Altered mental status (peds)
(Redirected from Altered Mental Status (Peds))
This page is for pediatric patients. For adult patients, see: altered mental status
Background
- Both cerebral cortices must be affected to cause altered mental status
- Must quickly determine if coma or lethargy is from diffuse or focal impairment
Clinical Features
- Depends on cause
- Diffuse brain dysfunction - lack of focal findings
- Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes
- Important to differentiate diffuse brain dysfunction from localized lesion as a patient may appear confused due to visual deficit, dysphasia, etc.
Differential Diagnosis
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
- UA
Management
- Immobilize cervical spine for suspected trauma
- Fluid resuscitation 20 mL/kg x3 as needed; start pressors thereafter
- Antibiotics for sepsis or meningitis (consider antiviral it patient is toxic)
- Naloxone for opioid 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.