General Approach to All Pediatric Patients

Altered Mental Status - Pediatric

This protocol is intended for pediatric patients with new altered mental status of unknown etiology.

Basic Life Support

  • If trauma suspected, stabilize spine
  • Supplemental 100% oxygen
  • Blood glucose check

Advanced Life Support

  • Full Pediatric ALS Assessment and Treatment
  • Determine blood glucose and treat glucose < 70 mg/dl
    • D10W at 5 ml/kg for children < 1 year old (max 40 ml)
    • D25W at 2 ml/kg for children 1-8 years old (max 50 ml)
    • D50W at 1 ml/kg for children ≥ 9 years old (max 50 ml)
    • If no IV available:
      • Glucose paste (if > 2 yo) or other oral glucose containing agent (e.g. orange juice) if patient alert enough to self administer oral agent
      • Glucagon 0.1 mg/kg IM (Maximum dose 1 mg)
    • If hypoglycemia persists:
      • Repeat blood glucose check with a different glucometer
      • Repeat Dextrose (as above) once if blood glucose < 70 mg/dl after 10 minutes
    • Naloxone at 0.1 mg/kg (Maximum individual dose 2 mg) via IV or IO route
      • If IV or IO unavailable Naloxone can be given IM or via mucosal atomizer device