Correct!
4. 1 and 3

The cause of his altered mental status was unclear. A mnemonic for possible causes of altered mental state was AEIOU TIPS (Table 1).

Table 1. Causes of an altered mental state

• A — Alcohol/Acidosis
• E — Endocrine or Encephalopathy
• I — Infection
• O— Opiates, Overdose
• U — Uremia
• T — Trauma
• I — Insulin (hypo or hyperglycemia)
• P — Poisoning/Psychosis
• S — Stroke/Seizure/syncope

The patient has back pain and his pupils were small. These are sufficient to warrant administration of naloxone for possible narcotic overdosage. He had a dramatic response to naloxone and becomes alert after naloxone administration. He states he may have taken some barbiturates. Initial laboratory values include:

• CBC: 13.8 K/mm3, hemoglobin 14.5 g/dL, hematocrit 44, platelets 240K/mm3
• Na+ 141 mmol/L, K+ 4.0 mmol/L, glucose 118 mg/dL, creatinine 1.7 mg/dL
• Lactate 1.0 mmol/L
• Aspartate aminotransferase (AST) 137 IU/L

He has no focal neurological signs and a head CT was not indicated at this time.

What additional laboratory testing should be done? (Click on the correct answer to proceed to the third of six pages)

1. Creatine phosphokinase (CPK)
2. Thyroid function testing
3. Urine drug screen
4. 1 and 3
5. All of the above

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