By what should diagnostic tests be guided?
The diagnostic evaluation should be guided by the pretest probability of the diagnoses under consideration.
List routine laboratory studies.
CBC with differential
Blood glucose
BMP
LFTs
Coagulation studies (e.g., INR, PTT)
Urinalysis with microscopy
What does Leukocytosis with neutrophilia suggest?
Leukocytosis with neutrophilia suggests bacterial infection
What does Lymphocytic leukocytosis suggest?
Lymphocytic leukocytosis is more strongly associated with viral infections and certain bacterial infections, e.g., TB.
What can a low white blood count or thrombocytopenia indicate?
A low white blood cell count or thrombocytopenia may be due to an infectious cause in patients with a history of recent travel.
What does an increase in eosinophil count suggest?
An increase in eosinophil count suggests drug-induced fever or parasitic infection.
What can hyper- or hypoglycemia indicate?
Hyperglycemia or hypoglycemia in a nondiabetic patient should raise concern for sepsis or septic shock.
Why is it important to evaluate BMP?
To evaluate renal function and electrolytes; also required to document baseline levels before initiating potentially nephrotoxic antibiotics, e.g., aminoglycosides
Which tests should be ordered in patients with suspected SIRS or sepsis?
Blood gas analysis
Serum lactate
Procalcitonin assay
ESR/CRP
Blood cultures (at least 2 sets)
Additional cultures from other sites as indicated
Chest x-ray
What should a minimum initial fever workup include?
In admitted patients with a new-onset fever, the minimum initial workup generally should consist of CBC with differential, serum lactate, urinalysis with microscopy, blood cultures (2 sets), and a CXR. Further testing should be guided by the suspected etiology of the fever.
Last changed2 years ago