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CRITICAL LABORATORY VALUES

Monitoring of critical laboratory values is now required of all laboratories by both the CAP and the JCAHO.  By definition a critical value is one which "reflects pathophysiologic derangements at such variance with normal as to be life-threatening if treatment is not instituted immediately".

CHEMISTRY CRITICAL VALUES

 Test

Low

High

Albumin 

<1.5 g/dl 

 

Amylase 

 

>3x upper limit of normal 

Bilirubin Total (Newborn) 

None 

15 mg/dl 

Bicarbonate (CO2) 

15 mMol/l 

40 mMol/L 

BUN 

 

>100 mg/dl 

Calcium 

7 mg/dl 

12 mg/dl 

Calcium (Newborn) 

6 mg/dl 

13 mg/dl 

Chloride 

80 mMol/L 

120 mMol/L 

Drug Analyses 

 

> upper limit of therapeutic range 

Glucose (Male) 

50 mg/dl 

400 mg/dl 

Glucose (Female) 

40 mg/dl 

400 mg/dl 

Glucose (Newborn) 

40 mg/dl 

300 mg/dl 

Glucose CSF 

<40 mg/dl 

 

Lactic Acid 

 

>5 mEg/dl 

Magnesium 

1.2 mg/dl 

>4.9 mg/dl 

Magnesium (OB) 

<4.0 mg/dl 

>8.0 mg/dl 

Osmolality Serum 

<265 mOsm/kg 

>320 mOsm/kg 

Osmolality Urine 

<100 mOsm/kg 

>800 mOsm/kg 

Phosphorous 

1 mg/dl 

none 

Potassium (Newborn) 

2.5 mEq/L 

6.5 mEq/L 

Potassium 

2.5 mEq/L 

8.0 mEq/L 

Sodium 

120 mEq/L 

155 mEq/L 

All drug analyses which exceed upper limit of therapeutic range will be called.

HEMATOLOGY CRITICAL VALUES

 Test

Low

High

Hematocrit 

   

   0-1 week 

None 

>65% 

   1 week - 12 years 

<30% 

>59% 

   >12 years 

<18% 

>59% 

Platelet Count 

50,000cumm 

>1,000,000/cumm 

WBC 

<2.5 

>30 

Ne# 

<0.5 

None 

INR 

None 

>5.0 

APTT 

   

   Non-heparinized 

None 

>70 sec 

   Heparinized 

None 

>100 sec 

Smear for Malaria 

None 

Positive 

Fibrinogen 

<100 mg/dl 

None 

Bleeding Time 

None 

>15 min 

Thrombin Time 

None 

>35.9 sec 


URINALYSIS CRITICAL VALUES

Urinalysis Critical Values

> 300 Glucose and large ketones on same specimen  >1000 Glucose regardless of ketones 


MICROBIOLOGY CRITICAL VALUES

Positive CSF (Directigen), blood culture or sterile body fluid culture or gram stain 

Positive India Ink for Cryptococcus neoformans 

Positive for parasites

Positive Urine CIE (newborn/infant)


BLOOD BANK CRITICAL VALUES

Identification of clinically significant antibodies


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