Extreme Lab Values

Aeterna, BSN, RN · Sep 10, 2012

I work with a lot of oncology patients and dialysis patients.

Do I need to say much more?

NurseOnAMotorcycle, ASN, RN · Sep 10, 2012

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!

TX.RN.Shannon · Sep 10, 2012

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.

RNperdiem, RN · Sep 10, 2012

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.

tamadrummer · Sep 10, 2012

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.

TX.RN.Shannon · Sep 10, 2012

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.

FLmed · Sep 10, 2012

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. :-)

jmdRN · Sep 10, 2012

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.. :confused:

TX.RN.Shannon · Sep 10, 2012

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.

psu_213, BSN, RN · Sep 10, 2012

Creatinine higher than hemoglobin. (and no I don't work on a dialysis unit...)

eatmysoxRN, ASN, RN · Sep 10, 2012

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.