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Buffysquirrel
12-29-2012, 09:25 PM
I've tried googling this but my fu is weak today.

It's a contemporary setting (UK).

My character has been hunted into a state of exhaustion and brought into A&E. Because he's exhibiting psychotic symptoms, and his records show these have been induced in the past by alcohol idiosyncratic intoxication, they do a blood test. It's negative for alcohol, but what would it show?

crunchyblanket
12-29-2012, 09:38 PM
Hmn. I haven't done A&E bloods in a long while, but it's likely they'd run the following:

- Thyroid Function Tests (overactive thyroid can, in extreme cases, cause psychotic episodes.)
- Certain drugs, such as marijuana, cocaine, amphetamines (although these would only be tested for if there were a strong suspicion of drug use, i.e other symptoms present, history of drug/alcohol abuse - they are specialist tests and expensive to run. In your character's case, they probably would run these.)
- Liver function tests inc. gamma GT (particularly if alcohol abuse is a possibility.)
- Urea and Electrolytes (aka Kidney Function Tests - part of a standard A&E profile, as far as I recall, and usually used to check for dehydration. Abnormal electrolyte levels can also present with psychiatric symptoms.)
- Full Blood Count (also a standard part of the A&E profile)
- Syphilis screening

Other possibilities, if psychotic symptoms are present, would be testosterone levels, Vitamin B12 levels and, if the patient is delirious at the time of admission, they'd probably want to run blood glucose levels as well.

It's worth noting that scans and such would only really be considered if there were definite neurological symptoms, and given the patient's history wouldn't be a main concern - they'd be more likely to assume drug/alcohol abuse.

Buffysquirrel
12-29-2012, 09:43 PM
Thanks :). He's pretty much out of it when he's first admitted so they don't really get concerned until he wakes up. I'm just wondering what he'd be told about the test results. If, say, they'd show elevated cortisol levels (because he'd been chased a lot). There is independent testimony that he was chased.

crunchyblanket
12-29-2012, 09:52 PM
Thanks :). He's pretty much out of it when he's first admitted so they don't really get concerned until he wakes up. I'm just wondering what he'd be told about the test results. If, say, they'd show elevated cortisol levels (because he'd been chased a lot). There is independent testimony that he was chased.

Cortisol does tend to show as elevated after a particularly stressful event, but it's unlikely they'd run cortisol for a psychotic break - it's typically used to diagnose adrenal disorders i.e Cushing's syndrome and Addison's disease. Basically, a single cortisol test wouldn't be enough to determine stress as the cause - they'd need to do multiple tests in order to determine why it's elevated, and that would involve overnight dexamethasone testing, which is usually done on an outpatient basis.

If he's admitted almost unconscious, how are the staff made aware of his psychosis? Their primary concern would be rehydrating and checking for physical injuries, assuming he arrived in a semi-conscious state. Is he delirious when he gets there?

Assuming his blood tests come back normal, they'd likely just tell him so. If anything was amiss - for example, he showed deranged liver function - they'd probably want to keep him in longer for repeat tests and scans.

Buffysquirrel
12-29-2012, 09:58 PM
Is he delirious when he gets there?

I think he must be for the scenario to work, so, let's say he is. You're being a huge help :).

crunchyblanket
12-29-2012, 10:05 PM
I think he must be for the scenario to work, so, let's say he is. You're being a huge help :).

No worries. I knew being a MLA would come in handy some day ;)

Okay, so on that assumption, they'd firstly be concerned with ensuring he's not a danger to himself or others. I figure the exhaustion would probably mean he's not particularly physically aggressive, so restraint/sedation would be unlikely (unless he's the kind of patient who likes to rip out IV's, in which case they might knock him out. Dehydration would be a major concern - replacing lost fluids and electrolytes is imperative in exhausted patients, doubly so in those suspected of alcohol poisoning.)

Getting bloods from him might be tricky. You might find he's less than amenable to the idea. Still, they'd want to do this before anything else, save determining his heart rate (tachycardia is likely to be present, especially if he's been running/panicking a lot) and checking for fever.

Also: it's likely he would not be left alone. Delirious patients have a nasty tendency of climbing over bed rails and hurting themselves.

Buffysquirrel
12-29-2012, 10:49 PM
Thanks :).