The document discusses altered mental status in children, highlighting the importance of simultaneous stabilization, diagnosis, and treatment to prevent irreversible brain damage. It outlines the pathophysiology, clinical features, historical elements, physical examination, diagnostic tests, and common causes, emphasizing the need for thorough evaluation and appropriate management. Treatment options include maintaining an open airway and addressing reversible causes, with follow-up care essential for discharged patients.

1. ALTERED MENTAL STATUS IN
CHILDREN
Dr. ASHUTOSH KUMARSINGH
EMERGENCY MEDICINE

2. Definition
• Failure to respond to verbal or physical stimulation appropriate to the
childs developmental level
• This condition is critical So it needs stabilization, diagnosis and treatment
simultaneously
• The aim of treatment is to sustain life & prevent
irreversible brain damage.

3. Pathophysiology
Dysfunction of ascending reticular system & cerebral hemisphere –
 Inadequate substrate for metabolic demand
 Insufficient blood flow
 Presence of toxins or metabolic waste products
 Alteration in body temperature

4. Clinicalfeatures
• Confusion- not alert to time and place and persons
• Delirium- abnormal perception, it is not common in children
• Lethargy- aroused with loud voice but go to sleep immediately
• Stupor- aroused with noxious stimulation, decreased motor activity, abnormal
vocalization
• Coma- can not be aroused with any stimulation like as phlebotomy, LP, arterial cath.
• Symptoms of increased intracranial pressure, Herniation

5. Important historical elements
• Prodromal events (recent trauma, infections, illnesses)
• Medications available at home
• Vaccinations
• Developmental status (milestone)
• Social environment (abuse, neglect)
• Family history
• Associated symptoms (fever, weight loss, vomiting, diarrhea, gait changes,
abdominal pain, seizure or abnormal movement, weakness, palpitation, head tilt,
rash, hematuria)

7. Physical exam
• General physical exam (pulse rate, Respiratory Rate, Temp, Blood
Pressure)
• Neurological exam (determine level of consciousness, pupillary reflex,
pattern of respiration, motor activity)
• Signs of abuse
• Signs of intoxication
• Expose the child
• Check blood glucose
• Monitoring

8. GCSin a child

9. AVPU scoringsystem

10. Signs ofherniation

12. Diagnosis
• Use mnemonic: AEIOU TIPS
• A: Alcohol, Acid base and metabolic, Arrhythmia and cardiac causes
• E: Encephalopathy, Endocrinology, Electrolytes
• I: Insulin, Intussusception
• O: Opiates, Oxygen
• U: Uremia
• T: Trauma, Tumors, Thermal
• I: Infections, Intracerebral vascular events
• P: Psychogenic, Poisoning
• S: Seizure

13. Routinediagnostictests
• Glucose
• Na, K, Ca, Cl, HCO3, BUN, Cr
• ABG
• Serum ammonia
• AST, ALT
• Blood and urine screen for toxins
• CSF analysis
• Neuroimaging (CT, MRI, MRV, MRA)
• EEG
Orders

14. Secondarytests
• Serum lead level
• Serum lactate
• Serum amino acids
• Acylcarnitine profile
Orders

15. Commoncauses in childhood
• Toxins
• Infections
• Head trauma
• Hypoxia/Ischemia (near drowning, cardiac arrest)
• Seizure (post ictal phase, subclinical status epilepticus)

16. Transient& RecurrentLOC
• Seizure
• Migraine (basilar or confusional migraine, agitation, ataxia, cortical blindness,
vertigo, headache)
• Syncope (neurocardiogenic, arrhythmia, obstructive cardiomyopathy)
• Hypoglycemia
• Hyperammonemia

17. General treatments options

18. Maintainopen airway
Sniffing position Jaw thrust

19. Discharge& follow up
• Transient and reversible causes in emergency department
• Diseases specific discharge instruction
• An evaluation within 24 hours of discharge
• PICU admission in prolonged and/or critical cases

20. References
• Tintinallis emergency medicine chapter 137

22. THANK YOU !!!