DOI: 10.1373/clinchem.2009.137596


A 3-year-old girl was transferred from an outside hospital to the emergency department after being found shivering and unattended outside of a public shopping area in winter. She presented with decreased mental status and possible hypothermia; she was lethargic and slipped in and out of consciousness. No cause for this alteration in her mental state was obvious; however, a physical examination revealed multiple abrasions and bruises. The patient had a temperature of 37 °C, a blood pressure of 134/74 mmHg, a heart rate of 103 beats/min, and a respiratory rate of 24 breaths/min. Computed tomography scans, a skeletal survey, and an ophthalmologic examination did not reveal additional injuries. An intravenous bolus of the opioid antagonist naloxone (Narcan) was administered shortly after her arrival in the emergency department.