Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (84 page)

   Liver and renal function tests

   Ketones, lactose, and osmolarity to rule out diabetic coma

   ABG

   PT and PTT

   Drug screen to include ethanol, acetaminophen, salicylates, opiates, benzodiazepines, barbiturates, cocaine, amphetamines, ethylene glycol, and methanol

If the initial screening is unrevealing, additional testing should include the following:

   Blood cultures

   Thyroid and adrenal function tests

   Blood smear: to screen for thrombotic thrombocytopenic purpura and hemolysis

   LDH,
D
-dimer, and fibrinogen to rule out DIC

   Antiphospholipids if a coagulation problem is suspected

   Carboxyhemoglobin if carbon monoxide poisoning is suggested

References

1.  Goldman L, et al.
Cecil Medicine. Coma and Other Disorders of Consciousness
, 24th ed. Philadelphia, PA: Saunders Elsevier; 2012.

2.  Plum F, Posner JB.
The Diagnosis of Stupor and Coma
, 4th ed. Philadelphia, PA: FA Davis; 1995.

3.  Hasbun R, Abrahams J, Jekel J, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis.
N Engl J Med.
2001;345:1727.

REYE SYNDROME (ACUTE TOXIC–METABOLIC ENCEPHALOPATHY)

   Definition

Reye syndrome is an acute toxic noninflammatory encephalopathy with fatty changes of the liver and kidney. Rarely, fatty changes are also seen in the heart and pancreas.

   Clinical Presentation