PED-Altered Mental Status

Pediatric Toxicological Emergency


  • If narcotic overdose, naloxone 0.1 mg/kg IV/IM/IN/IO (max 2 mg)
  • If toxin remains on patient, wash or brush off as appropriate. Alert medical control if patient will require further decontamination; patient NOT to be brought through regular Triage.
  • For eye exposure, flush the eyes with 0.9% NaCl for at least 15 min
  • If patient has ingested medications or other substance, obtain container(s), and bring with patient to ED

Pediatric Seizure

Altered Mental Status – PED


  • 100% O2 or BVM ventilate if needed
  • Consider nasopharyngeal airway

Seizing >5 min, give Midazolam

  • ≤12 kg = 0.2 mg/kg IV/IO/IM/IN
  • 13-40 kg = 5 mg IV/IO/IM/IN
  • Contact medical control for seizing >15 min

Pediatric Diabetic Reaction

Altered Mental Status – PED


IF blood glucose is < 70 mg/dl:

  • If dysrhythmia present, proceed to appropriate protocol
  • For shock, push 20 ml/kg 0.9%NaCl IV/IO (max 1 L)
  • If glucose ≤70, administer 1 ml/kg D50W IV/IO push; If child ≤3 y.o. or ≤ 15 kg, instead push 2 ml/kg of D25 IV/IO (D25 is made by mixing D50 1:1 with 0.9% NaCl)
  • If no IV, Glucagon 1 mg for ≥6 y.o. or 0.5 mg for children ≤5 y.o.

IF blood glucose is > 400 mg/dl or glucometer reads “HIGH”:

  • Give fluid bolus of 20 ml/Kg not to exceed 1000 ml IV/IO during transport if no evidence of pulmonary edema
  • Place patient on monitor for possibility of dysrhythmia

Altered Mental Status – PED