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



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


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


Test Low Possible Effect High Possible Effect
WBC <4000 Infection >30 Meningitis
Blast/tumor cells Any Malignancy



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


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




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