Evaluate for metabolic derangement +/- precipitant of decompensation
Labs:
Glucose level (most important/time sensitive!)
Ketones (urine or serum beta hydroxybutyrate)- helpful to obtain prior to giving dextrose in hypoglycemic patients, if possible
Ammonia
Should be <100 in normal neonate
BMP, LFTs
Anion gap (if >20, suggests an organic acidemia)
May see hypoglycemia, metabolic acidosis
VBG
Lactate and pyruvate (drawn at same time)
CBC
Blood culture, urine culture, +/- CSF
Additional tests to aid in definitive diagnosis (consider setting aside blood sample on ice prior to dextrose admin)
Muscle function tests (e.g. CPK, LDH, myoglobin)
Serum/plasma pyruvate, amino acids, acylcarnitine profile
Urine organic acids, acylglycines, orotic acid
Consider head CT (evaluate for cerebral edema and alternate etiologies of symptoms)
Evaluate for alternate etiologies
Glucose level (most important/time sensitive!)
Ketones (urine or serum beta hydroxybutyrate)- helpful to obtain prior to giving dextrose in hypoglycemic patients, if possible
Ammonia
Should be <100 in normal neonate
BMP, LFTs
Anion gap (if >20, suggests an organic acidemia)
May see hypoglycemia, metabolic acidosis
VBG
Lactate and pyruvate (drawn at same time)
CBC
Blood culture, urine culture, +/- CSF
Additional tests to aid in definitive diagnosis (consider setting aside blood sample on ice prior to dextrose admin)
Muscle function tests (e.g. CPK, LDH, myoglobin)
Serum/plasma pyruvate, amino acids, acylcarnitine profile
Urine organic acids, acylglycines, orotic acid
Should be <100 in normal neonate
Anion gap (if >20, suggests an organic acidemia)
May see hypoglycemia, metabolic acidosis
Muscle function tests (e.g. CPK, LDH, myoglobin)
Serum/plasma pyruvate, amino acids, acylcarnitine profile
Urine organic acids, acylglycines, orotic acid
Inborn errors of metabolism
THE MISFITS [1]
Thalassemia
Trauma
Retinoic acid syndrome
Heart
Neonatal jaundice
Congenital heart disease