Critical Values
Clinical Biochemistry
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Biochemistry
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Critical Values
To be called as soon as the result
is available
24 Hours a Day.
All Patients,
Unless Otherwise Noted
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| Acetaminophen |
Greater than 330 µmol/L |
| Amikacin |
Pre: Greater than 17.0 mg/L
Post: Greater than 60.0 mg/L |
| Amiodarone |
Greater than 5.4 µmol/L |
| Ammonia |
0-16 years: Greater than 109 µmol/L |
| Bilirubin (total) |
0-365 days: Greater than 300 µmol/L |
| Caffeine |
0-6 months: Greater than 258.0 µmol/L |
| Calcium (total) |
Less than 1.75 mmol/L
Greater than 3.25 mmol/L |
| Calcium (ionized) |
Less than 0.85 mmol/L
Greater than 1.50 mmol/L |
| Carbamazepine (Tegretol) |
Greater than 55.0 µmol/L |
| Creatinine |
0-31 days: Greater than 150 µmol/L |
| Desethylamiodarone |
Greater than 4.9 µmol/L |
| Digoxin |
Greater than 2.6 nmol/L |
| Ethanol |
Greater than 65.0 mmol/L |
| Ethosuximide (Zarontin) |
Greater than 700 µmol/L |
| Ethylene Glycol |
Greater than 2.0 mmol/L |
| Gentamicin |
Pre: Greater than 2.0 mg/L
Post: Greater than 10.0 mg/L |
| Glucose |
0-17 years: Less than 2.0 mmol/L, Greater than 20.0 mmol/L
18-150 years: Less than 2.0 mmol/L, Greater than 35.0 mmol/L |
| Isopropanol |
Greater than 2.0 mmol/L |
| Lactate |
Greater than 4.1 mmol/L |
| Lithium |
Greater than 1.50 mmol/L |
| Magnesium |
Less than 0.50 mmol/L
Greater than 1.50 mmol/L |
| Methanol |
Greater than 2.0 mmol/L |
| Osmolality |
Acute Care Patients Only:
Less than 250 mmol/kg
Greater than 320 mmol/kg |
| Phenobarbital |
Greater than 190.0 µmol/L |
| Phenytoin (Dilantin) |
0-3 months: Greater than 55.0 µmol/L
4 months-150 years: Greater than 80.0 µmol/L |
| Phosphate |
All: Less than 0.30 mmol/L
0-30 days: Greater than 3.49 mmol/L
31 days - 150 years: Greater than 3.00 mmol/L |
| Potassium |
All: Less than 2.5 mmol/L
4 months - 150 years: Greater than 6.0 mmol/L
0-3 months (venous): Greater than 6.4 mmol/L
0-3 months (capillary): Greater than 7.3 mmol/L
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| Primidone (Mysoline) |
Greater than 65.0 µmol/L |
| Salicylate |
Greater than 2.00 mmol/L |
| Sirolimus |
Greater than 30 µg/L |
| Sodium |
Less than 120 mmol/L
Greater than 155 mmol/L |
| Serum Tricyclic screen |
Greater than 1600 nmol/L |
| Spermatozoa - Urine |
Female less than 14 years |
| Tacrolimus |
Greater than 30 µg/L |
| Theophylline |
Greater than 110.0 µmol/L |
| Tobramycin |
Pre: Greater than 2.0 mg/L
Post: Greater than 10.0 mg/L
ACH CF pts: Greater than 25.0 mg/L |
| Troponin I |
Greater than or equal to 0.11 µg/L |
| Troponin T |
Ambulatory:
0-7 days: Greater than 0.34 µg/L
8-30 days: Greater than 0.19 µg/L
1 month - 150 years: Greater than 0.09 µg/L |
| Urate |
ACH only - Greater than 713 µmol/L |
| Valproic Acid (Depakene) |
Greater than 750 µmol/L |
| Vancomycin |
Pre: Greater than 20.0 mg/L
Post: Greater than 40.0 mg/L
Random: Greater than 40.0 mg/L |
Hematology
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Hematology
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Critical Values
To be called as soon as result is available 24 Hours/Day
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Hemoglobin
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Adults: Equal to or less than 60 g/L
0-6 days: Less than 100 g/L
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Platelet Count
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Equal to or less than 20 x 10E9/L
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Absolute Neutrophil Count
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Less than 0.5 x 10E9/L
(* See note)
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Prothrombin Time (PT)
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I.N.R. greater than 5.0
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Activated Partial Thromboplastin Time (APTT)
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Equal to or greater than 120 seconds
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Fibrinogen
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Less than 0.6 g/L
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D-Dimer (DVT/PE)
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Equal to or greater than 0.51 mg/L
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*Note: All the differential results are phoned, not just the neutrophil count.
Microbiology
Appropriate medical staff will be notified by fax or phone of the following results:
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1. Positive blood cultures
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2. Positive central nervous system specimens (CSF, brain, etc.) cultures and gram stains
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3. Positive tissue cultures (liver, bone biopsies, etc.)
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4. Beta-hemolytic Streptococci, Group A from sterile sites
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5. Neisseria gonorrhoeae from eyes
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6. Clostridium botulinum, Clostridium perfringens, Clostridium tetanus
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7. Corynebacterium diptheriae
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| 8. Legionella species |
| 9. Listeria species |
| 10. Positive Modified Acid Fast and Ziehl-Neelsen stains |
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11. Unusually resistant organisms including:
- Vancomycin resistant Enterococci (VRE)
- Methicillin resistant Staphylococcus aureus (MRSA)
- Multiply resistant gram negatives or any other highly resistant organism or organism with unusual susceptibility pattern. On Blood/Sterile fluids/Wound/AN02/Screening swabs, BAL, tracheal aspirates
- Extended spectrum beta lactamases (ESBLs)
- Glycopeptide intermediate Staphylococcus aureus (GISA), Borderline oxacillin resistant Staphylococcus aureus (BORSA)
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12. All Notifiable Diseases isolates http://www.health.gov.ab.ca/professionals/notifiablediseases.html
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13. Cryptococcus neoformans
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14. Zygomycetes from sinus/eye specimens
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15. Vitreous fluids from eyes (positive and negative reports from slide preparations)
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16. Blastomyces dermatitidis, Histoplasma capsulatum, Coccidioides immitis, Paracoccidioides brasiliensis, Sporothrix schenkii, Penicillium marneffi
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17.Level III organisms: Bacillus anthracis, Brucella spp., Francisella spp., Yersinia pestis
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18. Stenotrophomonas maltophilia: non-sterile sites
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19. Stool pathogens including Salmonella, Shigella, Yersinia, Campylobacter spp., Clostridium difficile, E-coli 0157:H7, Vibrio spp., Rotavirus
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20. All positive and/or STAT Malaria tests
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21. PCP - Pneumocystis jirovecii (carinii)
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22. RSV, Influenzae A; all positive results
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23. Varicella Zoster Virus: all positive results
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24. Parasites:Cyclospora spp.,Giardia, Entamoeba histolytica, Cryptosporidium spp., Acanthamoeba, Parasitic ova, worm, proglottid, and larvae
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Notes:
- Critical values are test results that are so abnormal that they generally indicate severe illness and require immediate medical intervention. For this reason, these values must be communicated to the attending physian immediately.
- While critical values are generally indicative of acute disease requiring intervention, there are some patients with marked metabolic derangements that are physiologically fairly well compensated. For example, renal patients can have chronically elevated potassium levels that are surprisingly well tolerated. A general rule of thumb is that chronic changes in physiological status are much better tolerated than rapid alterations.
- Some physicians or units may decline communication of critical values. In these cases, written documentation must be produced for the laboratory to comply with this request.
Some testing areas may wish to phone some abnormal results, and these discretionary decisions have not been built into the critical value list.
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