Possible causes that quickly respond to treatment should be addressed early. If this patient had been seen in the emergency department, she would have immediately received intravenous thiamine and 50 mL of 50% dextrose in water, even before the results of the laboratory analysis were available. Empirical administration of hypertonic dextrose has been standard practice in emergency assessment of altered level of consciousness. Some controversy surrounds possible adverse effects of this practice (1) because of the deleterious consequences in patients with cerebral ischemia (2). Thus, checking blood glucose levels immediately is ideal, but when this is not possible, rapid administration of hypertonic dextrose is still recommended (3). In hospitalized, nondiabetic patients, on the other hand, empirical management of possible hypoglycemia is not routine, although some authorities recommend it (4). In one study, failure to consider hypoglycemia as a cause of altered level of consciousness was the most frequent error in emergent scenarios (5). Timely diagnosis of hypoglycemia is especially important, because it is usually reversible and the degree of injury depends on how quickly treatment is started. In these situations, checklists can be very useful and should be more widely used.