Extreme Lab Values - page 2
Have had a few recently that have caught my atrention. **INR of 13! Gasp! **TPNI over 12---never seen it that high **BNP in high 60,000's **Na of 103---walking, talking pt., just "weak" Got... Read More
Sep 10, '12PT of 180...INR of 18... That patient got several doses of Vitamin K and FFP and blood...that one made me nervous. It was working, though. They had a nephrostomy that had tea-colored output and by the end of my shift it was clear yellow
I have seen BNPs in the 100,000s. Not sure how that is possible.
Creatinine of 10...
WBCs of 0.1
Sep 10, '12Lactate of 18, pt died. INR of wait for it.......30 YES 30. That was my brother in law, 4 units PRBC's, multiple units of FFP, not sure what caused his INR to go that high. He was never treated with coumadin or anything before. He went to the ER for bloody urine.
A recent admit had platlets of 3 at an outside hospital, received 5u PLT, transferred to us and received anoter 12u PLT and next check PLT 93. And Blood bank argued with me about giving 12 units.
Sep 10, '12K+ of 1.5 yesterday and dropping with boluses. Didn't work today and I'm not back until Thursday.
Sep 10, '12WBC 48 pt died shortly there after
Potassium 8.2 dialyzed and was fine only indication was sl irregular apical
Hgb 3.9 pt was "just a little tired and short of breath"
Sep 10, '12Quote from mochamonsterHad a pt who was getting K boluses his K during a bolus was 1.8, and elevated ST segment. 3 boluses were hung and ran wide open at the same time on his central line, and the next day he was >7 and on SLED.K+ of 1.5 yesterday and dropping with boluses. Didn't work today and I'm not back until Thursday.
Sep 10, '12Quote from TX.RN.ShannonFor onco patients, pancytopenia is a given if they've gotten chemo.I DON'T work with many dialysis or oncology patients, so not really used to seeing that extreme labs.
We routinely see WBC < 0.5, Hgb < 80, and platelets < 20.
Probably the worst I've seen with my own two eyes?
(Note: these are not on the same patient, thank goodness!)
WBC 0.1 (not uncommon with onco pts)
Plts < 1
On the flip side, we've had people with leukemia with WBC in the 70's!
For dialysis patients, lytes, creatinine, and other things go all over the place. Off the top of my head, I can't think of extreme values for these ones. I remember getting a patient transferred to our unit from ICU and the nurse said the patient's creatinine on admission was somewhere in the realm of 1000!
For lytes, probably the worst I've heard of was a patient's K+ was about 8(!)...and apparently she had been living at home this way for a while and now, her body is used to that kind of potassium level and can sustain that level with no ill effect. The doctor said it was the first time he's ever seen that happening. None of us could believe it! I don't think she was a renal patient, though.Last edit by Aeterna on Sep 10, '12
Sep 11, '12Quote from nrsang973 boluses of ivpb kcl running wide open at once????? Or fluid boluses with 20meq kcl additive???
Had a pt who was getting K boluses his K during a bolus was 1.8, and elevated ST segment. 3 boluses were hung and ran wide open at the same time on his central line, and the next day he was >7 and on SLED.
For me, Hgb 1.8, d dimer >20,000 with no discernable cause, k+ 8.9, ph 6.7, wbc 60, platelets 12 in a pt w/TTP, Etoh 0.65 walky talky, and the guy s/p motorcycle accident denied pelvic pain, just ankle pain and road rash.... Left Pelvis (I forget the name but the large flat part that we equate with our "hips" lol, completely snapped off where it attaches to the back, right pelvic/hip joint broken completely off and free floating... I couldn't believe he could still move his legs the whole time!!!
Sep 11, '12pH of 6.66 (swear!) post code on a 25 weeker. bad omen for sure. saw platelets of 7 once when I worked oncology.
Sep 15, '12Quote from whitecat5000I had a patient with a pH of 7.04. I didn't know that was possible.
pshhh 7.04? I've seen less than 6.9, sustained for days! Pt also had a WBC of 68! Kiddo survived too! Is she neurologically intact? No, but she wasn't prior to the event either, smiles & interacts though, she's only about a year and a half old.