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docB

docB

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  1. Attending Physician
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I can't believe we don't have a hall of fame thread for extreme lab values. Highest and lowest potassium, pH and the like. I'll start by nominating my patient for today who is walking and talking with a blood alcohol of ....
710 Hooray! He has been training like an Olympic athlete for many years to achieve this level of greatness. What a stallion!

ETOH = 710
 
BG=2390, asymptomatic
 
Cl- 57, K <2.0 (1.8 I think)

A 8 week kid whose (granted, uneducated but well meaning) parents had been taking him to the doctor for a few weeks because "all he does is throw up and get skinnier". Formula switched several times. Doctor unconcerned that baby 1 pound below birth weight. Parents hotlined for child neglect. Kid had pyloric stenosis.
 
A little elf said:
Ca of 4.3 in a 3 month old.
Click to expand...

What was the cause of that? Decreased calcium intake, vitamin D deficiency/receptor dysfunction, hypomag, hyperphos, excess calcitonin, what?

On this line I did see a kid with an incredibly high calcium level, which I can't remember off the top of my head. I think it was around 19. Kid had Williams syndrome.
 
CO2 180, pt in mild distress. (when your baseline is 90-130, not just a stretch)

CO2 318 (tubed a few minutes later)
 
inr 41 .....
confused elderly guy forgot daily for a week or so how much coumadin he took so took several times nl dose several times daily. bleeding from all orifices on presentation to e.d.
lived.....
 
WBC 0.1 (4.0-10.0).... is currently septic
 
Doesn't beat Emeda, but a good story:

INR: 39

Dude presents with BRBPA--tells us that he takes his coumadin "when I feel like my blood is too thick".

FYI: Not only did this guy live but he's still sure he knows how to take his meds better than we do. So how do you write that script?

Coumadin 5mg PO q4-6 hrs prn increased blood viscosity?

BTW Doc B: :clap: .710???? :clap: I think we all have something to shoot for now.
 
Nursing home patient.....bed bound...Na 183. The highest I have seen.....some one must have seen higher.
 
TSH - 220. :wow: AAO x 2. Low T4 --> Forgetfull-->Forget Synthroid Dose---> Lower T4...........
V
 
Virion said:
TSH - 220. :wow: AAO x 2. Low T4 --> Forgetfull-->Forget Synthroid Dose---> Lower T4...........
V
Click to expand...


230 a couple of days ago.

mike
 
Lithium Level: 8.1

K: 9.1

CO2 (pt. last night): 146, pH 6.9
 
K 11.2, Down 45 minutes.
Given Calcium Gluconate
Normal Sinus Established and pat. transferred to ICU - alive!
 
Question...they actually measured an INR greater than 12? Our labs simply state >12 (then correlate clinically).

Anyway: Sodium 109 (der seizing)
Hgb 3.5 (old lady...just hanging out)
 
Hgb--- 0.8 they kept her alive in an HBO chamber for 5 days hoping the EPO and Iron would work really, really fast...

K--- 11.5, got called to the VA ED because "I think this man is in V-Tach", took the lab 4.5 hours to get the numbers back ("we ran them 3 times because they couldn't be right"--- never called me).
 
As a Tech (i.e., minion), one of my duties is to get EtOH readings via breathalyzer. I've seen >250 enough now that it's no longer shocking. 350 is noteworthy... as one doc said, standing next to me and watching the numbers keeeeep going up, "hey, 330... 350... That's a career!"

That dude kept on a' going, to about 540. When I charted it, the incoming nurse at shift change got cranky and measured it again, with a different breathalyzer.

Oh, jeez, sorry. It was only 460. :meanie:
 
ETOH of 830.

No one in our ED had ever seen anything quite like it. We're not sure it wasn't a lab error to this day.

Guy wasn't walking, nor really what I would call "talking", but more mumbling and taking weak swings at people who came near his stretcher. He also looked a little like Santa Claus, only Santa doesn't have things growing in his beard like this human liver machine did.

He was, however, breathing quite well on his own.
 
EMRaiden has me beat on the hemoglobin, but.........

70y/o female alert and oriented.......feeling fatigued and short of breath and in very mild distress........hemoglobin 2! she was quite pale.

not a lab value but had a BP of 300/180!
 
INR 80.2 --> peaked at 92.0

My first month of IM intern, day float, had NO idea what was going on, ths happens at 7pm, I sign out, go home, find out next day that he got several units of FFP, and the INR was 4.0 the next day. Never figured out what happened, nl platelets, no bleeding - crazy!
 
H/H 2/8 (not an error) pt asymptomatic, getting blood as we speak.
 
T Billi 92. Recurrent Hep C post transplant. AA0 x 3. Not yellow, Green.
 
TSH - 425 - Homeless dude with undiagnosed hypothyroidism. Came in 1 wk earlier to ER with TSH 410. He 'might' have fogotten to take his synthroid...

Na - 107 - Other dude with HIV, Hep C, and hemochromatosis. No AMS. Refractory to electrolyte correction. D/Ced with Na - 111

pH - 6.1 - Elderly woman who coded. Put on vent. Walked out of hospital 4 days later....unbelievable. (this was the 2nd time this happened to her!!!)
 
pH 7.876 with a K of 2.0, bicarb 39.4 and pC02 of 19.9

Still working him up on MICU call, but I've managed to get his pH to 7.49 by snowing him and dropping his respiratory rate. I'll tell you more as I figure things out.
 
I've had 2 ARF (not long term ESRD) patients in the last week with a Creatinine of 23... one with a BUN of 117, the other 172! Both with HgB of 5. And get this... Nephrology tried to block BOTH admissions!
 
Na 221

Was told by PCP to but salt tablets down his G tube?

lived, tx was just NS IVF for a week.
 
Troponin 165
I got called to a code in the unit. Pt on max pressors (levo, dopa), bicarb gtt, vent, BP 40 all day. I walk in, RN says "We didn't think he'd make it this long." Squirt, squirt, squirt and out.
 
docB said:
Troponin 165
I got called to a code in the unit. Pt on max pressors (levo, dopa), bicarb gtt, vent, BP 40 all day. I walk in, RN says "We didn't think he'd make it this long." Squirt, squirt, squirt and out.
Click to expand...

Is that a troponin T, or I? 'Cause one attending was saying how he saw an I of 511 in Texas; the highest T I can give you is 53.
 
Apollyon said:
Is that a troponin T, or I? 'Cause one attending was saying how he saw an I of 511 in Texas; the highest T I can give you is 53.
Click to expand...

You know I'm not sure. I've been assuming my lab does I but I don't know for certain. I need to call them and ask.
 
Cholesterol - 928
No, not one of those hereditary dyslipidemias - a very sick man with hepatocellular carcinoma and portal vein thrombosis. Per the lab, blood was "grossly lipemic."
 
Had 2 patients complaining of cramps in the hands. Both had Mg of either 0.2 or 0.3.
 
debvz said:
Cholesterol - 928
No, not one of those hereditary dyslipidemias - a very sick man with hepatocellular carcinoma and portal vein thrombosis. Per the lab, blood was "grossly lipemic."
Click to expand...

I've seen tubes of blood that had that heavy cream layer on top. "Grossly lipemic," you'll know it when you see it.
 
Figured it was only a matter of time until I had something for this thread and then I got two in one weekend

CPK=120,000 The lab called and said, "is he even alive? we've never seen one this high" 40's male found down in the doctors parking lot. Methadone, Heroin, Valium overdose. Down so long he had incipient decub's on his back. Core body temp same as ambient air temp=88 degrees. Already in renal failure. Urine looked like black coffee.


Patient #2

Calcium=18 CC: constipation Actually orientedx3 but really sleepy and hadn't had a dump in days.
 
ERMudPhud said:
Figured it was only a matter of time until I had something for this thread and then I got two in one weekend

CPK=120,000 The lab called and said, "is he even alive? we've never seen one this high" 40's male found down in the doctors parking lot. Methadone, Heroin, Valium overdose. Down so long he had incipient decub's on his back. Core body temp same as ambient air temp=88 degrees. Already in renal failure. Urine looked like black coffee.


.
Click to expand...

Found down in the doctor's parking lot? 😕

Aren't you guys looking at what you are stepping over? I guarantee you a porsche doesn't have enough ground clearance to allow you to park on top of a person. 😀

Can't really blame you though. I'd be tempted as hell to pretend I didn't see him there. If he isn't in the ED with a chart and bed assigned, he might as well not even exist. 😉
 
edinOH said:
Found down in the doctor's parking lot? 😕

Aren't you guys looking at what you are stepping over? I guarantee you a porsche doesn't have enough ground clearance to allow you to park on top of a person. 😀
Click to expand...

No, but if you hit him fast enough with the front tires, you won't even bottom out the car as it flies over him. 🙂
 
edinOH said:
Found down in the doctor's parking lot? 😕

Aren't you guys looking at what you are stepping over? I guarantee you a porsche doesn't have enough ground clearance to allow you to park on top of a person.
Click to expand...

That's true which is why I recently upgraded to a full size pickup truck.
 
I think I got Margaritaboy's Na+ beat...

Had a patient, admitted to the MICU, with a sodium of 106.

Get this, it was an INTERNAL MEDICINE ATTENDING who apparently has brief psychotic episodes, thought he "had pneumonia" and treated himself with Levaquin, 750 for a week before being brought in in resp distress. This was like his 5th time htis year he had self-prescribed Levaquin.

106!!!!!!!!!!!!!! His Chloride was 66!!!!!!!!!!!

Q, DO
 
Temp 109 F
Pt was seizing. We have a problem with drunks that pass out on the sidewalk at night. When the sun comes up if they aren't found or if they don't wake up by the time the temp hits about 105 they are toast. Literally.
 
Q- got you beat on na+ but just barely...
91 yo fe complaining of chronic fatigue triaged to fast track with na of 105......on diuretics etc..must have gone done over a very long period of time for her to have adjusted so well. presented in nad, no seizures, no h/a, no other complaint than fatigue for a few months.....icu admit...
 
K of 1.2, guy was complaining that he couldn't stand up / walk
 
WBC count 393,000

New onset ALL.
 
Had a friend who saw a WBC higher than that, I'll have to ask him what it was.

My best: Na of 99. Polydypsia.
 
potassium of 8 in MICU. guy completely recovered.
 
12R34Y said:
potassium of 8 in MICU. guy completely recovered.
Click to expand...
Meh. Work on a renal service for a while and K's of 8 get boring. In med school, we had several that always came in with K's in the 7-8 range, angry, demanding food, spitting, etc.
 
southerndoc said:
pH (same patient): 6.75
QUOTE]

Initial pH less than 6.80 (we don't have the fancy machine apparently).

AFTER 3 amps of Bicarb, an Insulin drip, Bicarb Drip, and NS bolus.... pH jumped up to 6.83...
Click to expand...
 
Apollyon said:
CK 160,000 - young Hispanic male from Riker's Island, who was doing "deep knee bends" for 2+ hours. He never revealed if there was an associated beating with broomstick or rubber hose to go with it.
Click to expand...


Can't believe I forgot about this thread! I got ya'll beat by a long shot on the CK... >800,000. After 12 hours of calling the lab and their saying, "we're running it!" I finally asked why it was taking so long... "well, we keep having to dilute it... we're over 800,000 - want us to keep going?" You'd think they might've just said its a bit high earlier, right?

This was a young guy who used a bit too much coke... went into hepatorenal failure and after a long ICU course, WALKED out of the hospital with continued dialysis 😀
 
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