In coma of unknown etiology, what is a critical consideration?

• A. Check blood glucose
• B. Administer naloxone
• C. Perform lumbar puncture
• D. Assume stroke

Answer: (A)

When someone is in a coma with no known cause, the priority is to identify and rapidly treat a reversible metabolic problem, with blood glucose check at the top of the list. A quick bedside glucose test can reveal hypoglycemia or hyperglycemia, both of which can produce coma but are treatable or correctable right away. If glucose is low, administering dextrose promptly can rapidly reverse the condition and prevent further deterioration. If glucose is normal, you continue the primary survey and look for other potential causes, but you don’t delay treatment while awaiting imaging or invasive tests.

Administering naloxone might be considered if opioid involvement is suspected, but you don’t rely on that in an unknown-coma situation without evidence. Lumbar puncture and assuming stroke are not immediate steps because they’re invasive or require different workups and imaging before deciding specific therapies. The most reliable first move is to check blood glucose to identify a reversible cause early.