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APSA panic values

 

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

 

 

Chemistry

 

Test

Low

Possible Effect

High

Possible Effect

Albumin

1.7 g/dL

Hepatic failure

 

 

Amylase

 

 

>10X ULoN (U/L)

Acute pancreatitis

Ammonia

 

 

110 umol/L

Hepatic encephalopathy

Bilirubin total (neonates)

 

 

>15 mg/dl

Kerniktrus

Bilirubin direct (neonates)

 

 

>2mg/dl

Cholangitis –sepsis

Calcium

6 mg/dL

Tetany

13 mg/dL

Cardiac arrest

Calcium, Ionized

0.75 mmol/L

Tetany

1.6mmol/L

Cardiac arrest

Chloride

80 mmol/L

Tremors

120 mmol/L

Lethargy

Cholinesterase (acetyl), RBC

<0.50X LLoN

(U/L)

Apneoa

 

 

CO2

<10 mmol/L

Acidosis (m)

>40 mmol/L

Respiratory failure

Creatinine

 

 

6.5 mg/dL

Acute renal failure

Glucose

50 mg/dL

Coma

450 mg/dL

Keto acidosis

Iron

 

 

>55 umol/L (if age <10 years)

Hematochromatosis

Lipase

 

 

>10X ULoN (U/L)

Acute pancreatitis

Magnesium

1 mg/dL

 

4.9 mg/dL

Renal failure, hypothyroidism

Phosphorus

2 mg/dL

 

8.9 mg/dL

Heart block

Potassium

2.5 mEq/L

Ventricular tachycardia

6.5 mEq/L

Cardiac arrest

Protein (total)

3.4 g/dL

Hepatic failure

9.8 g/dL

Paraproteinemia

Sodium

120 mEq/L

Coma

160 mEq/L

 

Urea

 

 

200 mg/dL

Acute renal failure

Uric acid

 

 

13 mg/dL

 

 

CSF

 

Test

Low

Possible Effect

High

Possible Effect

WBC

<4000

Infection

>30

Meningitis

Blast/tumor cells

 

 

Any

Malignancy

 

Haematology

 

Test

Low

Possible Effect

High

Possible Effect

Hemoglobin

< 6g/dL

Heart failure

>20 g/dL

Thrombosis

Hematocrit

15%

Heart failure

>50%

Hemoconcentration

Platelet Count

 <20,000 / L

Bleeding

>1,000,000 / L

Thrombsis

Neutrophil Count

<500 / L

Infection

>40000 / L

Hyperviscosity

INR

 

 

>6.0

Bleeding

APTT

 

 

>100 seconds

Bleeding

Fibrinogen

100 mg/dl

Bleeding / DIC

 

 

Morphology

 

 

 

 

 

Positive malaria smears

 

 

 

Positive intracellular

bacteria in WBC

 

Cross match problems

 

 

Any positive results

 

 

Urine analysis

 

Test

Low

Possible Effect

High

Possible Effect

Ketenes

 

 

Present

DKA*

Myoglobin

 

 

Present

Acute renal failure

Hemoglobin

 

 

Present

Intravascular heamolysis

*DKA: Diabetic keto acidosis

 

Blood gases

 

Test

Low

Possible Effect

High

Possible Effect

pH

< 7.2

Acidosis, life threatening

> 7.6

Alkalosis, life threatening

pCO2

< 20 mmHg

 

> 65 mmHg

Respiratory failure

pO2

< 40 mmHg

Hypoxia

 

 

 

Microbiology (results could be delayed for several days)

 

Finding

Significance

Positive blood culture

Septicemia

Positive fungal cultures

Immunosuppression

Positive CSF cultures

Meningitis

Pseudomonas species from eye cultures

Loss of vision

Infection in immune-compromised patients

Overwhelming sepsis

 

Pathology (results could be delayed for several days)

 

Finding

Significance

Bacteria in bone marrow or heart specimens

Endocarditis

Crescents in kidney biopsy

Renal failure

Fat in mucosal biopsies, colonic endoscopic polypectomies, endometrial curettage

Perforation

Leukocytoclastic vasculitis

Organ failure

Malignancy

Variable

Mesothelial cells in endomyocardial or transbronchial biopsies

Perforation

Transplant rejection

Loss of graft

Uterine contents without villi or trophoblast

Ectopic pregnancy


 

 

Radiology

 

Finding

Significance

Acute aortic dissection

Ischaemia to vital organs

Acute deep vein thrombosis

Pulmonary embolism

Acute pulmonary embolism

Hypoxia – respiratory failure

Acute spinal cord compression

Loss of vital functions

Acute testicular/ovarian torsion

Necrosis – ischaemia

Ectopic pregnancy

Shock – rupture

Intracranial hemorrhage

Coning

Ischemic bowel

Sepsis

Leaking abdominal aortic aneurysm

Rupture

Massive hemoperitoneum on CT or ultrasound

Shock

Misplacement of tubes or catheters

Variable

New perforated viscus 

Sepsis

Pneumothorax, if unsuspected 

Respiratory embarrassment, hypoxia

Tension pneumothorax

Respiratory embarrassment, hypoxia

Unstable spine fracture         

Spinal cord compression

 

Therapeutic  drugs

 

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

 

Test

High

Possible Effect

Ethanol (plasma)

>33 mmol/L

Lactic acidosis

Lead

>3.0 umol/L

Porphyria

Methanol

All positives

Blindness

 

 

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