Altered mental status (peds)
This page is for pediatric altered mental status. See altered mental status for the adult page.
- Both cerebral cortices must be affected to cause altered mental status
- Must quickly determine if coma or lethargy is from diffuse or focal impairment
- 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.
- Glucose, CBC, chem, UA, CSF, LFT, utox, VBG, BAL, thyroid, Calcium (ionized)
- 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
- Source APLS page 182, 5th ed.