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This is a discussion on highest lab values you have seen in Ob/Gyn Nursing, part of Nursing Specialties ... So last night I have a patient in full blown HELLP syndrome. Very scary. Her labs were shocking...by lovemyjoblandd Jan 4So last night I have a patient in full blown HELLP syndrome. Very scary. Her labs were shocking to me, so I am kind of wondering how they compare to other HELLP patients (or really any sick OB patient). Here's a rundown ( I will start with her admission and then show how badly they progressed)
Admit (midnight): AST-148, ALT-153, HH 14.1/41, urine protein 150, platelets 94,000. Went to c/s (she was a repeat SROM'd, nothing emergent).
0500 labs: AST-1299, ALT-1246, HH 9.1/27, calcium 6.4, total bili 1.4, platelets 36,000. Mag started 2g/hr (!!!!!! low calcium). UO decreasing to about 7cc/hr.
1200 labs: AST-1899, ALT-1518, calcium 6.4, total bili 2.2. UO is up >30cc/hr
1900 labs: AST-2079, ALT-2248, HH 7.1/21 mag 6.7, total bili 0.8, platelets 22,000.
(now im completely freaking out. DTRs barely registering, RR 11-12, pt lethargic. VS stable. UO 75-125cc/hr. MD says stick with what we got. Please please please no DIC!!!! lol did xfuse 2 unit PRBS ((PLATELETS PLEASEEEEEEE!)))
0500 labs:AST-1871, ALT-1912, HH 9.7/29, calcium 6.5, platelets 20,000, coags wnl.
d/c'd mag before I left this morning. came back tonight and they had (finally) xfused platelets and got her up to 63 and she was doing much better. She went to the hall and looked like a new woman. So so grateful.
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- Jan 4 by kloneI've never seen platelets at 20 before! Wowza. Lowest I've seen were about 60.
- Jan 4 by lovemyjoblanddI left out a WHOLE lot of this story for privacy stuff. Really don't want to get too specific, but it's such a good learning case lol. To be noted, she went under general anes, had a demerol PCEA pump going, and also an internal hematoma was found at the incision.
- Jan 5 by FyreflieI had a lady with idiopathic low platelets once. We ran admission cbc& type & screen on everyone and her platelets were 35!!! She had a vag delivery with no complications. I almost started 2 IVs in labour to ward off evil spirits!
I don't think I've ever had a spiraling hellp case. A couple if DICs due to undiagnosed clotting disorders though! 20 is pretty ******.
- Jan 5 by lovemyjoblanddI left out the fact that with her 1st pregnancy she was idiopathic thrombocytopenic and had to be under general for her p c/s, but had no other complications. This was her second, and she was also ITP but no s/s of PIH. She had been put on Medrol the week before to up her platelets. She was scheduled for her section next week, but came in SROM'd and actively laboring (thank God!!! it probably saved her life). Her pressures were up, but she was in pain so we weren't too worried ( I was not her nurse this night). Got her sectioned quickly and in recovery her BPs dropped and she was tachy. She got some hemabate which resolved the bleeding quickly but not the tachy. pressures were 90s/50s but that is baseline for her. then she got her labs drawn which is where i started with the OP lol.
- Jan 6 by IrishIzRNI had a pt with plts in the teens. It was awful. There was a vaginal delivery of an iufd and the bleeding was quite awful. She was in DIC. I transfused a ton of stuff that night.
- Jan 7 by dah dohNot being a OB nurse, those ladies shouldn't be in my unit since I work ICU. The first one had a hgb of 3 when I sent her back to surgery because the surgeon couldn't stop her bleeding out with a vag pack. We get HELLP as well...liver enzymes were five digits and platelets in teens...gave so much blood products that she went into DIC and ARDS! On non-OB pts, lowest pH 6.3 and lived and highest K is 9 also lived.
- Jan 11 by lovemyjoblanddWhile the platelets were scary low, and I was terrified of DIC, what really made me scratch my head was her liver enzymes. >2000! I'd never seen that. I guess that's why I named this "highest lab values" lol.
- Jan 12 by ReneeRN0521Pt. came in for "back pain", assessment showed B/P 240/120, hyperactive reflexes with +2 clonus, HA, Blurred vision, upper right quadrant pain, +4 protein in her urine, and super swollen (+3 edema in all extremities). Labs drawn: Platelets 19, AST/ALT in the 4-5000's. Don't remember the rest of the lab but she got platelets infused BEFORE they took her back for an emergency section then went to ICU!
- Jan 12 by lovemyjoblanddRenee, thanks for your story! Makes me feel a little better about my patient not being as sick as she could!