Laboratory Data

1. Basic metabolic panel, glucose, calcium. Electrolyte abnormalities (hypernatremia, hyponatremia, hypocalcemia) and hypoglycemia or hyperglycemia can present with alteration of mental status. Metabolic acidosis is seen with underlying metabolic disorders or intoxication. Respiratory acidosis may be seen in other intoxications (alcohol, benzodiazepines, and barbiturates).

2. Renal and hepatic profile. Can indicate acute or chronic endorgan dysfunction.

3. CBC with differential. Elevated WBC count may indicate active infection.

4. Toxicology screening or drug levels. Obtain blood levels of prescription medications, ingested medications, or substances of abuse, as indicated, based on patient's history.

5. ABGs. Obtain if hypoxia or acid-base problems are suggested by history.

6. Lumbar puncture. Perform if intracranial infection (meningitis or encephalitis) or subarachnoid hemorrhage is suspected. Do not complete procedure if increased intracranial pressure or mass-occupying lesion is noted, because of risk of herniation.

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