Critical Values
It is the policy of the laboratory to notify the ordering location of any laboratory results which are so far from the reference range that they indicate a potentially dangerous condition requiring immediate attention by the clinician. The ordering locations are notified even to those areas with computer printers or terminals. CRITICAL LABORATORY RESULTS ARE ALWAYS REPORTED BY TELEPHONE. In accordance with JCAHO requirements, it is required that we request a read-back of results to ensure that the results were properly noted by the recipient.
ANALYTE |
CRITICAL VALUES |
| Absolute Neutrophil (non-oncology) | <0.5 THOU/mcL |
| Bilirubin, newborn (under 30 days old) | >12.0 mg/dL |
Blood Gases, Adult
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Blood Gases, Newborn
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| Calcium, ionized | <0.78 or >1.58 mmol/L |
| Calcium, total | <6.0 or >13.0 mg/dL |
| Carbon Dioxide | <10 or >40 meq/L |
| Carbon Monoxide | >20% |
| Fibrinogen | <100 mg/dL |
| Glucose, adult | <45 or >500 mg/dL |
| Glucose, newborn | <40 or >200 mg/dL |
| Glucose, CSF | <20 mg/dL |
| Hematocrit | <20% |
| Hemoglobin by oximetry | <6.0 g/dL |
| Magnesium | <1.2 or >4.2 mg/dL |
| Osmolality | <250 or >350 mOsm/kg |
| Partial thromboplastin time | >120 sec |
| Phosphate | <1.0 mg/dL |
Platelet Count
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| Potassium | <2.5 or >6.0 meq/L |
| Prothrombin Time | INR >5 |
| Sodium | <120 or >160 meq/L |
| Sodium, CSF | <120 or >160 meq/L |
| T4, adult | >18.0 mcg/dL |
| T4, newborns | <3.5 or >18.0 mcg/dL |
Critical Values for Microbiology
Critical Values in Microbiology are results that indicate a potentially dangerous condition requiring immediate attention by the clinician. CRITICAL LABORATORY RESULTS ARE ALWAYS REPORTED BY TELEPHONE. In accordance with JCAHO requirements, it is required that we request a read-back of results to ensure that the results were properly noted by the recipient. They include the following:
- Positive blood culture
- Positive direct exam or culture on spinal fluid (CSF)
- Positive Cryptococcal antigen (serum or CSF)
- Positive direct exam on any specimen from the Operating Room
- Positive AFB stain or culture from any specimen
- Positive Herpes simplex virus PCR on cerebral spinal fluid (CSF)
Toxic Drug Levels
Toxic Drug Levels are those results that are so far from the therapeutic range that they indicate a potentially dangerous condition requiring immediate attention by the clinician. CRITICAL LABORATORY RESULTS ARE ALWAYS REPORTED BY TELEPHONE. In accordance with JCAHO requirements, it is required that we request a read-back of results to ensure that the results were properly noted by the recipient.
DRUG |
TOXIC LEVEL |
| Acetaminophen | >50 mcg/dL |
| Amikacin (Trough) | >10.0 mcg/mL |
| Caffeine | ≥50.0 mcg/mL |
| Carbamazepine | >14.0 mcg/mL |
| Cyclosporine by HPLC (Trough) | >600 ng/mL |
| Digoxin | >3.0 ng/mL |
| Flecainide | >1.0 mcg/mL |
| Gentamicin (Trough) | >10.0 mcg/mL |
| Isopropanol and Acetone | >200 mg/dL |
| Lidocaine | >7.0 mcg/mL |
| Lithium | >2.0 mmol/L |
| Phenobarbital | >60.0 mcg/mL |
| Phenytoin (Dilantin) | >30.0 mcg/mL |
| Phenytoin, Free | >4.0 mcg/mL |
| Procainamide | >15.0 mcg/mL |
| Total Procainamide | >40.0 mcg/mL (TPcain= Pcain + NAPA) |
| Quinidine | >7.0 mcg/mL |
| Salicylate | >50 mg/dL |
| Theophylline | >25.0 mcg/mL |
| Thiocyanate | >20 mg/dL |
| Tobramycin (Trough) | >10.0 mcg/mL |
| Tricyclic Antidepressants | >500 ng/mL |
| Vancomycin (Trough) | >40.0 mcg/mL |
| Valproic Acid (VPA) | >200 mcg/mL |
Critical values last reviewed: April 30, 2008