Workup
Laboratory Studies
Standard laboratory tests for poisoned patients are indicated if the patient has significant symptoms. Such tests may include the following:
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Rapid bedside glucose determination
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Arterial blood gas determination - Indicated if a compromise in oxygenation or ventilation is suspected
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Lactate level - May be useful in phases 2 and 3 of an acute overdose to help determine end-organ perfusion
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Determination of serum electrolyte, calcium, and magnesium levels - Calculation of the anion gap possibly helpful in screening for co-ingestions (see the Anion Gap calculator)
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Serum acetaminophen level and salicylate level - Indicated in intentional overdoses
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Screening for serum levels of alcohol (ethanol, methanol, isopropyl alcohol) - Indicated if alcohol ingestion is clinically suspected
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Urine pregnancy test - Indicated in all women of childbearing age
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Urinalysis and urine pH determination - May be useful in the setting of rhabdomyolysis
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Urine drug screening - Comprehensive drug screening and screening for commonly abused drugs is possibly helpful in assessing co-ingestions
Quantitative levels of monoamine oxidase inhibitors are not readily available and, therefore, are not clinically useful. Consider workup for hypertensive emergencies if any signs or symptoms are present.
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Imaging Studies
Chest radiography is indicated if aspiration is a concern. Perform postintubation chest radiography to evaluate the position of the endotracheal tube in relation to the carina if respiratory support is needed.
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