Approach to altered mental status (pediatrics) Quiz: Ace Your Exams

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A 2-week-old boy is brought to the emergency department for evaluation of lethargy and poor feeding. The infant was born at 39 weeks gestation via spontaneous vaginal delivery. The pregnancy was uncomplicated. There is a maternal history of group B Streptococcus, and antibiotics were administered three hours prior to delivery. The infant has been breastfeeding and returned to birth weight at 10 days of life. Over the past 24 hours, the infant has been fussier, fatigued, and feeding poorly. There have been three minimally saturated wet diapers in the last 24 hours. Weight is at the 20th percentile, length is at the 28th percentile, and head circumference is at the 35th percentile. Temperature is 101.8°F (38.8°C), blood pressure is 70/48 mmHg, pulse is 170/min, respiratory rate is 42/min, and oxygen saturation is 97% on room air. On physical examination, the infant appears lethargic. The anterior fontanelle is open and bulging. No murmur is appreciated, and femoral pulses are 2+. Respiratory and abdominal examinations are normal. Which of the following would confirm the cause of this patient’s altered mental status? 

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