Definition of the Complaint
Altered mental status is a broad, nonspecific term that includes dysfunction of cognition, attention, awareness, or consciousness. Although not a defined disease, altered mental status is a symptom of an underlying disease process. The Glasgow Coma Scale provides a structured system for categorizing a child’s mental status based on eye opening, verbal, and motor response. The simpler AVPU (alert, verbal, pain, unresponsive) provides rapid classification of a child’s mental status. The onset of altered mental status is generally acute, chronic, or progressive and may be obvious or subtle in its presentation. This chapter will focus on the causes of acute altered mental status in children.
Although all disease processes that manifest themselves as an altered mental status are serious, life-threatening disorders must be recognized early and treated appropriately. The brain’s reticulated activating system mediates wakefulness and disruption of these neurons results in an altered mental status. Infection, toxin-mediated, metabolic, and traumatic injury are the most common life-threatening disorders affecting the reticulated activating system. Unfortunately, the presentation of even the life-threatening disorders can be subtle and a high index of suspicion is necessary for proper diagnosis.
Complaint by Cause and Frequency
Altered mental status does not constitute a diagnosis, but it is a symptom of an underlying disease process that requires a thorough investigation. The causes of altered mental status in childhood vary by age (Table 8-1) and may also be grouped based on the following etiologies (Table 8-2).
Table 8-1. Causes of Altered Mental Status in Childhood by Age. |Favorite Table|Download (.pdf)
Table 8-1. Causes of Altered Mental Status in Childhood by Age.
–hyper- or hyponatremia
Heavy metal poisoning
Central venous thrombosis
Table 8-2. Causes of Altered Mental Status by Etiology. |Favorite Table|Download (.pdf)
Table 8-2. Causes of Altered Mental Status by Etiology.
Arterial venous malformation
Central venous thrombosis
Decreased cerebral perfusion
–congenital heart disease
Hyper- or hyponatremia
Primary brain tumor
Metastatic CNS disease
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