Given the difficulties with communication and high frequency of medical problems observed in developmentally disabled adults, it is often useful to obtain ancillary studies that would ordinarily not be required in nondisabled adults. Although the results of some laboratory examinations (e.g., thyroid function tests) will not be available while the patient is in the ED, it is often important nonetheless to obtain them, particularly if there are any difficulties with phlebotomy or concerns about the adequacy of outpatient care. Most ancillary studies are chosen based on the complaints elicited or behavior observed. If the presentation does not suggest localizing symptoms or have helpful physical signs, generalized "screening" studies may be necessary. For most developmentally disabled patients, these screening studies include a complete blood count, electrolytes, liver function tests, urinalysis, and serum drug levels if the patient is on anticonvulsants or lithium —l4 (I§ble302-3). When obtaining these studies, it is essential that all procedures are carefully explained at the patient's developmental level. It may also be helpful to use topical anesthetic cream for phlebotomy.
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