Lucy, a 16-Year-Old Girl with Altered Mental Status

Abstract

CASE PRESENTATION Lucy is a 16-year-old girl who is being seen in the emergency department (ED) for confusion and vomiting. In the ED, her noncontrast computed tomography (CT) scan of the head is negative for intracranial hemorrhage, the result of a finger-stick blood glucose test is normal, and she is given an intravenous (IV) fluid bolus of normal saline (0.9%) at 20 mL/kg and a dose of IV ondansetron. Multiple serum and urine studies are collected and are pending. The ED physician reports that Lucy has a Glasgow Coma Scale score of 13. Because of Lucy’s altered mental status, the ED physician calls you to discuss hospitalization for close monitoring and further diagnostic evaluation, if needed. After speaking to the physician caring for her in the ED, you begin your evaluation.