Approach to altered mental status (pediatrics) Quiz: Ace Your Exams
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A 7-year-old girl is brought to the emergency department for evaluation of altered mental status in the setting of persistent non-bloody, nonbilious emesis for 48 hours. A caregiver reports the child has not been able to keep any food down and is only tolerating tiny amounts of water. The child has urinated once in the last 10 hours. There have been a few episodes of non-bloody diarrhea. There is no recent travel or known sick contacts. Weight is at the 15th percentile, and height is at the 30th percentile. Temperature is 101°F (38.3°C), blood pressure is 96/57 mmHg, pulse is 135/min, respiratory rate is 22/min, and oxygen saturation is 100% on room air. On physical examination, the child appears lethargic and is unable to answer questions appropriately. She is disoriented to place. Mucous membranes are dry, and capillary refill is 3 seconds. A soft flow murmur is noted. The abdomen is soft and mildly tender to palpation without rebound or guarding. Glasgow coma scale (GCS) is 12. Which of the following is the best next step in management?
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