This episode covers an approach to children with altered level of consciousness.  We present an approach to the initial management in these cases, with a focus on the ABC and DFG approach. Investigations and imaging are discussed. Some specific causes of altered LOC are covered.  This episode was written by Peter MacPherson and Dr. Melanie Lewis. Peter is a medical student at the University of Alberta. Dr. Lewis is a general pediatrician and an Associate Professor of Pediatrics at the University of Alberta and Stollery Children's Hospital. She is also the Clerkship Director.  ~~~ Differential Diagnosis of Altered Level of Consciousness: 1) Structural causes: cerebrovascular accident, cerebral vein thrombosis, hydrocephalus, intracerebral tumor, subdural empyema, trauma (intracranial hemorrhage, diffuse cerebral swelling, abusive head trauma/shaken baby syndrome) 2) Medical causes: anoxia, diabetic ketoacidosis, electrolyte abnormality, encephalopathy, hypoglycemia, hypothermia or hyperthermia, infection (sepsis), inborn errors of metabolism, intussusception, meningitis or encephalitis, psychogenic, postictal state, toxins, uremia (hemolytic-uremic syndrome) Adapted from: Avner J (2006) Altered states of consciousness. Pediatr Rev 27: 331-338. Related Content: Case: Unresponsive 2 month old baby Case: Intoxication in a 13 year old female Podcast: Meningitis Podcast: Approach to Pediatric Head Injury