Pediatric emergency medicine trisk 4157 4157
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children may also have concomitant medical problems and, in fact, are at
greater risk for presenting with emergent medical conditions such as injuries
and ingestions than are nonpsychiatrically ill children.
A thorough medical history, including current medication and possible
ingestions, followed by a complete physical examination, including a
complete neurologic examination is all that is required for the majority of
patients. There is no “standard” set of laboratory evaluations that must be
obtained to “clear” a psychiatric patient. Patients with new onset of or acute
change in psychiatric symptoms, especially psychosis or alterations in
mental status, must be carefully evaluated for possible underlying medical
conditions. These patients may require additional laboratory evaluation or
subspecialist consultation. In addition, some psychiatric facilities may
request or require baseline laboratory data before accepting a transfer.
Toxicologic screens and pregnancy tests in postpubertal teens are the most
frequently obtained laboratory tests. Table 126.2 lists laboratory evaluations
that may be considered for psychiatric patients.
TABLE 126.2
SCREENING TESTS FOR MEDICAL ILLNESS
1. Complete blood cell count with differential
2. Complete blood chemistries (including measurements of electrolytes,
glucose, calcium, and magnesium levels and tests of hepatic and renal
function)
3. Thyroid function tests
4. Pregnancy test
5. Urinalysis
6. Urine and serum toxicology screen
7. EKG
8. Plasma levels of any drugs being taken, if appropriate
9. Neuroimaging (if clinically indicated)
10. Lumbar puncture (if clinically indicated)
EKG, electrocardiogram; CT, computed tomography.
Adapted from Sadock BJ, Sadock VA, eds. Kaplan & Sadock’s Synopsis of Psychiatry . 9th ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2003:24.
