Triage: New onset seizure

History of Present Illness: A 45-year-old male is brought to the ER for a seizure.  He drove his car into a parked car at low speed.  He denies any injury or history of seizure

Vital Signs: Vital signs are normal except for a heart rate persistently elevated in the 110-120 range and BP in the 150’s-160’s systolic

Physical Exam: Other than tachycardia, the physical exam is otherwise normal except for tongue contusion on both sides and tongue tremor as well as hand tremor

What diagnostic testing below is the least critical? 

  1. Magnesium level
  2. Head CT
  3. EKG
  4. CBC

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWERS: 

  1. Magnesium level – critical, especially in an alcoholic with a seizure – was 0.9
  2. Head CT – critical – even if suspect metabolic cause of seizure and especially with trauma – was normal
  3. EKG – critical, especially if could be syncope rather than seizure – was normal with normal QTc
  4. CBC – CORRECT – should be done but less important than other options unless hypotensive

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CASE CONCLUSION: See above.  Was admitted for alcohol withdrawal seizure and hypomagnesemia

CASE LESSONS:

  1. Low magnesium itself doesn’t cause EKG changes when potassium is normal.