Approach to altered conscious level

Question 1

Describe the initial investigations in a patient with altered conscious level

Answer 1

• Blood sugar level
• Full blood count
• Urea, Electrolytes, Creatinine
• Paracetamol, Ethanol level
• Urinalysis
• Urine drug screen if available
• +/- Head CT/MRI
• +/- Lumbar Puncture

Question 2

What are the differential diagnosis for conditions that mimic seziures?

Answer 2

• Eclampsia
• Nonepileptic seizures/pseudoseizures
• Syncope
• Acute dystonic reactions
• Rigors
• Cardiac disorders (e.g. Dysrhythmias, Long QT syndrome, HOCM)

Question 3

What are the 2 types of status epilepticus?

Answer 3

Convulsive (typical, sustained generalised tonic-clonic seizure) and non-convulsive status (long or repeated absence or focal impaired awareness seizure).

Question 4

Why should paracetamol levels not be taken within 4 hours of last ingestion?

Answer 4

Because plasma concentration of paracetamol reaches its peak at 4 hours.

Question 5

When is NAC most effective?

Answer 5

If given within 8 hours of paracetamol ingestion.

Question 6

What substance can be used in poisonings and overdoses to prevention absorption and enhance the elimination of the drugs from the body?

Answer 6

Activated charcoal

Question 7

TCA overdose features

Answer 7

• Hypotension
• Seizures
• Coma
• Broad complex tachycardia

Question 8

Treatment for TCA overdose?

Answer 8

IV bicarbonate

Question 9

What is the single most important prognostic factor in paracetamol overdose?

Answer 9

Arterial pH