From the Guidelines
Confusion screen blood tests should include a complete blood count, electrolyte panel, blood urea nitrogen, creatinine, liver function tests, glucose, inflammatory markers, and other relevant tests as outlined in the initial laboratory workup for patients with spontaneous intracerebral hemorrhage, as recommended by the 2022 American Heart Association/American Stroke Association guideline 1. When evaluating a patient with confusion, it is crucial to order a comprehensive set of blood tests to identify potential underlying causes. These tests help clinicians detect common physiological disturbances that can cause confusion, such as infections, metabolic abnormalities, organ dysfunction, or medication toxicity.
- The initial laboratory workup should include:
- Complete blood count
- Blood urea nitrogen and creatinine to assess kidney function
- Liver function tests
- Glucose
- Inflammatory markers like ESR and/or CRP
- Prothrombin time (with INR) and an activated partial thromboplastin time
- Specific tests for direct oral anticoagulants (DOACs) when appropriate, as recommended by the 2022 guideline 1
- Additional tests may be included based on the patient's clinical presentation and medical history, such as cardiac-specific troponin, ECG, urine toxicology screen, and pregnancy test in women of childbearing age. The results of these tests guide immediate treatment decisions, such as correcting electrolyte imbalances, treating infections, or adjusting medications, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
As with other benzodiazepines, periodic blood counts and liver-function tests are recommended for patients on long-term therapy The confusion screen blood tests include:
- Complete Blood Count (CBC): to monitor for leukopenia or other blood cell abnormalities
- Electrolyte panel: not explicitly mentioned in the provided drug labels
- Blood Urea Nitrogen (BUN): not explicitly mentioned in the provided drug labels
- Liver-function tests: to monitor for potential liver damage or dysfunction It is recommended to perform these tests periodically for patients on long-term therapy with lorazepam 2.
From the Research
Confusion Screen Blood Tests
Confusion screen blood tests are a set of laboratory tests used to identify the underlying cause of confusion in patients. These tests include:
- Complete Blood Count (CBC) 3, 4
- Electrolyte panel
- Blood Urea Nitrogen (BUN)
- Other relevant laboratory tests
Components of Complete Blood Count (CBC)
The CBC test measures the total numbers and characteristics of cell components in the blood, including:
- Red blood cell count
- Hemoglobin
- Hematocrit
- Red blood cell indices (including mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration, and red cell distribution width)
- Reticulocyte count
- White blood cell count and differential
- Platelet count 3, 4
Use of Confusion Screen Blood Tests
Confusion screen blood tests are used to rule out systemic or mechanical problems in the brain that may be causing confusion 5, 6. These tests can help identify potentially reversible causes of confusion, such as metabolic disorders, infections, and medication side effects 6. In some cases, confusion screen blood tests may not show any abnormal results, and further specialized investigations may be needed to diagnose the underlying cause of confusion 7.
Laboratory Evaluation
Laboratory evaluation, including confusion screen blood tests, is an important part of the diagnostic approach to confused elderly patients 6. The results of these tests can help healthcare providers identify the underlying cause of confusion and develop an appropriate treatment plan.