A 11year female come uncouncious with seizure in causalty and looked very weak.ON doing RBS it was 18mg/dl only.25%dextose and 10%dextrose was given as per guidelines and after some minute she became completly contious.ON further investigation her SGOT was 2104,SGPT2069,ALP900,Bilirubin2.6 of which direct was 2.Further Rbs was normal and USG showed vascular calcification.Since the patient is from a village and came few days ago to the land lords house detail history could not be elicitated.Only information was that it was his second attack and even his three sibling in the village has jaundice for the last year and are very yellow.Mp and widal was negative.These episode happened at sleep .What are the remaining investigation needed to be done as facility here is scarce.

You may take this as Reye's syndrome or Hepatic encephalopathy in which hypoglycemia can occur. Rule out infective hepatitis by doing at least a minimum of Hepatitis A and Hbsag. If no infective cause, then metabolic conditions such as Wilson's disease, lactic acidosis and Fatty acid oxidation defects should be ruled out. Do her serum ammonia and PT/PTT for acute management.