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