Correct!
5. All of the above

The immediate need is to support the patient and search for the cause of the acidosis which likely is leading his obtundation. He needs intubation to protect him from aspiration and a drug screen is indicated. In the absence of a focal neurological sign a head CT scan might be controversial but most physicians would probably obtain one. His head CT was reported as unremarkable. He becomes progressively hypertensive with systolic blood pressures into 200’s and a nicardipine drip is begun. At this time, he was transferred to Banner University Medical Center – Phoenix.

At arrival pertinent findings on his physical examination include

• An obtunded man with a normal blood pressure
• Pupils equal, round and reactive to light at 3mm
• No clonus

His ethanol/aspirin/acetaminophen/lithium drug screen was negative.

Which of the following should be done at this time? (Click on the correct answer to proceed to the fifth of six pages)

1. Begin fomepizole
2. Order an ethylene glycol and methanol level
3. Repeat the urinalysis
4. 1 and 3
5. All of the above

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