Certain tests have critical values. These are results that may pose an immediate threat to the patient or, in the case of infectious disease, to those around the patient.

When a critical value is confirmed, the result is called to the patient's nurse (inpatient) or a nurse (physician) at the physician's office (outpatient). Laboratory policy further requires that nurse or physician taking the report repeat the results for verification. Documentation of verbal notification and verification read-back is made by computer comment entry in the LIS. Documentation must specify the identity (full name and credentials of person receiving and reading back the result, date and time of call and initials of the technologist who made the call. Documentation in the computer ensures the printed patient test report indicate when and to whom the report was called.

CRITICAL VALUES
TEST	NHRMC	CFH
Acetaminophen	>200 ug/mL	>200 ug/mL
Alcohol, Ethyl (ETOH)	>400 mg/dL	>400 mg/dL
Amylase	>599 U/L	>599 U/L
Bilirubin	>15.0 mg/dL	>15.0 mg/dL
Bilirubin (neonatal 0-15 days)	>10 mg/dl	>10 mg/dl
Blood Culture	any positive	any positive
Blood Gases	pH: <7.300 or >7.550 pO₂: <55 mmHg pCO₂: <20 or >60 mmHg pH neonate <7.26	pH: <7.300 or >7.550 pO₂: <55 mmHg pCO₂: <20 or >60 mmHg pH neonate <7.26
Calcium	<7.0 or >13.5 mg/dl	<7.0 or >13.5 mg/dl
Carbamazapine (Tegretol)	>15.0 ug/mL	>15.0 ug/mL
Chloride	>149 mmol/L	>149 mmol/L
Cholinesterase (PCHE)	<7.0 u/mL	NA
CKMB	>5.6 ng/mL (first elevation)	>5.6 ng/mL (first elevation)
Creatinine (non-dialysis)	> 9.9 mg/dl	> 9.9 mg/dl
CSF Culture	Any positive direct gram stain or culture	Any positive direct gram stain or culture
Cyclosporin	>700 ng/mL	>700 ng/mL
Digoxin	>2.5 ng/mL	>2.5 ng/mL
Fibrinogen	<100 mg/dL	<100 mg/dL
Fibrin Split Products	> 40 ug/mL	> 40 ug/mL
Gentamycin	Trough: >3 ug/mL Peak: >12 ug/mL	NA
Glucose	<40 or >450 mg/dL neonate: <45 or ≥ 250 mg/dl	<40 or >450 mg/dL neonate: <45 or ≥ 250 mg/dl
Hematocrit	<20.0 or >65.0%	<20.0 or >65.0%
Hemoglobin	<7.5 or >20.0 g/dL pre-op <10.0 g/dL	<7.5 or >20.0 g/dL pre-op <10.0 g/dL
Lactic Acid	> 4.0 mmol/L
Lithium	>1.2 mmol/L	NA
Magnesium	<1.3 or >5.0 mg/dL (non-OB)	<1.3 or >5.0 mg/dL (non-OB)
Phenobarbital	>60 ug/dL	>60 ug/dL
Phenytoin (Dilantin)	>25 ug/mL	>25 ug/mL
Phosphorus	<1.5 mg/dL	<1.5 mg/dL
Platelet Count	<50,000 or >800,000 K/uL pre-op <100,000 K/uL	<50,000 or >800,000 K/uL pre-op <100,000 K/uL
Potassium	<3.0 or >6.0 mmol/L	<3.0 or >6.0 mmol/L
Protein, Total	>12.9 g/dL	>12.9 g/dL
PT with INR	PT >45 seconds INR > 5 seconds pre-op >13.5 seconds	PT >45 seconds INR > 5 seconds pre-op >13.5 seconds
PTT	>100 seconds pre-op >39.1 seconds	>100 seconds pre-op >39.1 seconds
Reducing Substances (< or =1 year of age)	positive	positive
Salicylate	>30 mg/dL	>30 mg/dL
Smear for Blood Parasites	Positive	Positive
Sodium	<125 or >155 mmol/L	<125 or >155 mmol/L
Theophylline	>20 ug/mL	>20 ug/mL
Tobramycin	Trough: >3.0 ug/mL Peak: >12.0 ug/mL	NA
Troponin	>0.7 ng/mL, 1st elevation	>0.7 ng/mL, 1st elevation
Valproic Acid	>150 ug/mL	NA
Vancomycin	Neonatal Peak: >90 ug/mL	Neonatal Peak: >90 ug/mL
WBC	<1.0 or >25.0 K /uL outpatient >15 k/uL pediatric outpatient from 2 weeks to 5 years of age > 20 k/uL	<1.0 or >25.0 K /uL outpatient >15 k/uL pediatric outpatient from 2 weeks to 5 years of age > 20 k/uL
NHRMC: New Hanover Regional Medical Center CFH: Cape Fear Hospital

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