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Critical Values

Hematology
Previously undiagnosed in the last month. Immature cells, Blast, Mononuclear Cells and Variant Lymphs

Test	Low Values	High Values
CBC
WBC	<1000 cu.mm.	>25,000 cu.mm.*
*previously unknown in the last 7 days
Neutrophils	<10%
Hematocrit	<21%	None
Hemoglobin	<7 gm/dl	>20 gm/dl
Hemoglobin (newborn)	<9.5 gm/dl	>22 gm/dl*
*previously unknown in the last 48 hours unless there is a >=2 gm/dl decrease in the last 48 hours
Platelet Count	<40,000 cu.mm.*	None
*previously unknown in the last 7 days
Known Thrombocytopenia	<20,000 cu.mm.*	None
*patients known or seen for thrombocytopenia
PT INR	>=4.5
PTT	None	>150 sec
Urinalysis	Uncommon parasites
Infants	Positive acetone or glucose
CSF
WBC	>10 cu.mm.
Differential	Any mircoorganisms or malignant cells

Microbiology

Positive AFB Culture and/or smear
Positive Blood Culture
Positive CSF Culture and/or smear including India ink
Positive gram stain of normally sterile sites (i.e. body fluid, aspirate, wounds)
Identification of any malarial parasite
Positive herpes culture indicative of possible systemic
Infection
Vancomycin Resistant Enterococcus
Methicillin Resistant Staph. Aureus
FAX alert to floor on inpatients.

Chemistry

Test	Low Values	High Values
Creatinine	None	>7.5 mg/dl*
*previously unknown within the last 48 hours unless there is a >=2 mg/dl increase within the last 48 hours
CSF Glucose	<35 mg/dl	>250mg/dl*
*previously unknown within the last 48 hours
Osmolality (Serum)	<250 mOsm/kg	>325 mOsm/kg
Bilirubin (Neonatal)
Infant <24 hrs old	None	>12 mg/dl
Infant >24 hrs old	None	>15 mg/dl
Calcium	<7 mg/dl	>13 mg/dl
Potassium	<2.5 mEq/L	>6.5 mEq/L
Pre-Surgical Only	<3.0 mEq/L
Called to Anesthesiologist
Sodium	<120 mEq/L	>160 mEq/L
CO2	<10 mEq/L	>40 mEq/L
Magnesium	<1 mg/dl	>4 mg/dl
Magnesium (OB patients)	<1 mg/dl	>8 mg/dl
Glucose
Newborn	<=35 mg/dl	>300 mg/dl
Infants >72 hrs old and adolescents	<=45 mg/dl	>300 mg/dl
Adults	<=45 mg/dl	>500 mg/dl
SGOT	None	>1,000 U/L*
*previously unknown within the last 7 days
SGPT	None	>1,000 U/L*
*previously unknown within the last 7 days
Ethanol	None	>300 mg/dl

Therapeutic Drug Monitoring (TDM) Toxic Levels

Acetaminophen	Time PP Dependent
Carbamazepine		>15 ug/ml
Digoxin		>2.5 ng/ml
Lithium		>1.5 mEq/L
Phenobarbital		>50 ug/ml
Dilantin (Phenytoin)		>30 ug/ml
Theophylline		>20 ug/ml
Salicylate		>30 mg/dl
Valproic Acid		>120 ug/ml
Toxic symptoms begin to appear between 10-20 ug/ml in many people while other individuals tolerate these levels without difficulty

Aminoglycosides	Peak (ug/ml)	Trough (ug/ml)
Gentamycin	>10	>2
Tobramycin	>10	>2
Vancomycin	>40	>15
(Any value that any reference laboratory considers toxic or potentially toxic should be called.)

Blood Bank

Coombs	All positive cord blood
Antibody	Any antibody that would delay transfusion

Angella Callwood