>2+</sup>], PO<sub>4</sub><br> | ||
Revision as of 02:46, 27 January 2019
This page is for pediatric altered mental status. See altered mental status for the adult page.
Background
- Both cerebral cortices must be affected to cause altered mental status
Clinical Features
Differential Diagnosis
| A | Alcohol | O | Opiates |
| Acid-base and metabolic disorders | U | Uremia | |
| Diabetes mellitus | Chronic renal failure | ||
| Dehydration | Hemolytic-uremic syndrome | ||
| Hypercapnia | T | Trauma | |
| Hepatic failure | General trauma with hypovolemia | ||
| Hypoxia | Head injury | ||
| Inborn errors of metabolism | Mass lesion | ||
| Arrhythmia and cardiogenic causes | Cerebral edema | ||
| Ventricular fibrillation | Cerebrovascular accident | ||
| Adams-Stokes attack | Electric shock | ||
| Aortic stenosis | Decompression sickness | ||
| Pericardial tamponade | Tumor | ||
| E | Encephalopathy | Thermal extremes | |
| Hypertensive encephalopathy | I | Infection | |
| Reye syndrome | Meningitis | ||
| Hemorrhagic shock and encephalopathy syndrome | Encephalitis | ||
| Brain abscess | |||
| Postimmunization encephalopathy | Visceral larva migrans | ||
| Disseminated encephalomyelitis | Severe systemic infection | ||
| Human immunodeficiency virus disease | Intracerebral vascular disorders | ||
| Subarachnoid hemorrhage | |||
| Endocrinopathy | Venous thrombosis | ||
| Addison's disease | Arterial thrombosis | ||
| Congenital adrenal hyperplasia | Intracerebral or intraventricular hemorrhage | ||
| Thyrotoxicity | |||
| Cushing syndrome | Cerebral embolus | ||
| Pheochromocytoma | Acute infantile hemiplegia | ||
| Hepatic porphyrias | Acute confusional migraine | ||
| Electrolyte abnormalities | Moyamoya malformation | ||
| [Na+], [Ca2+], [Mg2+], PO4 |
P | Poisoning | |
| I | Insulin | Psychogenic unresponsiveness | |
| Hypoglycemia | S | Seizure | |
| Ketotic hypoglycemia | Shunt malfunction |
Additional[1]
- Sympathomimetics/cocaine
- Anticholinergics
- Arsenic
- LSD
- PCP
- Phenothiazines
- Salicylates
- Theophylline
- Thyroxine
Evaluation
- Labs
- Glucose, CBC, chem, UA, CSF, LFT, utox, VBG, BAL, thyroid, Calcium (ionized)
- ECG
- Neuroimaging
- XR
- Urine
Management
- Immobilize cervical spine for suspected trauma
- Fluid resuscitation 20 mL/kg x3 as needed; start pressors thereafter
- Antibiotics for sepsis or meningitis (consider viral it patient is toxic)
- Naloxone for opiate or clonidine overdose (0.01-0.1mg/kg IV q2 min)
- Glucose for hypoglycemia (2 mL/kg of 25% dextrose)
- Avoid sodium bicarbonate for metabolic acidosis unless pH <7.0
- Control seizures
- Prevent hypothermia, treat hyperthermia
See Also
External Links
References
- ↑ Source APLS page 182, 5th ed.
