# Pediatric altered mental status

Protect ventilation, assess perfusion, check glucose, and treat the identified cause.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-altered-mental-status/
Official source: [SO-P-065 — Altered Mental Status - Pediatric](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Do not give oral glucose to a child who cannot protect the airway.
- Use the glucose threshold in this condition order; the seizure order has different threshold wording.

## Source documents

- [SO-P-065 — Altered Mental Status - Pediatric](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf)

## Initial assessment

- Protect the airway and assist ventilation with BVM when needed. Monitor rhythm and document a strip.
- Check SpO₂; below 95% on room air, provide high-flow mask oxygen or nasal cannula/direct blow-by as tolerated. Obtain history, medication access, onset, and a measured or appropriately estimated weight.

## Poor perfusion

- For poor perfusion or systolic BP below 80, establish IV/IO and give normal saline 20 mL/kg, maximum 250 mL, with base contact.
- May repeat twice for three total boluses. Reassess BP, lung sounds, skin signs, and mental status rather than giving repeats automatically.

## Hypoglycemia

- Measure and document glucose. Below 60 mg/dL, use oral glucose only if tolerated with intact airway reflexes, or D10 5 mL/kg IV, maximum 250 mL.
- If IV cannot be established, glucagon is 0.5 mg IM. IO dextrose under this order requires unconsciousness, glucose below 60, inability to obtain IV, and no response to IM glucagon.

## Suspected opioid toxicity & transport

- For suspected narcotic toxicity with respiratory rate at or below 12/min, support ventilation and give naloxone 0.1 mg/kg IN/IM/IV, maximum 1 mg, every 3 minutes as needed. The source separately lists the preloaded 4 mg/0.1 mL nasal spray.
- Reassess and document response to every treatment. Provide ALS escort to an appropriate ERC; contact base as needed, with a pediatric-capable base preferred.