• SDN Site Updates

    Hey everyone! The site will be down for approximately 2 hours on Thursday, August 5th for site updates.

docB

Chronically painful
Moderator Emeritus
15+ Year Member
Nov 27, 2002
7,889
718
Las Vegas, NV
Status (Visible)
  1. Attending Physician
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
 
About the Ads

beriberi

Senior Member
7+ Year Member
15+ Year Member
Jan 25, 2004
250
0
midwasteland
Status (Visible)
  1. Attending Physician
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.
 

southerndoc

life is good
Volunteer Staff
15+ Year Member
Jun 6, 2002
12,942
2,432
Atlanta
Status (Visible)
  1. Attending Physician
A little elf said:
Ca of 4.3 in a 3 month old.

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.
 

beyond all hope

Senior Member
7+ Year Member
15+ Year Member
Dec 18, 2003
623
7
47
Status (Visible)
CO2 180, pt in mild distress. (when your baseline is 90-130, not just a stretch)

CO2 318 (tubed a few minutes later)
 

Emedpa

GlobalDoc
15+ Year Member
Aug 26, 2001
6,189
411
Taking an Away team....
Status (Visible)
  1. Post Doc
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.....
 

*Wing of Zock*

Member
7+ Year Member
15+ Year Member
Feb 9, 2004
48
0
Status (Visible)
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.
 

jashanley

Senior Member
10+ Year Member
15+ Year Member
Dec 10, 2002
232
5
45
Chicago
www.uic.edu
Status (Visible)
  1. Resident [Any Field]
Nursing home patient.....bed bound...Na 183. The highest I have seen.....some one must have seen higher.
 

Virion

Junior Member
7+ Year Member
15+ Year Member
May 19, 2003
17
1
Status (Visible)
TSH - 220. :wow: AAO x 2. Low T4 --> Forgetfull-->Forget Synthroid Dose---> Lower T4...........
V
 
About the Ads

mikecwru

M.D. = Massive Debt
15+ Year Member
Oct 21, 2002
949
15
Ohio
Status (Visible)
  1. Attending Physician
Virion said:
TSH - 220. :wow: AAO x 2. Low T4 --> Forgetfull-->Forget Synthroid Dose---> Lower T4...........
V


230 a couple of days ago.

mike
 

NinerNiner999

Senior Member
10+ Year Member
15+ Year Member
Nov 5, 2003
1,516
229
Where it's at.
Status (Visible)
  1. Attending Physician
K 11.2, Down 45 minutes.
Given Calcium Gluconate
Normal Sinus Established and pat. transferred to ICU - alive!
 

DocWagner

Senior Member
7+ Year Member
15+ Year Member
Aug 1, 2002
520
8
Status (Visible)
  1. Attending Physician
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)
 

EMRaiden

Senior Member
15+ Year Member
Dec 19, 2002
120
9
Status (Visible)
  1. Attending Physician
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).
 

Febrifuge

Grizzled Old Newcomer
7+ Year Member
15+ Year Member
May 7, 2003
1,520
24
febrifuge.blogspot.com
Status (Visible)
  1. Non-Student
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. :smuggrin:
 

jpgreer13

Senior Member
7+ Year Member
15+ Year Member
Oct 1, 2002
119
3
44
G-Vegas, in The Old North State
Status (Visible)
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.
 

12R34Y

Full Member
10+ Year Member
15+ Year Member
Apr 6, 2000
1,678
5
Status (Visible)
  1. Attending Physician
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!
 
About the Ads

Virion

Junior Member
7+ Year Member
15+ Year Member
May 19, 2003
17
1
Status (Visible)
T Billi 92. Recurrent Hep C post transplant. AA0 x 3. Not yellow, Green.
 

margaritaboy

Senior Member
15+ Year Member
Apr 13, 2003
402
6
The Desert
Status (Visible)
  1. Attending Physician
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!!!)
 

pinbor1

Full Member
10+ Year Member
15+ Year Member
Jan 9, 2003
252
1
Kansas City, MO
globalhealthhacks.wordpress.com
Status (Visible)
  1. Attending Physician
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.
 

Scrubbs

Chisellers beware!
7+ Year Member
15+ Year Member
Feb 28, 2003
1,065
12
NeverNeverLand
Status (Visible)
  1. Attending Physician
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!
 
Nov 24, 2002
22,291
7,961
SCREW IT!
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.

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.
 

DrQuinn

My name is Neo
Moderator Emeritus
10+ Year Member
15+ Year Member
Dec 6, 2000
4,227
16
Wisconsin
Status (Visible)
Troponin I of 129... patient the same as the one I posted in the "Interesting cases" thread here on the EM forums.

Q, DO
 

debvz

Wandering Spleen
15+ Year Member
Apr 13, 2004
250
2
Status (Visible)
  1. Attending Physician
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."
 
About the Ads

EMIMG

Senior Member
7+ Year Member
15+ Year Member
Nov 19, 2002
127
8
Status (Visible)
Had 2 patients complaining of cramps in the hands. Both had Mg of either 0.2 or 0.3.
 

docB

Chronically painful
Moderator Emeritus
15+ Year Member
Nov 27, 2002
7,889
718
Las Vegas, NV
Status (Visible)
  1. Attending Physician
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."

I've seen tubes of blood that had that heavy cream layer on top. "Grossly lipemic," you'll know it when you see it.
 

ERMudPhud

Back for a visit
15+ Year Member
Feb 24, 2003
1,085
24
Status (Visible)
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.
 

edinOH

Can I get a work excuse?
7+ Year Member
15+ Year Member
Nov 13, 2002
768
4
Status (Visible)
  1. Attending Physician
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.


.

Found down in the doctor's parking lot? :confused:

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. :D

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. ;)
 

Sessamoid

1K Member
15+ Year Member
Sep 11, 2003
1,658
9
Los Angeles
www.kickingsparrows.com
Status (Visible)
edinOH said:
Found down in the doctor's parking lot? :confused:

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. :D

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. :)
 

docB

Chronically painful
Moderator Emeritus
15+ Year Member
Nov 27, 2002
7,889
718
Las Vegas, NV
Status (Visible)
  1. Attending Physician
edinOH said:
Found down in the doctor's parking lot? :confused:

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.

That's true which is why I recently upgraded to a full size pickup truck.
 

DrQuinn

My name is Neo
Moderator Emeritus
10+ Year Member
15+ Year Member
Dec 6, 2000
4,227
16
Wisconsin
Status (Visible)
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
 

emtp2pac

Member
7+ Year Member
15+ Year Member
Nov 3, 2003
70
0
Status (Visible)
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...
 

Seaglass

Quantum Member
15+ Year Member
Jul 25, 2003
1,614
6
42
Winston Salem, NC
Status (Visible)
  1. Attending Physician
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.
 

12R34Y

Full Member
10+ Year Member
15+ Year Member
Apr 6, 2000
1,678
5
Status (Visible)
  1. Attending Physician
potassium of 8 in MICU. guy completely recovered.
 

EMRaiden

Senior Member
15+ Year Member
Dec 19, 2002
120
9
Status (Visible)
  1. Attending Physician
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...
 

Scrubbs

Chisellers beware!
7+ Year Member
15+ Year Member
Feb 28, 2003
1,065
12
NeverNeverLand
Status (Visible)
  1. Attending Physician
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.


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 :D
 
About the Ads
This thread is more than 5 years old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.