Blood and urine cultures should be collected, and lumbar puncture should be performed, particularly in patients demonstrating meningismus or toxicity. Altered mental status with fever suggests central nervous system (CNS) infection such as meningitis or encephalitis, or systemic infection such as sepsis caused by bacteremia or toxin production. A detailed neurological exam is essential.įocusing on broad categories such as infection, further diagnostic evaluation should include a CBC with differential. Vital signs can suggest underlying pathologies such as infection, toxic ingestion, or increased intracranial pressure. A thorough physical exam will help focus the diagnostic evaluation. Review of systems should be expansive and include screening for headaches, seizures, fatigue, rash, nausea, vomiting, abdominal pain, and abnormal bowel movements. 2ĭetailed and thorough history taking can significantly narrow the differential diagnosis and should encompass medical history developmental history medications for the child or others in the home family history of similar events recent trauma or illnesses and prodromal events prior to change in mental status. Given the extremely broad differential diagnosis, the workup of acute-onset AMS in children is particularly challenging and the vast array of etiologies can be remembered utilizing the Table. 1 Children who present with AMS should be assessed for impairment of airway, breathing, and circulation, and stabilized before etiology is formally evaluated. A chest x-ray and kidneys/ureters/bladder x-ray series are also normal.Īltered mental status (AMS) in children is characterized by the inability to respond to stimulation at a level appropriate to the child’s developmental stage. The patient is unwilling to cooperate with performing a cerebellar examination.Ĭomplete blood count (CBC), basic metabolic panel, urinalysis, hepatic function panel, and serum acetaminophen and salicylate levels are all normal. He has normal muscle bulk, tone, and strength throughout but is unwilling to stand or walk without support. Fundoscopic exam is normal with clearly defined optic discs without papilledema. Neurological exam is limited by participation, but there are no obvious focal neurological deficits and the patient is able to track across midline without nystagmus. Related: Detecting secondhand exposure to marijuanaĪbdominal exam reveals normoactive bowel sounds and a soft, nondistended abdomen with diffuse tenderness and voluntary guarding but no rebound tenderness. Cardiac and pulmonary auscultation is unremarkable. Head is normocephalic and atraumatic, and his neck is supple without lymphadenopathy. Pupil diameter is 3 mm, equal and reactive to light. His temperature is 98.0✯ heart rate is 130 beats per minute blood pressure is 106/70 mm Hg and respiratory rate is 30 breaths per minute. The patient appears to be agitated by loud noises, lights, and touch. On physical exam, the patient is a well-developed, well-nourished but listless boy with intermittent irritability that is consolable by his mother. There are no other unusual ingestions reported, and his parents deny access to any chemicals or medications in the home. He did not have any new or unusual foods for dinner aside from individually wrapped Halloween candy he had collected while trick-or-treating a week earlier. A review of systems is negative for headaches, seizures, rash, nausea, vomiting, and abnormal bowel movements. The patient’s medical and developmental history are unremarkable. The morning of presentation, he was difficult to arouse with intermittent fussiness and reluctance to ambulate. During the night, the boy slept poorly, sporadically awakening with crying followed by brief periods of calmness. According to his parents, he was well until the night before when he began to behave abnormally, becoming excessively tired approximately 2 hours after eating dinner. A 3-year-old boy presents to the emergency department (ED) with a 1-day history of irritability and listlessness.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |