From the Research
For a patient in status epilepticus, the initial lab tests indicated include a complete blood count (CBC), basic metabolic panel (BMP) including electrolytes, glucose, calcium, and renal function, liver function tests, toxicology screen, antiepileptic drug levels (if applicable), and arterial blood gas (ABG), as these tests provide crucial information about the patient's overall health status and potential causes of the seizure, as suggested by 1.
Initial Laboratory Workup
The following tests should be included in the initial laboratory workup for a patient in status epilepticus:
- Complete blood count (CBC) to reveal infections or hematological disorders
- Basic metabolic panel (BMP) including electrolytes, glucose, calcium, and renal function to identify electrolyte imbalances, hypoglycemia, or renal dysfunction that may trigger seizures
- Liver function tests to assess the metabolism of antiepileptic drugs
- Toxicology screen to detect substance abuse or accidental ingestion that may have caused the seizure
- Antiepileptic drug levels (if applicable) to determine if subtherapeutic levels contributed to the crisis
- Arterial blood gas (ABG) to provide information about oxygenation and acid-base status, which can be affected during prolonged seizures
Rationale
These tests are essential in the initial management of status epilepticus, as they help identify potential causes of the seizure and guide further treatment, as noted in 2 and 1. The CBC, BMP, and liver function tests can help identify underlying conditions that may have contributed to the seizure, while the toxicology screen and antiepileptic drug levels can help determine if substance abuse or medication non-adherence played a role. The ABG provides critical information about the patient's oxygenation and acid-base status, which can be affected during prolonged seizures.
Additional Considerations
Additional tests, such as neuroimaging (CT or MRI) and EEG, may be necessary but are typically performed after initial stabilization and are not part of the immediate laboratory workup, as suggested by 3. It is essential to prioritize patient stabilization and seizure control alongside obtaining these laboratory tests, ensuring proper airway management, administering benzodiazepines if the seizure is ongoing, and monitoring vital signs closely.