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Medical

Pediatric AMS

Signs and Symptoms: Differential Diagnosis:
• Decreased Mental Status/Coma • Head Trauma
• Bizarre Behavior • Stroke
• Somnolence • CNS Tumor/Mass/Bleed/Infection
• Diaphoresis/Dry, Red Skin • Thyroid Dysfunction
• Polyuria/Polydipsia • Hyperglycemia/Hypoglycemia
• Sweet/Fruity Breath • Diabetic Ketoacidosis
• Altered Respirations • Toxic Ingestion
• Signs of Trauma • Environment (Hyperthermia/Hypothermia)
• Fever • Hypoxia
• Psychiatric Disorders
• Seizure Disorder
• Sepsis
Universal Patient Care Guideline Glucose >250?
Continued from: O2 (if Hypoxemic)
IV/IO Guideline
Tactical Evacuation Guideline Cardiac Monitor 20mL/kg IVF
Check Blood Glucose
12-lead ECG
Blood Glucose <60? Consider Spinal Immobilization
Guideline NO Arrhythmia?
Evidence of Malnourishment? LESS Normal (65-120) Blood Glucose? MORE YES
NO YES Bradycardia Tachycardia
with Pulse
with Pulse
Thiamine 25mg IV/IM and Poor and Poor
Unimproved YES Perfusion Perfusion
nd
Oral Glucose (*See Pearls) After 2 dose Consider Alternate Causes:
OR (AEIOU-TIP) Pediatric Cardiac

25% Dextrose 2mL/kg Arrest
OR Consider:
Glucagon 0.5mg IM Naloxone 0.1mg/kg IV/IM Consider Alternate Causes:

(If NO IV Access) • Alcohol / Acidosis
NO IVF 20mL/kg IV • Epilepsy
• Insulin
Return to Baseline? Improved Unimproved
and Continuous Monitoring: 12-lead ECG • Overdose
Glucose Normalized? Recheck Glucose: Titrate additional IVF if Glucose • Uremia / Renal Failure
>250. Be alert for signs of fluid overload. If DKA • Trauma
watch for hypovolemia and acidosis • Infection
YES • Psychosis
Pearls:
• Be aware of Altered Mental Status (AMS) as a presentation of environmental exposure/toxins/hazmat–
use personal protection accordingly/decontamination.
• Recheck blood glucose after each intervention.
• *Oral glucose okay if patient alert, protecting airway, and solution available. Proteins+complex
carbs (e.g., sandwich, granola) are better, longer lasting glucose source than simple sugars.
• EKG should be obtained in all suspected toxin or diabetic ketoacidosis cases–evaluate for tall, peaked
T-waves (hyperkalemia) or QRS widening >100ms (toxins).
• Glucagon may cause nausea/vomiting–should have anti-emetic prepared.
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