Critical Laboratory Values
The Laboratory Department, in conjunction with the Medical Staff, has established “critical (life-threatening) values”. Results that can be classified as “critical values” will be repeated and upon verification, called immediately to the appropriate designee as outlined in the policy. The same individual reporting the value shall be responsible for calling the value and annotating it in the computer system. A call box has been queued to respond to critical values and it will automatically insert date, time and identification of the technician/technologist. The only information to be entered into the Meditech box is the person who was given and read back the critical value. The values on this list are for all ages unless otherwise specified.
ARTERIAL BLOOD GAS
| TEST | LOW | HIGH |
| pH | 7.2 | 7.6 |
| pCO2 | <20 mmHg | >70 mmHg |
| pO2 – 0-1 month | <60 mmHg | |
| pO2 — > 1 month | <40 mmHg | >200 mmHg |
BLOOD BANK
| TEST | LOW | HIGH |
| DAT | POSITIVE | |
| Transfusion reaction | Suspected hemolytic reaction | |
CHEMISTRY
| TEST | LOW | HIGH |
| Bilirubin — 0-1 month | None | > 12.0 mg/dl |
| Bilirubin — > 1 month | None | > 15.0 mg/dl |
| BUN | None | > 70 mg/dl |
| Calcium | < 6.9 mg/dl | > 13.0 mg/dl |
| Calcium – Ionized | < 0.8 mmol/L | > 1.5 mmol/L |
| Carboxyhemoglobin | None | > 10% |
| CO2 (Carbon dioxide) | < 10 mmol/L | > 40 mmol/L |
| Creatinine — 0-12 years | None | > 3.8 mg/dl |
| Creatinine — >12 years | None | > 7.5 mg/dl |
| CK (Creatine Kinase) | None | > than reference/normal range |
| CK Interpretation | None | Positive |
| Glucose — 0-12 years | < 50 mg/dl | > 300 mg/dl |
| Glucose — > 12 years | < 50 mg/dl | > 500 mg/dl |
| Magnesium | < 1.0 mg/dl | > 4.9 mg/dl |
| Phosphorus | < 1.0 mg/dl | > 8.9 mg/dl |
| Potassium | < 3.0 mmol/L | > 6.1 mmol/L |
| Sodium | < 122 mmol/L | > 156 mmol/L |
| Troponin-I | None | > 1.5 ng/ml |
THERAPEUTIC DRUGS
| TEST | LOW | HIGH |
| Acetaminophen | (4 hours after last dose-peak) > 150 ug/ml | |
| Carbamazapin | None | > 11.0 ug/ml |
| Digoxin | (87% of patients >2 years exhibit symptoms) > 2.0 ng/ml | |
| Gentamicin | Trough > reference range | > 8.1 ug/ml (peak) |
| Lithium | None | > 2.0 mEq/L |
| Phenobarbital | None | > 40 ug/ml |
| Phenytoin | None | > 20 ug/ml |
| TEST | LOW | HIGH |
| Salicylate | None | > 30 ug/ml |
| Theophylline | None | > 20 ug/ml |
| Tobramycin (Ref. lab) | Trough > reference range | > 10 ug/ml (peak) |
| Vancomycin | Trough > reference range | > 40 mg/ml (peak) |
COAGULATION
| TEST | LOW | HIGH |
| APTT | None | > 70 seconds |
| PT/INR – 0-12 years | None | > 21 seconds / >2.0 |
| PT/INR — >12 years | None | > 5.0 |
HEMATOLOGY
| TEST | LOW | HIGH |
| Hematocrit – 0-1 month | < 30% | > 60% |
| Hematocrit — > 1 month | < 20% | > 60% |
| Hemoglobin – 0-1 month | < 9.5 g/dl | > 20 g/dl |
| Hemoglobin – > 1 month | < 6.5 g/dl | > 20 g/dl |
| Platelet | 20,000 /mm3 | 1,000,000,000 / mm3 |
| WBC – 0-12 years | < 2,400 /mm3 | > 23,000 / mm3 |
| WBC — > 12 years | < 2, 000 / mm3 | > 25,000 / mm3 |
MICROBIOLOGY
| AFB (ref. lab.) | Positive smear and/or culture |
| Blood culture | Positive gram stain and/or culture |
| Catheter tip | Positive culture |
| Clostridium difficile (ref. lab.) | Positive antigen screen or culture |
| CSF | Positive gram stain and/or culture, India ink, cryptococcal antigen |
| Gastric aspirate – newborn | Positive for WBCs or gram positive cocci |