In a 14-year-old with dilated pupils, diaphoresis, and panic-like behavior, the most appropriate initial testing would be

In a 14-year-old with dilated pupils, diaphoresis, and panic-like behavior, the most appropriate initial testing would be

• A. Urine screen for drugs
• B. Urine screen for drugs and radioimmunoassay for LSD
• C. Test to determine blood glucose level
• D. Test to determine blood alcohol level

Answer: (B)

These signs point to a substance-related toxidrome, most compatible with hallucinogenic or stimulant intoxication. In a teen with dilated pupils, diaphoresis, and panic-like agitation, the first step is to identify any ingested substances so you can guide management quickly. A urine drug screen covers a broad range of common substances that could explain acute agitation and autonomic symptoms. Because LSD can cause exactly this pattern and is not always detected on standard screens, adding a targeted LSD immunoassay improves early identification and helps confirm exposure. While checking glucose or alcohol levels is reasonable in the workup, they don’t address the specific symptom cluster as effectively as a tox screen with an LSD assessment, and that broader testing leads to more timely, appropriate management and safety precautions.

These signs point to a substance-related toxidrome, most compatible with hallucinogenic or stimulant intoxication. In a teen with dilated pupils, diaphoresis, and panic-like agitation, the first step is to identify any ingested substances so you can guide management quickly. A urine drug screen covers a broad range of common substances that could explain acute agitation and autonomic symptoms. Because LSD can cause exactly this pattern and is not always detected on standard screens, adding a targeted LSD immunoassay improves early identification and helps confirm exposure. While checking glucose or alcohol levels is reasonable in the workup, they don’t address the specific symptom cluster as effectively as a tox screen with an LSD assessment, and that broader testing leads to more timely, appropriate management and safety precautions.