OK, so everyone in medicine seems to revel in extremes. This seems especially true when one talks about lab values. Docs and RN’s seem to always want to one-up each other about extremes of lab values. So here are my most extreme (as officially reported by the lab). What are yours? For those non-medical people out there, these are numbers that are often not compatible with life – just pray your or your loved ones never have any of these numbers!
1. Potassium. Lowest: 1.9 (died) Highest: 10.2 (survived)
2. Sodium. Lowest: 109 (survived) Highest: 180 (survived)
3. Calcium (corrected please): lowest: 4.0 (survived) Highest 15.0 (survived)
4. CPK (total): 300,000 (give or take) – (survived)
5. Lipase. highest: 18,000 (died)
6. Blood Glucose. Lowest: 1 (survived but vegetative) Highest: 2400 (survived)
7. Systolic Blood Pressure. Highest: 325 (died)
8. BUN. Highest: 170 (survived)
9. Ph: Lowest: 6.78 (died) Highest: 7.78 (survived)
I am sure I may remember some other extremes later – but last night I had a guy with a K+ of 2.2 and it got me thinking…..
Oh, I almost forgot,
10. ETOH: 630 (lived amazingly)
11. Hgb. Lowest: 1.7 (survived amazingly as well)
OK not ER, but NICU. We had a cord pH of 6.75 an arterial of 6.77- kid lived, but not well. We had a CO2 of 268- lived but died the next day.
Serum EtOH — 562 (not only survived, was up and walking with -that- level)
In ER (but the patient was already in Neurology when the lab values came)…potassium 1,4. Not only survived, but he had no heart problems except some problems in ripolarization.
BTW a very interesting case….it turned out it was a hypokaliemic periodic paralysis related to hyperthyroidism (Graves’disease).
Lowest Na+ (pt. had CP and survived): 78.
Lowest Hemoglobin: 3.4 (Fibroids-compensated-survived).
Highest WBC: Approxomately 424,000 (Acute leukemia-lived acutely but eventually died).
Highest Lipase: 24,000. Lived.
My mom’s lowest k+ was 1.3 and she survived. We didn’t even know anything was wrong until her legs stopped working. For some reason that no one can figure out, her potassium drops suddenly from time to time. Other low figures — 1.5, 1.9.
Can you give us laymen the “normal” levels for each?
Highest pCO2 197 (lived – bad COPDer)
Lowest Hgb 4.1 (lived – dieulafoy’s)
Highest BNP 32000 (not proBNP)
eos 54% (NSAID-induced eosinophilic pneumonia really exists!)
largest prostate 200g (acute retention x3days– “large, with significant BPH symptoms” per urology is 90g)
systolic BP 300 (asyptomatic, lived, presented for a knee complaint I think)
WBC 54K (AML, lived) – same patient plts 7
Trop 25 (lived, with NO MI – odd case…)
we have a ‘record board’ at work – I’ll have to look for more doozies
A personal value, so obviously I lived:
An AST/SGOT of >8,000 secondary to an uncommon med reaction.
No sequelae and values are all normal now.
For you lay-folk, normal is about 5-40.
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On a patient, I saw a recent HgbA1c of over 15% (in the interest of HIPAA stuff, probably best I don’t post the exact number) – still alive and very poorly controlled DM obviously.
We see some pretty extremem CBCs in heme-onc and BMT. The highest white count I’ve seen was over 100,000. At that point they need leukophoresis like yesterday or they’ll cardiac arrest. He made it, at least for the immediate time being. We’ll see WBCs of <0.01 on a daily basis on our BMT patients. *yawn*. I saw a hgb of 4.0 and a Plt count of 3 on the same person once, who was obviously bleeding. She got a ton of transfusions and then did okay.
Highest potassium I saw was back in an internship in renal (uhm, duh?). Chick tried to commit suicide by drinking gallons of OJ. Her K+ was 13 when she came in. She got HD asap and did well to. It was amazing how close to successful she was with such unconventional means.
We had an Epsom salts overdose the other day. Mg 16.3. Survived.
The lowest Hg I’ve heard of was 1.5 by a sickler with fibroids. She survives chronically at these levels.
On the ETOH thing: a reading of 630 doesn’t mean 63% of the circulating blood/fluid is alcohol, does it? My statistics must be screwed up, or I’m misunderstanding how blood level is calculated.
No, ETOH is grams/decilitre so 630 equals .63% blood alcohol (by breathaliser).
Here is a link to “normal” lab values:
http://www.globalrph.com/labs.htm
ETOH 630?
That is pretty crazy…
I worked at a detox/addictions center for a couple years and had to breath people all day long and I must say a 630 is freaking ridiculous. I guess I would not know our highest ETOH as the breathalyzer only said “HI” after 500. Often, we would be the only ones getting the numbers though as the ED did not want to have to breath people because then they would have to wait until they were medically stable which they never would actually become…
god, I loved working with addicts. It was super cool. Miss it.
7
Troponin I: 180.3, 99% occluded LAD, went to cath lab and survived.
Na of 97 – died (end stage cirrhosis)
correcte Na of 183 died (DKA)
Ca low 3.6 (s/p parathyropidectomy, stopped all meds, seized, survived with severe neuro impairment)
Ca high (corrected) 19.7 survived
CPK 423,000 died
Highest BUN tht survived 211 (Upper GI bleed + renal failure)
K 1.7 – died
but my all time favorite was one night in ICU as a resident:
Admission #1 pH 7.77 died (we suspect this was not correct though)
Admission #2 – found down, pH 6.66 (real) – died
Alcohol level: greater than 1000
Lived.
Highest TSH 610 (normal 0.5-5.0)
Na = 102 (died)
Co2 = 4 (died)
K = 1.7 and 10.2 (both lived)
Glucose = L = 12 H= 2200 (Both Lived)
CK = 250,000 (lived)
Lipase = 40,000 (LTFU – Transferred)
Hgb = 2.2 (ruptured ectoptic, Lived)
BP = 325/200 give or take 20 (Died)
HR = 14 ( that was unnerving ) Lived ( severe dig toxicity: > 10.)
pH = 6.7 / 7.4
BAL: 820 (slept comfortably in ED for 10hrs.) Had more than enough walkie / talkie 600’s.
109 years old. She lived.
I linked to this post. This is great stuff. Happy
Wow Shadowfax, >1000 ETOH. That guy (or gay) has some cajones!
Oh, I forgot, I had a patient that was 110 years old. I will post on her soon.
TSH 610 Scalpel? Did she/he look like the Michelin Man?
She had an obvious goiter, but her only complaints were slight dizziness and blurry vision.
Not the lowest ever, but an employee came in with weakness and tachycardia dressed in her work uniform (boss said ‘you look sick WTF’), Hgb 4.2 or something, HR 150, bp WNL. Aside from the pasty skin, you couldn’t tell anything was really wrong. Walking, talking, and chewing gum at the same time, etc. (Heme-pos stool for the curious—ie slow, compensated for GI bleed)
Temp – 109 Rectal (AFTER fairly aggressive cooling measures in the ambulance) – lived
Whitecap, ditto…109 Rectal after cooling measures in the ambulance…lived, but, his brain’s “like chicken soup.” Doc’s words, not mine.
Lowest glucose was 24…and he was talking, coherently! Frequent flier…when he died we all went to his funeral.
Oh yeah, I forgot about highest and lowest temperatures.
Highest: 110 degrees (survived but was in bad shape)
Lowest: 78 degress (died once we warmed him up)
Forgot about the glucose: 26 – talking coherently – we were doing a 72hr fast and he lasted about 18hr – huge insulinoma = whipple’s
My father was in the ICU for respiratory problems this summer. His CO2 was off the chart, and his Ph was 6.8 at one point… it scared the heck out of everybody.
He’s still breathing (much better) now, thanks to the folks at Denton Presbyterian.
Saw a patient in clinic today who walked in looking a little pale. His hemoglobin? 4.0. I thought that was the lowest I’ve ever seen until I repeated it. It came back as 3.6.
Serum creatinine of 29. Died.
I’ve seen a few pH levels below 7. People that critically ill usually go to a tertiary care facility, so I don’t know what happens to them.
My dad has chronically low sodium, as did my grandmother, and I appear to have it too. Both have been/were (Grandma died last year at 91) hospitalized for it; Grandma’s was once 120 and the doctor couldn’t believe she was talking to him. After that admission, my dad said, “Next time I see her at the nursing home, I’m going to give her nurse a bottle of salt tablets and tell her to make sure she takes them!” Uh, not so fast – you need a physician’s order for those!
Blood sugar >1500, more than once. Don’t remember what happened to them.
There’s no lowest entry for SBP? I was once called to review a patient post-op and asked for the vitals as I usually do. When the nurse told me the BP was 40/20 I nearly fainted and asked her to bring in the crash cart stat, until she convinced me the patient was sitting up in bed and said her BP was always like that. When I reached the ward, true enough, the patient was walking around with a SBP of 40-60!! I took it 5 times manually before I was convinced! She was on daily midodrine.
How about the smallest and largest patients you have had?
My hospital does not have a Level III NICU, but once in a while we have emergency micropreemie deliveries, and we had a 600-gram baby a few months ago. She was flown out and lived 3 days.
We’ve had a few 600-pound patients here too. Thing is, I once worked at a hospital that did bariatric surgery and the biggest patient I saw who had that done was around 350 pounds.
Smallest patient, 450g born in the ED. Lived for about an hour. Tough situation.
Largest, 875lbs. Wall of his house had to be knocked down before bringing him into the ED.
Highest Creatinine 28-lived.
Plts-7-was doing just fine clinically, healthiest patient on the ward (had ITP).
8am serum cortisol: 0.1 (normal 8-23)
Glad I didn’t get into a fender bender on the way to the lab. Eek.
Had a new lowest hemoglobin last night- 3. Will be fine. Got 4 units of PRBCs.
Also got an all time record pulse pressure. BP was 200/10. Yeah, you read that correctly. Was very septic, maxed on levophed and vassopressin, and all it was doing was raising her systolic, not doing squat for her diastolic.
She was being kept alive by “heroic” measures when I last saw her, but will surely die soon.
Wow, I guess my mom is lucky!! Potassium level upon admission 1.8, calcium of 20!! She was discharged after two weeks in hospital. Still don’t know what caused it.
Youngest mom: 13. Indian reservation, stepfather was FOB.
Oldest mom: 48. Seen this twice.
Grandest multipara: G18 P14 L15. Amish.
We have a bunch of low plt values from our oncology ward but three days ago we had one that we had to report out as zero it reached the linear low limit of our sysmex. It was pretty crazy. Surprisingly though she had Itp and not a leukemia
Had a patient with a blood pressure of 38/18. Confirmed by my partner. He was unconscious lying in a pool of diarrhea (the patient, not my partner) and he was hypoglycemic, had a bit of alcohol on board. Unresponsive to deep painful stimulus. Bounding radial pulses. Woke up with D50 and his BP returned to normal.
For blood alcohol levels we should break them down into chronic and occasional consumers of alcohol. I used to work in places with both a university and a bit of a skid row. We would have unconscious students with 300s, but conscious career drinkers with twice that level. The therapeutic level on some of the chronic drinkers is probably enough to knock some people out.
I was on Mag Sulfate and my levels came back at a 27, turns out the nurse drew it from the arm w/ the IV. Recheck was well within normal limits.
Highest weight-1267lbs on admit, down to 823 on d/c to a SNF–died the next day from MI.
I’m not actually a doctor, but my potassium was 1.2 when I was admitted in the ER, and I am still alive. I didn’t know there was anything wrong.
Highest CK 622,000 (survived)
Highest Myoglobin: 400,000
When I was intern at Kings County Hospital, Brooklyn, I diagnosed a patient with Chronic Pernicious Anemia who had disease undiagnosed for over 25 years. I received him as a patient following his collapse while wandering around in our Emergency room area. The lines in his hands were pure white (instead of red) and his nailbeds extremely white, obviously he had a severe anemia. His pulse over 150 and thready. Patient was unconscious during my initial exam and therapy, but given he was a 6.4 inch Norwegian (from the uniform he wore), with blond hair, blue eyes and with a thick tongue with loss of normal papillae, loss of normal knee reflexes, and extremely pale fingernail bed I, of course was pretty sure he was a “Classic” PA patient. I performed his Hb level three times and I could never get a reading over 1.2 gm. I did sternal marrow which showed innumerable megaloblasts. No normal human could survive a Hb of 1.2 for even a day, but this patient was able to reach this incredibly low level due to the many year chronicity of his disease reaching an unbelievable homeostatic state, that most would think incompatible with life which is why I am sharing this case with whomever.
I gave him 2 units concentrated blood, and injection Vt B12; 2-3 weeks later his retic count up to 48%. About 10 minutes after blood transfusion he regained consciousness and he was clearly psychotic, after he regained consciousness. I month later his Hb was about 11 & he was discharged from hospital, and very surprisingly he was no longer psychotic (not supposed to happen) and he told me he was going to return to Norway now that he had regained his “mind”. He was a former naval officer & wandered about the emergency room I had found out for many years during winter in a fecal stained Norwegian naval uniform on which he had pinned several ancient defunct watches. He thanked me, for savings his life and he told that he realized that he was probably insane for at least 15 years in the USA.
After giving him the 2 units of blood his Hb was about 5 gm, but I didn’t give him anymore, since I was afraid of possibly throwing him into heart failure and killing him with overzealous treatment. After all if he could get to 1.2 gm and still be alive a Hb of 5 was probably safe. I believe it would have been a great mistake to have tried to get him into a normal Hb range in too short a time (as in a few hours to a couple of days). He did most of the work with his own body following the Vt B12 shot. The hematologists said they had never seen a 48% reticulocyte count before either, perhaps another lab record, I don’t know.
Great case!! Perhaps a World’s record for lowest Hb level. I forgot what his hematocrit was as this incredible case of PA dates back to 1964.
I got Hep-A while traveling in the tropics. SGPT: 7000 u/l
Since I see this is still live:
alpha fetoprotein is a marker for some tumors but occurs in the blood anyway. In the language of the hospital concerned the normal level was below 1, anything over that was abnormal, 50 was pretty bad and 500 was a terminal diagnosis (usually liver mets) – can’t for the life of me remember the units, it was 16 years ago today. When they measured my husband’s it was nearly 50,000 (yes – fifty thousand), or at least in that sort of region as it could only be estimated by diluting the sample and that brings up all sorts of multiplying up problems. It was a mediastinal teratoma (usually testicular cancer but sitting nicely behind his sternum, just pushing the lungs to one side – very compliant, lungs). At the start of treatment it was about the size of a rugby football. After 9 lots of chemo the debris was removed at surgery together with a lot of lung tissue and any possible left-overs (no viable tissue found at histology) mopped up with radiotherapy. Symptoms before diagnosis – a bit of a cough until the day before admission when he coughed up some blood, probably due to the pressure being exerted on the lung, the tumor was outside the lung, which had been treated with 3 different antibiotics and asthma medication “try this because your peak flow is a bit low, must be asthma” – I kid you not!
Sixteen years on – survived, just rather deaf due to the chemo and still has a cough due to the radiotherapy-related fibrosis. To my knowledge hasn’t been written up as a case!!! But I think it was a success!
Granted I haven’t been doing this very long but we cathed an anuric gentelman the other day and removed 3800 cc of urine (severe prostatitis).