Altered mental status (peds)
Revision as of 21:07, 7 September 2014 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Altered Mental Status (AMS) (Peds) to Altered Mental Status (Peds))
Background
- Both cerebral cortices must be affected to cause AMS
- AVPU scale
- Alert (GCS 15)
- Responsive to verbal stimuli (GCS 13)
- Responsive to painful stimuli (GCS 8)
- Unresponsive (GCS 3)
DDX
- AEIOU TIPS
- Alcohol
- Encephalopathy
- Insulin
- Opiates
- Uremia
- Trauma
- Infection
- Poisoning
- Seizure
| 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 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 imbalances | Moyamoya malformation | ||
| [Na+], [Ca2+], [Mg2+], PO4 |
P | Poisoning | |
| I | Insulin | Psychogenic unresponsiveness | |
| Hypoglycemia | S | Seizure | |
| Ketotic hypoglycemia | Shunt malfunction |
Work-Up
- Labs
- Glucose, CBC, chem, UA, CSF, LFT, utox, VBG, BAL, thyroid, Calcium (ionized)
- ECG
- Neuroimaging
- XR
- Urine
Treatment
- Immobilize cervical spine for suspected trauma
- Fluid resuscitation 20 mL/kg x3 as needed; start pressors thereafter
- Abx for sepsis or meningitis (consider viral it patient is toxic)
- Naloxone for opiate or clonidine overdose (0.01-0.1 mg/kg IV q2 min)
- Flumazenil for pure benzo overdose (0.01 mg/kg IV)
- 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
Source
Tintinalli