APSA panic values
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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
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Chemistry
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| 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 | ||||
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CSF
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| Test | Low | Possible Effect | High | Possible Effect | |
| WBC | <4000 | Infection | >30 | Meningitis | |
| Blast/tumor cells | Any | Malignancy | |||
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Haematology |
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| 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 | |||
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Morphology
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Positive malaria smears | ||||
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Positive intracellular bacteria in WBC |
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| Cross match problems | Any positive results | ||||
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Urine analysis
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| Test | Low | Possible Effect | High | Possible Effect | |
| Ketenes | Present | DKA* | |||
| Myoglobin | Present | Acute renal failure | |||
| Hemoglobin | Present | Intravascular heamolysis | |||
| *DKA: Diabetic keto acidosis | |||||
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Blood gases |
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| 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 | |||
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Microbiology (results could be delayed for several days)
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| 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 | ||||
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Pathology (results could be delayed for several days)
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| 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 | ||||
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Radiology
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| 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 | |
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Therapeutic drugs
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| 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 |
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Toxic drugs
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| 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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