A child may present with lethargy, altered mental status or drowsiness. Lethargy can be a manifestation of a number of clinical conditions , ranging from toxic and metabolic conditions to seizures. The differential diagnosis is broad and a proper workup is needed apart from a detailed history and physical examination.
Basic Metabolic Panel
Electrolyte abnormalities ( hypo/hypernatremia, hypo/hyperkalemia, hypo/hypercalcemia ) and hypo/hyperglycemia can present with alteration of mental status. Matabolic acidosis may point to an underlying metabolic disorder or intoxication. Respiratory acidosis can be seen in intoxications with alcohol, benzodiazepines and barbiturates.
Renal and Hepatic Profile
Can indicate acute or chronic end organ dysfunction.
CBC with differentials
Elevated WBC count may indicate acute infection.
Toxicology Screening and Drug levels
Based on patient’s history, order blood levels of prescription medications, ingested medications or substances of abuse.
Obtain if hypoxia or acid base problems are suggested by history or physical examination.