Altered mental status (peds)

Both cerebral cortices must be affected to cause altered mental status The objectives of the examination are to identify occult infection, trauma, toxicity, or metabolic disease

Although several coma scales have been published, the most simplified and functional in an emergency setting is the AVPU scale. This is a descriptive tool in which A means "alert," V means "responsive to verbal stimuli," P means "responsive to painful stimuli," and U means "unresponsive." The A, V, P, and U values correspond to Glasgow Coma Scale scores of 15, 13, 8, and 3 respectively.7

AEIOU TIPS (alcohol, encephalopathy, insulin, opiates, uremia, trauma, infection, poisoning, and seizure

A	Alcohol	O	Opiates
	Acid-base and metabolic disorders	U	Uremia
	Diabetes mellitus		Chronic renal failure
	Dehydration		Hemolytic-uremic syndrome
	Hypercapnia	T	Trauma
	Hepatic failure		General trauma with hypovolemia
	Hypoxia		Head injury
	Inborn errors of metabolism		Mass lesion
	Arrhythmia and cardiogenic causes		Cerebral edema
	Ventricular fibrillation		Cerebrovascular accident
	Adams-Stokes attack		Electric shock
	Aortic stenosis		Decompression sickness
	Pericardial tamponade		Tumor
E	Encephalopathy		Thermal extremes
	Hypertensive encephalopathy	I	Infection
	Reye syndrome		Meningitis
	Hemorrhagic shock and encephalopathy syndrome		Encephalitis
			Brain abscess
	Postimmunization encephalopathy		Visceral larva migrans
	Disseminated encephalomyelitis		Severe systemic infection
	Human immunodeficiency virus disease		Intracerebral vascular disorders
			Subarachnoid hemorrhage
	Endocrinopathy		Venous thrombosis
	Addison disease		Arterial thrombosis
	Congenital adrenal hyperplasia		Intracerebral or intraventricular hemorrhage
	Thyrotoxicity
	Cushing syndrome		Cerebral embolus
	Pheochromocytoma		Acute infantile hemiplegia
	Hepatic porphyrias		Acute confusional migraine
	Electrolyte imbalances		Moyamoya malformation
	[Na+], [Ca2+], [Mg2+], PO4	P	Poisoning
I	Insulin		Psychogenic unresponsiveness
	Hypoglycemia	S	Seizure
	Ketotic hypoglycemia		Shunt malfunction