Tests
1st tests to order
pulse oximetry
Test
Oxygen saturation should be monitored if there are any features of central nervous system (CNS) depression, as respiratory and CNS depression may coexist.
Result
normal in mild overdose
CBC
Test
Performed in all patients with suspected overdose as part of a basic screen.
Result
normal
serum chemistry panel with blood glucose
Test
Performed in all patients with suspected overdose as part of a basic screen.
Result
Usually normal in small overdoses. In significant overdose patients may develop acute kidney injury or rhabdomyolysis.
plasma acetaminophen concentration
Test
The possibility of a mixed overdose involving acetaminophen should be considered, particularly if an intentional overdose is suspected
Result
elevated if co-ingestion with acetaminophen
serum ethanol
Test
Alcohol is commonly ingested with benzodiazepine (BZD) overdose. It is also a central nervous system suppressant.
Result
elevated if coingestion with alcohol
urine toxicology screen
Test
Necessary to exclude coingestion of other drugs or illicit substances.
Result
negative result with pure BZD overdose; positive result indicates coingestion of other drugs or illicit substances
ECG
Test
Performed in all patients with suspected overdose as part of a basic screen to exclude other causes of symptoms.
Result
abnormalities may include transient first and second degree block and QT prolongation
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