Panic Values Table
Prepared by APSA Panic Values eForum and Medical Research Institute Patient Safety Group إعداد منتدى النقاش الإلكترونى و مجموعة السلامة بمعهد البحوث الطبية
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Chemistry
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Test |
Low |
Possible Effect |
High |
Possible Effect |
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Albumin |
1.7 g/dL |
Hepatic failure |
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Amylase |
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>10X ULoN (U/L) |
Acute pancreatitis |
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Ammonia |
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|
110 umol/L |
Hepatic encephalopathy |
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Bilirubin total (neonates) |
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>15 mg/dl |
Kerniktrus |
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Bilirubin direct (neonates) |
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>2mg/dl |
Cholangitis –sepsis |
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Calcium |
6 mg/dL |
Tetany |
13 mg/dL |
Cardiac arrest |
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Calcium, Ionized |
0.75 mmol/L |
Tetany |
1.6mmol/L |
Cardiac arrest |
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Chloride |
80 mmol/L |
Tremors |
120 mmol/L |
Lethargy |
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Cholinesterase (acetyl), RBC |
<0.50X LLoN (U/L) |
Apneoa |
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|
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CO2 |
<10 mmol/L |
Acidosis (m) |
>40 mmol/L |
Respiratory failure |
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Creatinine |
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|
6.5 mg/dL |
Acute renal failure |
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Glucose |
50 mg/dL |
Coma |
450 mg/dL |
Keto acidosis |
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Iron |
|
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>55 umol/L (if age <10 years) |
Hematochromatosis |
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Lipase |
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>10X ULoN (U/L) |
Acute pancreatitis |
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Magnesium |
1 mg/dL |
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4.9 mg/dL |
Renal failure, hypothyroidism |
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Phosphorus |
2 mg/dL |
|
8.9 mg/dL |
Heart block |
|
Potassium |
2.5 mEq/L |
Ventricular tachycardia |
6.5 mEq/L |
Cardiac arrest |
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Protein (total) |
3.4 g/dL |
Hepatic failure |
9.8 g/dL |
Paraproteinemia |
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Sodium |
120 mEq/L |
Coma |
160 mEq/L |
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Urea |
|
|
200 mg/dL |
Acute renal failure |
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Uric acid |
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|
13 mg/dL |
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CSF
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Test |
Low |
Possible Effect |
High |
Possible Effect |
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WBC |
<4000 |
Infection |
>30 |
Meningitis |
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Blast/tumor cells |
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Any |
Malignancy |
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Haematology
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Test |
Low |
Possible Effect |
High |
Possible Effect |
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Hemoglobin |
< 6g/dL |
Heart failure |
>20 g/dL |
Thrombosis |
|
Hematocrit |
15% |
Heart failure |
>50% |
Hemoconcentration |
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Platelet Count |
<20,000 / L |
Bleeding |
>1,000,000 / L |
Thrombsis |
|
Neutrophil Count |
<500 / L |
Infection |
>40000 / L |
Hyperviscosity |
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INR |
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>6.0 |
Bleeding |
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APTT |
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>100 seconds |
Bleeding |
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Fibrinogen |
100 mg/dl |
Bleeding / DIC |
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Morphology
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Positive malaria smears |
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Positive intracellular bacteria in WBC |
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Cross match problems |
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Any positive results |
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Urine analysis
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Test |
Low |
Possible Effect |
High |
Possible Effect |
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Ketenes |
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Present |
DKA* |
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Myoglobin |
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Present |
Acute renal failure |
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Hemoglobin |
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Present |
Intravascular heamolysis |
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*DKA: Diabetic keto acidosis |
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Blood gases
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Test |
Low |
Possible Effect |
High |
Possible Effect |
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pH |
< 7.2 |
Acidosis, life threatening |
> 7.6 |
Alkalosis, life threatening |
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pCO2 |
< 20 mmHg |
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> 65 mmHg |
Respiratory failure |
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pO2 |
< 40 mmHg |
Hypoxia |
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Microbiology (results could be delayed for several days)
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Finding |
Significance |
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Positive blood culture |
Septicemia |
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Positive fungal cultures |
Immunosuppression |
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Positive CSF cultures |
Meningitis |
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Pseudomonas species from eye cultures |
Loss of vision |
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Infection in immune-compromised patients |
Overwhelming sepsis |
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Pathology (results could be delayed for several days)
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Finding |
Significance |
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Bacteria in bone marrow or heart specimens |
Endocarditis |
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Crescents in kidney biopsy |
Renal failure |
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Fat in mucosal biopsies, colonic endoscopic polypectomies, endometrial curettage |
Perforation |
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Leukocytoclastic vasculitis |
Organ failure |
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Malignancy |
Variable |
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Mesothelial cells in endomyocardial or transbronchial biopsies |
Perforation |
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Transplant rejection |
Loss of graft |
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Uterine contents without villi or trophoblast |
Ectopic pregnancy |
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Radiology
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Finding |
Significance |
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Acute aortic dissection |
Ischaemia to vital organs |
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Acute deep vein thrombosis |
Pulmonary embolism |
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Acute pulmonary embolism |
Hypoxia – respiratory failure |
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Acute spinal cord compression |
Loss of vital functions |
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Acute testicular/ovarian torsion |
Necrosis – ischaemia |
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Ectopic pregnancy |
Shock – rupture |
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Intracranial hemorrhage |
Coning |
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Ischemic bowel |
Sepsis |
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Leaking abdominal aortic aneurysm |
Rupture |
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Massive hemoperitoneum on CT or ultrasound |
Shock |
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Misplacement of tubes or catheters |
Variable |
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New perforated viscus |
Sepsis |
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Pneumothorax, if unsuspected |
Respiratory embarrassment, hypoxia |
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Tension pneumothorax |
Respiratory embarrassment, hypoxia |
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Unstable spine fracture |
Spinal cord compression |
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Therapeutic drugs
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Test |
High |
Possible Effect |
Acetaminophen |
>660 umol/L (>4 hrs post ingestion ) |
Liver failure, encephalopathy |
Carbamazepine |
>63 umol/L |
Ataxia, confusion |
Digoxin |
>3.5 nmol/L (>6 hrs post dose) |
Arrhythmia |
Lithium |
>2.5 mmol/L |
Agitation |
Phenobarbital |
>250 umol/L |
Coma, renal failure |
Phenytoin |
>130 umol/L |
Seizers |
Salicylate |
>3.0 mmol/L |
Acidosis,GIT bleeding, renal failure |
Theophylline |
>220 umol/L |
Supravetricular tachycardia |
Amitriptyline |
>1.8 umol/L |
Coma |
Gentamicin |
Trough >2.0 mg/L (>8 hours post dose for multiple daily dosing) |
Renal failure |
Valproic Acid |
>1400 umol/L |
Cardiac arrest, apnea |
Toxic drugs
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Test |
High |
Possible Effect |
Ethanol (plasma) |
>33 mmol/L |
Lactic acidosis |
Lead |
>3.0 umol/L |
Porphyria |
Methanol |
All positives |
Blindness |
