Extreme Lab Values

  1. 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 any to add?
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  2. 25 Comments

  3. by   Aeterna
    I work with a lot of oncology patients and dialysis patients.
    Do I need to say much more?
  4. by   NurseOnAMotorcycle
    Quote from TX.RN.Shannon
    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 any to add?
    How about the patients walking around in 3rd degree heart block: "I get tired a lot."
    People driving themselves to the hospital with pneumothorax and tracheal deviation: "I'm ok, just need to catch my air for a minute."

    Amazed at what some human bodies can cope with!
  5. by   TX.RN.Shannon
    Quote from Aeterna
    I work with a lot of oncology patients and dialysis patients.
    Do I need to say much more?
    I DON'T work with many dialysis or oncology patients, so not really used to seeing that extreme labs.
  6. by   RNperdiem
    For me it is: PTT of WHAT! Oops, I drew that lab from the central line with the heparin still running. Nevermind. Time to redraw some labs.
  7. by   tamadrummer
    Had an inr of 13 the other day bruised from head to toe. ( can't imagine what his vital organs looked like)
    Crazy enough in the room next door had a completely non-symptomatic inr of 10. Both got 4 units of FFP and I went off duty and gone for 3 days. Not sure what the outcome was.
  8. by   TX.RN.Shannon
    Quote from tamadrummer
    Had an inr of 13 the other day bruised from head to toe. ( can't imagine what his vital organs looked like)
    Crazy enough in the room next door had a completely non-symptomatic inr of 10. Both got 4 units of FFP and I went off duty and gone for 3 days. Not sure what the outcome was.
    The lovely lady with the high INR got one dose of Vitamin K and had an INR of 2.7 or 2.8 in a 12 hour follow-up. Haven't seen that only one dose could change it that radically so quickly. Just FYI, she had been off Coumadin for a week or so prior to admit.
  9. by   FLmed
    Quote from TX.RN.Shannon

    The lovely lady with the high INR got one dose of Vitamin K and had an INR of 2.7 or 2.8 in a 12 hour follow-up. Haven't seen that only one dose could change it that radically so quickly. Just FYI, she had been off Coumadin for a week or so prior to admit.
    I bet that INR of 13 was an incorrect value the lab messed up. I just can't see how 1 dose of vitamin K could bring it back down to almost a therapeutic level. I've seen a potassium at 7.4 before and it was incorrect. It was drawn a second time within 1/2 hour and it was 4.1. The labs aren't always perfect. :-)
  10. by   jmdRN
    Hmmm... have a pancytopenia pt this week, palliative care, transfuse for comfort ?!!? (worst Rx I've read in a while)
    wbc is 1.2 (norm 7-10)
    hb is 95 post transfusion (135-155 normal)
    and the kicker.. platelets at 9 (yes 9!!!) where normal should be 150-450.
    received 5 units of platelets yesterday, and was up to platelets at 55 this am..
  11. by   TX.RN.Shannon
    Quote from FLmed

    I bet that INR of 13 was an incorrect value the lab messed up. I just can't see how 1 dose of vitamin K could bring it back down to almost a therapeutic level. I've seen a potassium at 7.4 before and it was incorrect. It was drawn a second time within 1/2 hour and it was 4.1. The labs aren't always perfect. :-)
    That's what I thought--especially with NO bruising, not bleeding much after a fingerstick, etc.
  12. by   psu_213
    Creatinine higher than hemoglobin. (and no I don't work on a dialysis unit...)
  13. by   eatmysoxRN
    Water intoxication that led to a potassium that was ~2. Coding. Coded several times. Ended up walking and talking and asking for water. I felt sorry for him. That potassium was definitely incompatible with life.
  14. by   canchaser
    Lactic acid 35.5

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