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Altered Level Of Consciousness: Evidence-Based Management In The Emergency Department

January 2017

Abstract

A child who presents to the emergency department with an altered level of consciousness can be clinically unstable and can pose a great diagnostic challenge. The emergency clinician must quickly develop a wide differential of possible etiologies in order to administer potentially life-saving medications or interventions. The history, physical examination, and appropriate diagnostic tests can aid greatly in rapidly narrowing the differential diagnosis. Once initial stabilization, workup, and first-line interventions are completed, most patients who present with unresolved or unidentified altered level of consciousness should be admitted for further evaluation and close monitoring. This issue provides a review of the etiologies of altered level of consciousness as well as guidance for the management and disposition of patients with this condition.

Key words: altered level of consciousness, ALOC, altered mental status, clouding of consciousness, confusion, lethargy, obtundation, stupor, coma, Glasgow Coma Scale, GCS, pediatric, children

Points

  • Altered level of consciousness (ALOC) has an extensive differential diagnosis, and mnemonics such as “AEIOUTIPS” and “MOVESTUPID” can assist providers in recalling potential etiologies.
  • Hyponatremia usually presents with seizures and should be corrected slowly, with a goal of correction of 12 to 15 mEq/L (12-15 mmol/L) over a 24-hour period.

Pearl

  • Bedside tests (eg, point-of-care glucose and venous blood gas with electrolytes) may quickly reveal easily reversible causes of ALOC.
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Last Modified: 10/19/2017
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