ALTERED MENTAL STATUS IN CHILDREN

ALTERED MENTAL STATUS IN CHILDREN

 

Pathophysiology

The pathologic conditions that affect awareness and arousal can be divided into three broad pathologic categories: supratentorial mass lesions, subtentorial mass lesions, and metabolic encephalopathy

 

cerebral cortices

reticular activating system

 

Treatment

General Treatment Measures for Altered Mental Status

Assess airway, breathing, and circulation. Immobilize cervical spine for suspected trauma. Initiate continuous pulse oximetry; consider capnometry; administer oxygen. Provide fluid resuscitation, 20 mL/kg x3 as needed. Administer antibiotics for suspected sepsis or meningitis. Give naloxone for suspected opiate or clonidine overdose, 0.01 to 0.1 milligram/kg IV every 2 min. Administer flumazenil for suspected pure benzodiazepine overdose, 0.01 milligram/kg IV. Give glucose for hypoglycemia, 2 mL/kg of a solution of 25% dextrose in water IV. Avoid sodium bicarbonate for metabolic acidosis unless pH is <7.0. Control seizures. Prevent hypothermia with heat lamps during resuscitation, treat hyperthermia.

 

Clinical deatures

History taking: recent illnesses or infectious exposures, and determine the likelihood of trauma or abuse. Ask about antecedent fever, headache, head tilt, abdominal pain, vomiting, diarrhea, gait disturbance, seizures, drug ingestion, palpitations, weakness, hematuria, weight loss, and rash. For infants and young children, review developmental milestones. The medical, immunization, and family histories are important in children of all ages

 

Diagnosis

AEIOU TIPS (alcohol, encephalopathy, insulin, opiates, uremia, trauma, infection, poisoning, and seizure)

 

Disposition and Follow up

require admission to an intensive care unit or transfer to a tertiary care center with pediatric intensive care capabilities