Pediatrics

8 year old boy with altered mental status

Shilpa Gulati on May 26, 2013

You’re working in the ED on a Saturday night and an 8 year old boy with altered mental status is brought in by his parents. For the past day he has become increasingly confused, obtunded, vomited twice, and has been taking slower breaths. Mom notes that he has lost weight recently.

  • Temp  97 C
  • HR  108
  • BP  95/50
  • RR  10
  • O2  0% on

Physical exam:

GCS score: 12. Patient is able to localize motor response to pain, but is disoriented in his verbal response and opens his eyes only to painful stimulus.

General: Pale and diaphoretic

HEENT: Dry mucous membranes, eyes appear sunken, breath with fruity odor

Extremities: Capillary refill ~4 sec

 

CBC, basic metabolic panel, and UA are obtained.

CBC within normal limits.

Basic: Na 152, Cl 110, BUN 60, K 5.3, Bicarb 19, Cr 1.1, Glucose 820, 

UA positive for 2+ glucosuria.

 

You’re working in the ED on a Saturday night and an 8 year old boy with altered mental status is brought in by his parents. For the past day he has become increasingly confused, obtunded, vomited twice, and has been taking slower breaths. Mom notes that he has lost weight recently.

  • Temp  97 C
  • HR  108
  • BP  95/50
  • RR  10
  • O2  0% on

Physical exam:

GCS score: 12. Patient is able to localize motor response to pain, but is disoriented in his verbal response and opens his eyes only to painful stimulus.

General: Pale and diaphoretic

HEENT: Dry mucous membranes, eyes appear sunken, breath with fruity odor

Extremities: Capillary refill ~4 sec

 

CBC, basic metabolic panel, and UA are obtained.

CBC within normal limits.

Basic: Na 152, Cl 110, BUN 60, K 5.3, Bicarb 19, Cr 1.1, Glucose 820, 

UA positive for 2+ glucosuria.

 

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