Altered mental status in children presenting to an emergency department.Stupor and other alterations of consciousness are among the most serious life-threatening emergencies faced by the ED. The epidemiology of children who present to an ED with altered mental status is not well studied. Prospective evaluation of all children <18 years old from 6/99 to 12/03 who presented with altered mental status. There were 145 children, 84 (57.9%) males 43 (29.6%). Mean age was 8.13 [+ or -] 5.9 years old (95% CI, 7.15-9.10), range 22 days old to 17 years old. Abnormal vital signs were hypotension in 5 (3.4%), hypertension in 20 (13.7%), tachycardia in 27 (18.6%), tachypnea tachypnea /tach·yp·nea/ (tak?ip-ne´ah) very rapid respiration. tach·yp·ne·a n. Rapid breathing. Also called polypnea. in 16 (11%). Other symptoms were cough (14.8%), fever (6.8%), vomiting (11.7%), and diarrhea (4.8%). There were 31 different diagnoses: overdoses in 18 (12.4%), ethanol intoxication in 15 (10.3%), seizures in 13 (8.9%), dehydration in 13 (8.9%), medication side effects in 7 (4.8%), hypoglycemia in 6 (4.1%), traumatic brain injury in 6 (4.1%), VP shunt failure in 4 (2.7%), febrile seizure in 4 (2.7%), DKA in 4 (2.7%), pyelonephritis pyelonephritis: see nephritis. pyelonephritis Infection (usually bacterial) and inflammation of kidney tissue and the renal pelvis. Acute pyelonephritis is usually localized and may have no apparent cause. in 3 (2%), viral meningitis in 2 (1.3%), CO poisoning in 2 (1.3%), viral infection in 2 (1.3%), and pneumonia in 2 (1.3%). There were 3 with internal injuries from abuse. In 8 (5.5%), a diagnosis could not be obtained and the altered mentation mentation mental activity, state of mind. resolved on its own. Abnormal laboratory evaluation: leukocytosis Leukocytosis Definition Leukocytosis is a condition characterized by an elevated number of white cells in the blood. Description Leukocytosis is a condition that affects all types of white blood cells. in 16 (11%), hypernatremia Hypernatremia Definition The normal concentration of sodium in the blood plasma is 136-145 mM. Hypernatremia is defined as a serum sodium level over 145 mM. Severe hypernatremia, with serum sodium above 152 mM, can result in seizures and death. in 19 (13.1%), hyponatremia in 4 (2.7%), hyperkalemia Hyperkalemia Definition The normal concentration of potassium in the serum is in the range of 3.5 to 5.0 mM. Hyperkalemia refers to serum or plasma levels of potassium ions above 5.0 mM. in 7 (4.8%), hypokalemia Hypokalemia Definition Hypokalemia is a condition of below normal levels of potassium in the blood serum. Potassium, a necessary electrolyte, facilitates nerve impulse conduction and the contraction of skeletal and smooth muscles, including the heart. in 3 (3%), low C[O.sub.2] in 5 (10.3%), elevated BUN in 12 (8.2%), hypoglycemia in 6 (4.1%), and hyperglycemia in 27 (18.6%). Urine toxicology in 63 (43.4%) was positive in 13 children. CT scan of the head in 42 (28.9%) was abnormal in 8 children. There were 17 (11.73%) with life-threatening causes. Altered mentation in children is unexpectedly caused by medications and drugs. The presence of an abnormal vital signs and an elevated WBC count was useful in detecting all those children with a life-threatening causes for the altered mentation. Antonio E. Muniz, MD. Department of Emergency Medicine and Pediatrics, Virginia Commonwealth University Medical Center, Richmond, VA. |
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