Is there scope for checking serum biochemistry in the epilepsy clinic?

We often request blood investigations, almost as a knee-jerk reaction, without asking ourselves why and what we expect to exclude or confirm by doing the test. We often fail to put the patients presentation into clinical perspective. Here, we present a scenario where routine blood tests were unexpectedly abnormal. A patient presents to the First Fit clinic, having sustained two generalised tonic-clonic epileptic seizures. She was commenced on anti-epileptic medication by her GP prior to being seen by the neurologists. Routine blood investigations taken in the clinic revealed significant hypocalcaemia. She was investigated for the cause of this biochemical derangement and started on 1-alphahydroxycholecaliferol. Her antiepileptic drug was discontinued once her serum calcium was corrected since she was considered to have symptomatic seizures. The discussion deals with the causes of hypocalcaemia, which is less commonly encountered than hypercalcaemia, and the relevance of checking a patients biochemistry in the First Fit clinic. In view of the latter point, there is no clear answer and its use fails to be justified by any strong evidence.