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PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round three
7. Identifying the
causes of reduced consciousness
Other investigations
7e (xxiv) g) Cerebrospinal fluid should be analysed initially for:
lactate
|
Position |
Comment |
|
Neuro s |
I’m guessing this will take a while and that previously undiagnosed mitochondrial problems are low on the list of causes of reduced GCS |
|
Metab |
I neither agree nor disagree. There are of course other causes of high CSF lactate, than mitochondrial disorders, (meningitis, cerebral malaria, perhaps cerebral hypoxia itself). A CSF lactate at the time of coma may not advance the diagnostic process in any way, and still have to be done at a later stage. I think a test for the cold light of day, rather than an emergency test. |
|
paed |
I would send for lactate only if the history suggests the strong possibility of a metabolic disorder. |
|
Endo |
Saves repeating it and probably not a big problem for most labs |
|
PICU |
would need more info re: practicalities
in lab and positive/negative predictive values |
|
Paed ED |
Can this sample be saved to process if necessary rather than repeat the LP. What would the cost of testing routinely- probably not needed in majority of children |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
57% |
35% |
8% |
7e (xxii) (g) A cranial CT scan should be considered when the patient is stable if the working diagnosis is:
Intracranial abscess
|
Position |
Comment |
|
PICU |
with contrast |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
100% |
% |
% |