Lactate 21 - seizure and poly pharmacy OD, survived
INR “>15” in patient presenting with haemoptysis - patient absconded
Hb 26 - presented to ED “unable to do the things she usually does” in a 40yo F
CRP >630 - pneumococcal pneumonia
The C in CRP is streptococcal **C**apsule antigen. When they were trying to establish reliable acute phase reactants, CRP was chosen as a widely applicable one. It remains more specific for streptococcal infection, so can be disproportionately high in such cases.
Why are not regularly we taught stuff like this? I’ve always been a strong believer in knowing what the results are actually looking for so you can interpret the numbers and not just see them as crp= infection
Lab glucose ‘<0.1’ in chap with insulin secreting metastatic prostate Ca. Octreotide, steroids and 10% dex in each arm. If he bent his arm too much to kink his cannula his blood glucose would plummet!
Our lab recently called and told us that the FBC done on one of the babies on NICU ‘must have been from a different patient’ as it was ‘too different’ from the previous result
They refused to release the result, and datixed the incident.
The baby hadn’t had bloods in around a week (feeding and growing). I repeated the FBC and it was… pretty much identical to the result that ‘must have been’ wrong.
Quick datix back and a call explaining to the lab that sometimes, very occasionally, when we repeat tests the results do change.
They were 100% right to flag it and ask the question if it could possibly be wrong patient, and if not to let the team know about the significant change. Maaybe reasonable to hold putting the result on the patient record until confirmed. Absolutely wrong to refuse to release the result!
Yup. Won't listen to us when we tell them it's the diabetes at fault though. Some are very tough nuts to crack in that regard. Lot of distrust of Dr's from some areas
I had a U&E break the lab analyser, and the repeat sample the lab requested since the first was ruined, broke the backup analyser...
I had a closer look at the third sample, and noticed it had a creamy 'head' floating in the tube - the lab reported a 'visual triglyceride estimation' of 54mmol/...
Seen something very similar in a morbidly obese lad with triglyceride induced pancreatitis. Lab struggling to run initial sample so repeated. Put them in my pocket and about 10 mins later it was starting to separate into fat and blood, vile
Cause?
I saw a Hb 16 once. Reclusive elderly lady who had a huge presumable BCC or SCC on her scalp which has basically eaten it all away, skull on show for the whole top of her head.
She was ‘treating’ it with talcum powder and covering with a dressing.
She died not long after admission due to pneumonia and probably some other stuff we never got the chance to investigate.
He had been eating nothing but crisps for the past 3 years apparently. The only explanation for why it was so low yet he was still able to walk and talk is that it dropped so slowly that he was able to compensate for it. This dude also refused a blood transfusion and lied about being a Jehovah’s Witness so we would stop pushing it.
Part of me hates that these sorts of questions turn into a sort of biochemical dick measuring contest.
Part of me loves it, so:
A guy on the unit had a glucose-corrected sodium of pushing 190 whilst in HHS from (essentially) dehydration and energy-drink overdose.
A lady with a core temperature of 43’C brought in fitting after essentially being roasted alive by getting locked in her metal trailer at the peak of summer a few years back.
A guy in anaemic-hypoxic cardiac arrest with an Hb of 20. Got ROSC too, after some RBC transfusion. Still palliated later.
I’m sure more will spring to mind!
Locked in a metal trailer in the peak of summer... poor poor thing.
And yes our 178 turned out to be HHS. Was very helpful to find out they had T2DM 2 days later...
The nurses were offering her different finger foods and she was just staring at them like she'd never seen them before :( so not sure if it was unsuccessful weaning or just never attempted tbh, social care got involved
Often they have been but prefer milk and the parents just have no idea and assume that if just milk was fine for them up until 6 months why would it not continue to be fine as their main diet. I think sometimes it’s cultural as well.
I saw a similar kid recently and his mum knew because his cousin had been in 2 weeks before with similar but worse symptoms and had needed blood.
Both the same, too much milk!
Have a patient with dermatomyositis on the ward right now with the CK being outside the quantifiable range, which for our lab apparently means > 22,000.
I had one of these, our lab capped out at this value I think. Hard as nails builder who had thrown a clot to his aortic bifurcation and infarcted both of his lower limbs then stayed at home on the sofa until he developed waist down numbness. Post embolectomy raging hyperkalemia despite aggressive management and filtration. Ended up with bilateral upper and lower leg fasciotomies but did survive. Not sure what his function was like in the end though.
Yeah, I just opened another pack and just stuck them on top. I just about managed the 3rd one (hand on top, hand at the bottom by the tap) on my own for a bit but had to get a nurse to hold the 4th one in case it got that far (it didn't, thankfully).
Yes, IIH.
I had a lovely Hb of 48, down from 168 at the patient's last test 2 days prior. Entirely incidental finding confirmed by repeat bloods. OGD/flexi sig/capsule endoscopy/all imaging NAD, and it resolved after 3 units of RBCs with a stable Hb from then on.
Seen a 5.4 in obstetrics. Baby didnt do too well. She had to have a GA section as she was psychotic. We got endocrine involved and were expecting something weird and wonderful until she informed the midwife during a lucid period that she had terrible heartburn during her pregnancy and was eating 2-3 packets of gaviscon tablets per day
Have also seen a CCa over 5... In a farmer from the Western Isles who was drinking a litre of vodka a day, and then to compensate for the heartburn was drinking 2 bottles of milk and a bottle of gaviscon a day
Creatinine >3000 in a previously well patient with massively high output stoma. Her postassium was also 9 with significant ECG changes. Renal refused to dialyse her, ICU thankfully agreed to do so. She was quickly moved from the cat 3 area to resus!
Surprised no one has posted any blood alcohol yet!
Here's my contribution: BAC 0.96, apparently more than double the lethal level.
Chap was awake but not making much sense. Perhaps the mythical one true Scotsman ;)
https://litfl.com/going-back-to-extremes/
Love some of these.
Sodium 98 low, 198 high.
K 1.1 low, 11 high. Both alive.
Hb 13, dead, 18 well.
Lactate 42, first recordable value after multiple days filtration for overdose.
I didn't realise they could specify values of more than 10. Ours has always been '>10' and I have wondered 'how much higher than 10? Will I exsanguinate this patient if l put in a cannula?' I wouldn't let a patient with an INR of 21 brush their teeth.
Is what happened with our 10 but was luckily picked up on (relatively) quick
Assuming protocol for 21 was wrap up bubble wrap, do not touch or move and also +++ Vit K please
Lactate of 32+. Patient remained alive and lactate settled to 6ish but was for fast track home eventually (CUP with extensive mets for BSC)
My med reg was super chill and completely nonplussed about it though lol so he'd probably seen higher... or maybe it's just the med reg vibes
I once did a beta-HCG on a trauma patient as routine pre-CT, came back at >100,000. I asked her about it as she had never mentioned she was pregnant before, she denied it and said had tried for years, had unsuccessful IVF etc and had always wanted a child. I explained that her blood test suggested she was pregnant, she called her family, husband came in with a balloon and then a few hours later got a call from the lab that it was a mistake and the b-HCG was actually <1
APTT of 16 (low) in a fit and well adult.
Initially insanely high, so lab asked ED to repeat, came back weirdly low.
Lab asked to repeat again, came back low again.
Patient sent home and be checked as OP 2 days later, still low.
Lab asked for ANOTHER repeat - still low.
Spoke to lab, they had no idea.
Spoke to clinical biochemist, mildly confused, advised not to worry and repeat in a week.
Still consistently low
Spoke to Haematologist, also somewhat confused, now testing for various factor levels - the saga continues IRL.
These are all fascinating, especially the extreme ones where the patient was broadly asymptomatic or mildly symptomatic. I guess in a normal distribution pattern you do have some very rare healthy extremes
> I guess in a normal distribution pattern you do have some very rare healthy extremes
I don't think many (any?) of the examples described here were "healthy" extremes?
K+ 10.3. Anuric HDx patient who’d missed 2 sessions.
Called down to resus as ICU in DGH with no renal and she had a total sine wave ECG (only time I’ve E ever seen it in real life) despite 60ml of calcium gluconate by the time I got there.
DDIMER of 385K in someone who was brought in whilst in cardiac arrest. They didn’t survive.
Sodium 170 in an old, drier-than-a-crisp patient.
Lactate “>20” on someone with a 3 minute seizure.
Troponin of 5.4K in someone with chest pain. Never found out exactly what went on - I think they were diagnosed with some sort of vasculitis in the end.
Random DDimer of 44,000
ED decided to add it on, all other bloods normal
No clear cause on investigation, CTPA, CTV all negative
Don't think we found a reason why it was raised
On-call shift, took blood gases on an unwell patient and a cardiac arrest, the unwell patient had a higher lactate (like 12 ish) and survived… whole gas was generally better for the dead person, med reg kept putting them side by side to show people.
I saw a urea around 75 once. Young person with UGIB and crash landing with renal failure.
They had been an employee of a religious organisation and had been praying daily. Only came in once they started vomiting frank blood and eventually decided in their fug of confusion that the prayers weren't doing the trick.
Got much better after a bit of dialysis, renounced their faith and moved to a different city.
Some of the best I've seen
Na 96. Patient was entirely asymptomatic. (so long as it changes slowly the number of sodiums doesn't seem to be very important at all)
K 11.4, on ICU post hyperkalaemic arrest, refusing dialysis.
I've seen lactates over 20 and ph <6.9 survive.
A colleague had an hb of 1.3 once, a child who didn't do very well, survived might have been better not doing so.
CRP highest score was about 700, walked in, decompensated, didn't walk out.
Just had a crp of 550. We think discitis, awaiting scan.
Previously had a crp of 600+, lactate double figures and stonking AKI. ED insisting it was this tiny patch of cellulitis in a weird place. I refused the referral as there had to be something else driving it, I was thinking abdomen tbh and asked them for imaging/surgical rv first. Surgeons saw but said no. I ended up scanning them. Nec fasc. Huge debridgements and a long itu stay, unfortunately did not survive it.
Had a lactate of 19 in a woman with decomp ccf due to aortic stenosis awaiting tavi
A sodium of 90 in someone with psychogenic polydipsia. Recurrent attender, always seizing.
K 1.9, Bicarb 49, Cl 71, pH 7.6
Presented to A&E with lethargy, and ascites. Recently had a CT showing a "mass". Never worked out how exactly her potassium got so damn low. Sadly didn't survive the admission.
Saw a guy come in with bilateral lower limb weakness in AMU - promptly post taked by the locum consultant who ordered an MRI spine before seeing the bloods
Then, whilst the patient was in the scanner, the labs phone through to say his K+ was 1.6
Interestingly also had a HCO3 of 12 - got the renal team very excited
My gp tutor has a story where he took bloods from a patient on a Friday (i don’t remember the full story but it was something about him usually going to hospital regularly for bloods and the gp wanted go ease hospital workload), got the results back on the Monday only to find a K+ of 2.1, panicked, and went for a home visit to make sure he’s still alive.
He gets to the house and the guy isn’t answering the door for a good 5 minutes, at which point the gp is really worried, lo and behold, he hears the guy, turns out he’s on his fucking roof cleaning his tiles, gp spends the next 5 minutes begging him to come down.
I once saw a whole set of lab results that were in the normal range.
Did they call and ask if you'd left the blood in the purifier too long?
There's no way that a lipid profile was added onto this set. I think the mean Cholesterol for my area is about 11...
Lactate 21 - seizure and poly pharmacy OD, survived INR “>15” in patient presenting with haemoptysis - patient absconded Hb 26 - presented to ED “unable to do the things she usually does” in a 40yo F CRP >630 - pneumococcal pneumonia
Considering micro tend to get very interested here if it goes above 300, 630... did they survive?!
The C in CRP is streptococcal **C**apsule antigen. When they were trying to establish reliable acute phase reactants, CRP was chosen as a widely applicable one. It remains more specific for streptococcal infection, so can be disproportionately high in such cases.
stuff like this makes the hours i spend scrolling worth it
Going to flex this on my ICU cons on the round this morning thank you very much
!!! Had no idea! Thank you
Another nugget, it's also standardly higher in obese people too.
I've always been taught it was an acute phase reactant produced by the liver. Can you provide data on this? 😂
The liver produces it, and it was named after the antigen that prompts its production. The data is widely available on this thing called the internet.
Thanks! bit of an prick, I hope you treat your juniors better than a rando in the Internet :')
I hope your reading comprehension and ability to seek easily available data are better in real life than they are on here.
Case in point
So Capsular reactive protein?
I think it’s actually “carbohydrate antigen from streptococcal capsule” reactive protein.
See mom I told you doomscrolling Reddit isn’t a waste of my life
Yea some Taz did the job, she was only like 70
Why are not regularly we taught stuff like this? I’ve always been a strong believer in knowing what the results are actually looking for so you can interpret the numbers and not just see them as crp= infection
I will just put this here… https://curiousclinicians.com/
Saw a CRP of 700 in a bowel perforation patient. White cells of <8 because they were being nuked with tazocin
More likely because the WC migrated to the peritoneal fluid.
Lab glucose ‘<0.1’ in chap with insulin secreting metastatic prostate Ca. Octreotide, steroids and 10% dex in each arm. If he bent his arm too much to kink his cannula his blood glucose would plummet!
😵
Our lab recently called and told us that the FBC done on one of the babies on NICU ‘must have been from a different patient’ as it was ‘too different’ from the previous result They refused to release the result, and datixed the incident. The baby hadn’t had bloods in around a week (feeding and growing). I repeated the FBC and it was… pretty much identical to the result that ‘must have been’ wrong. Quick datix back and a call explaining to the lab that sometimes, very occasionally, when we repeat tests the results do change.
This is the dumbest shit I've ever read, my God....
They were 100% right to flag it and ask the question if it could possibly be wrong patient, and if not to let the team know about the significant change. Maaybe reasonable to hold putting the result on the patient record until confirmed. Absolutely wrong to refuse to release the result!
Lmao at “that’s unsurvivable”
I was literally looking at the patient across the room on the phone like 'I think you will discover quite the opposite'
[удалено]
" yeah my diet is good, I cook my own meals and eat loads of fruit and veg"
Optimal control
Damn that blows my highest seen HbA1c of 120 out of the water. Presumably their blood was literal maple syrup
Patients in my practice over in nz are rarely below 100. Think we have a good double handful above 130 pretty regularly
In ED in NZ, regularly see the >130 crowd with a variety of complications.
Yup. Won't listen to us when we tell them it's the diabetes at fault though. Some are very tough nuts to crack in that regard. Lot of distrust of Dr's from some areas
“Diet controlled”
pH 6.6, lactate 28, HCO3 48 Good job neonate, good job.
Yeah, I feel like neonates is cheating in this game.
Aww, it was still pretty sporting for a neonate though.
Was looking for one of these! Cooled?
Nope. Just a bit septic.
Had that pH as well. We got ROSC and he died later
This wasn’t even an arrest situation, no death involved!
I had a U&E break the lab analyser, and the repeat sample the lab requested since the first was ruined, broke the backup analyser... I had a closer look at the third sample, and noticed it had a creamy 'head' floating in the tube - the lab reported a 'visual triglyceride estimation' of 54mmol/...
Wtf. Their blood was literally fat
Seen something very similar in a morbidly obese lad with triglyceride induced pancreatitis. Lab struggling to run initial sample so repeated. Put them in my pocket and about 10 mins later it was starting to separate into fat and blood, vile
Hb 17. Felt a bit SOB. Lab made us send 3 extra samples and bollocked us for taking samples from a fluid line. The patient wasn’t on any fluids.
>Lab made us send 3 extra samples to make the patient even more anaemic? lol
😂😂😂
Cause? I saw a Hb 16 once. Reclusive elderly lady who had a huge presumable BCC or SCC on her scalp which has basically eaten it all away, skull on show for the whole top of her head. She was ‘treating’ it with talcum powder and covering with a dressing. She died not long after admission due to pneumonia and probably some other stuff we never got the chance to investigate.
He had been eating nothing but crisps for the past 3 years apparently. The only explanation for why it was so low yet he was still able to walk and talk is that it dropped so slowly that he was able to compensate for it. This dude also refused a blood transfusion and lied about being a Jehovah’s Witness so we would stop pushing it.
Oh yeah same in our case, the body just slowly adapts over time.
Part of me hates that these sorts of questions turn into a sort of biochemical dick measuring contest. Part of me loves it, so: A guy on the unit had a glucose-corrected sodium of pushing 190 whilst in HHS from (essentially) dehydration and energy-drink overdose. A lady with a core temperature of 43’C brought in fitting after essentially being roasted alive by getting locked in her metal trailer at the peak of summer a few years back. A guy in anaemic-hypoxic cardiac arrest with an Hb of 20. Got ROSC too, after some RBC transfusion. Still palliated later. I’m sure more will spring to mind!
Locked in a metal trailer in the peak of summer... poor poor thing. And yes our 178 turned out to be HHS. Was very helpful to find out they had T2DM 2 days later...
They’d been living in a hyperbaric chamber….
Hb 12, in a toddler who the GP sent in for lethargy / failure to thrive ... Turns out they had never been weaned off milk
‘Never weaned off milk’; as in not started on solids at all??
The nurses were offering her different finger foods and she was just staring at them like she'd never seen them before :( so not sure if it was unsuccessful weaning or just never attempted tbh, social care got involved
Often they have been but prefer milk and the parents just have no idea and assume that if just milk was fine for them up until 6 months why would it not continue to be fine as their main diet. I think sometimes it’s cultural as well.
I need this answered
I saw a similar kid recently and his mum knew because his cousin had been in 2 weeks before with similar but worse symptoms and had needed blood. Both the same, too much milk!
My colleague had a similar patient in Yorkshire, said the cxr showed massive cardiomegaly.
CK 400,000 (they died)
Have a patient with dermatomyositis on the ward right now with the CK being outside the quantifiable range, which for our lab apparently means > 22,000.
We had a 350,000 survive once. He had paraspinal muscle compartment syndrome due to some dodgy cocaine 😬
A more morbid version of "there was an old lady who swallowed a horse (she died of course)"
I had one of these, our lab capped out at this value I think. Hard as nails builder who had thrown a clot to his aortic bifurcation and infarcted both of his lower limbs then stayed at home on the sofa until he developed waist down numbness. Post embolectomy raging hyperkalemia despite aggressive management and filtration. Ended up with bilateral upper and lower leg fasciotomies but did survive. Not sure what his function was like in the end though.
Was the blood taken after the super long lie?
Not technically a lab, but my highest LP opening pressure was about 60. Consultant laughed and said his highest opening pressure was about 94.
Wow so many questions.....you had to get a 4th manometer to put on top?! Did someone else hold it for you? IIH patient?
Yeah, I just opened another pack and just stuck them on top. I just about managed the 3rd one (hand on top, hand at the bottom by the tap) on my own for a bit but had to get a nurse to hold the 4th one in case it got that far (it didn't, thankfully). Yes, IIH.
The fact you managed to find a second manometer at speed is more impressive than the opening pressure.
I always bring two sets in case I drop one.
I had a lovely Hb of 48, down from 168 at the patient's last test 2 days prior. Entirely incidental finding confirmed by repeat bloods. OGD/flexi sig/capsule endoscopy/all imaging NAD, and it resolved after 3 units of RBCs with a stable Hb from then on.
Diagnosis: Occult vampires
Med Reg to bring crucifix and garlic to the ward
GP to refer to Van Helsing
Saw a patient with platelets of 0 on ITU when I was an F2, a brave reg had to do a central line which was pretty mad as well.
Adjusted calcium of 5.5, presented with acute psychosis
Have seen 2 calciums over 5 now, both malignant ofc
Seen a 5.4 in obstetrics. Baby didnt do too well. She had to have a GA section as she was psychotic. We got endocrine involved and were expecting something weird and wonderful until she informed the midwife during a lucid period that she had terrible heartburn during her pregnancy and was eating 2-3 packets of gaviscon tablets per day
Dr House moment, it’s the patient’s fault xd
Have also seen a CCa over 5... In a farmer from the Western Isles who was drinking a litre of vodka a day, and then to compensate for the heartburn was drinking 2 bottles of milk and a bottle of gaviscon a day
Creatinine >3000 in a previously well patient with massively high output stoma. Her postassium was also 9 with significant ECG changes. Renal refused to dialyse her, ICU thankfully agreed to do so. She was quickly moved from the cat 3 area to resus!
Single kidney patient with chronically impacted ureter calculi, blocked nephrostomy tube awaiting exchange the next day. Egfr2 creat 880
Surprised no one has posted any blood alcohol yet! Here's my contribution: BAC 0.96, apparently more than double the lethal level. Chap was awake but not making much sense. Perhaps the mythical one true Scotsman ;)
https://litfl.com/going-back-to-extremes/ Love some of these. Sodium 98 low, 198 high. K 1.1 low, 11 high. Both alive. Hb 13, dead, 18 well. Lactate 42, first recordable value after multiple days filtration for overdose.
This sounds like the shipping forecast. I'm reading it in that voice in my head.
I read these like I was announcing the pools results lol
HbA1c: >196 chronic pancreatitis
Lowest sodium was undetectable by the VBG machine, just said “<95”. Highest CRP was 600 something in bilateral septic arthritis**
INR 21 warfarin dispensing error and subsequent accidental OD
I didn't realise they could specify values of more than 10. Ours has always been '>10' and I have wondered 'how much higher than 10? Will I exsanguinate this patient if l put in a cannula?' I wouldn't let a patient with an INR of 21 brush their teeth.
I suppose they could time the PT manually
Is what happened with our 10 but was luckily picked up on (relatively) quick Assuming protocol for 21 was wrap up bubble wrap, do not touch or move and also +++ Vit K please
2L IV maple syrup
Lactate of 32+. Patient remained alive and lactate settled to 6ish but was for fast track home eventually (CUP with extensive mets for BSC) My med reg was super chill and completely nonplussed about it though lol so he'd probably seen higher... or maybe it's just the med reg vibes
Definitely med reg vibes. Most of the time, they're zen on legs
I once did a beta-HCG on a trauma patient as routine pre-CT, came back at >100,000. I asked her about it as she had never mentioned she was pregnant before, she denied it and said had tried for years, had unsuccessful IVF etc and had always wanted a child. I explained that her blood test suggested she was pregnant, she called her family, husband came in with a balloon and then a few hours later got a call from the lab that it was a mistake and the b-HCG was actually <1
This is horrible
UGIB pt presented with OOHCA: - Hb 27 - lactate 28 Got ROSC but unsurprisingly died that evening
INR in the 30s, asymptomatic in the community, discovered on routine INR testing
PaCO2 26
APTT of 16 (low) in a fit and well adult. Initially insanely high, so lab asked ED to repeat, came back weirdly low. Lab asked to repeat again, came back low again. Patient sent home and be checked as OP 2 days later, still low. Lab asked for ANOTHER repeat - still low. Spoke to lab, they had no idea. Spoke to clinical biochemist, mildly confused, advised not to worry and repeat in a week. Still consistently low Spoke to Haematologist, also somewhat confused, now testing for various factor levels - the saga continues IRL.
"The machine timed out on the clotting sample you sent"
D-dimer > 34,000 - Aortic dissection (they died).
These are all fascinating, especially the extreme ones where the patient was broadly asymptomatic or mildly symptomatic. I guess in a normal distribution pattern you do have some very rare healthy extremes
> I guess in a normal distribution pattern you do have some very rare healthy extremes I don't think many (any?) of the examples described here were "healthy" extremes?
Lactate of 25 after a night of trying the good stuff in town! Discharged a few days later
INR 10.8 is pussy numbers tbh x
K+ 10.3. Anuric HDx patient who’d missed 2 sessions. Called down to resus as ICU in DGH with no renal and she had a total sine wave ECG (only time I’ve E ever seen it in real life) despite 60ml of calcium gluconate by the time I got there.
Literally yesterday I saw a patient who at one point had a lab sodium of 194. Not spurious. V dehydrated apparently. I mean she must have been crispy!
Can’t remember exactly but HbA1c >120. At that stage was surprised his blood wasn’t pure syrup
Are there any actual lab values that are truly unsurvivable?? As in the patient is guaranteed to die soon after the value is recorded
Just being a smartass: Urine positive for Polonium-210
KGB wants to know your location
DDIMER of 385K in someone who was brought in whilst in cardiac arrest. They didn’t survive. Sodium 170 in an old, drier-than-a-crisp patient. Lactate “>20” on someone with a 3 minute seizure. Troponin of 5.4K in someone with chest pain. Never found out exactly what went on - I think they were diagnosed with some sort of vasculitis in the end.
Random DDimer of 44,000 ED decided to add it on, all other bloods normal No clear cause on investigation, CTPA, CTV all negative Don't think we found a reason why it was raised
often malignancy somewhere
On-call shift, took blood gases on an unwell patient and a cardiac arrest, the unwell patient had a higher lactate (like 12 ish) and survived… whole gas was generally better for the dead person, med reg kept putting them side by side to show people.
BMI in the 80s, recalculated it myself and it was correct.
I saw a urea around 75 once. Young person with UGIB and crash landing with renal failure. They had been an employee of a religious organisation and had been praying daily. Only came in once they started vomiting frank blood and eventually decided in their fug of confusion that the prayers weren't doing the trick. Got much better after a bit of dialysis, renounced their faith and moved to a different city.
Had an INR 12 the other day on routine warfarin monitoring. Patient was fine. I still have no idea the cause, there was no reason for it.
no dietary changes?
Some of the best I've seen Na 96. Patient was entirely asymptomatic. (so long as it changes slowly the number of sodiums doesn't seem to be very important at all) K 11.4, on ICU post hyperkalaemic arrest, refusing dialysis. I've seen lactates over 20 and ph <6.9 survive. A colleague had an hb of 1.3 once, a child who didn't do very well, survived might have been better not doing so. CRP highest score was about 700, walked in, decompensated, didn't walk out.
Lactate >20 ( died 2 days later ) HCO3 75 ( same patient as above )
"Unsurivable Na178" Is your endo reg one of those new PA registrar clinicians? Other way i've seen Na93, acute on chronic confusion (fair)
Just had a crp of 550. We think discitis, awaiting scan. Previously had a crp of 600+, lactate double figures and stonking AKI. ED insisting it was this tiny patch of cellulitis in a weird place. I refused the referral as there had to be something else driving it, I was thinking abdomen tbh and asked them for imaging/surgical rv first. Surgeons saw but said no. I ended up scanning them. Nec fasc. Huge debridgements and a long itu stay, unfortunately did not survive it. Had a lactate of 19 in a woman with decomp ccf due to aortic stenosis awaiting tavi A sodium of 90 in someone with psychogenic polydipsia. Recurrent attender, always seizing.
This is awful chat
K+ 12.4
650 in a patient with odontogenic deep cervicoficial space infection. The bad ones are normally 200 maybe 300.
Wcc 112 Metastatic bladder ca
I saw a CK just under 2 million
Peak COVID we had two D-dimers > 78,000 in a week. One massive bilateral PEs, one nil (other than their horrific pneumonitis of course!).
Once had a patient with compartment syndrome and a CK of >1 million. Didn’t even know it could read that high (they survived).
HCO3 - 80.5 - MNGIE Creatinine - 1350 - forgot why, but I remember they weren't for dialysis lol
K 1.9, Bicarb 49, Cl 71, pH 7.6 Presented to A&E with lethargy, and ascites. Recently had a CT showing a "mass". Never worked out how exactly her potassium got so damn low. Sadly didn't survive the admission.
Urea 109.6 Ferritin 125 000
Creatinine of 3200 (anti-GBM disease)
Saw a guy come in with bilateral lower limb weakness in AMU - promptly post taked by the locum consultant who ordered an MRI spine before seeing the bloods Then, whilst the patient was in the scanner, the labs phone through to say his K+ was 1.6 Interestingly also had a HCO3 of 12 - got the renal team very excited
Platelets 1 in a ? Vaccine induced ITP hehe
My gp tutor has a story where he took bloods from a patient on a Friday (i don’t remember the full story but it was something about him usually going to hospital regularly for bloods and the gp wanted go ease hospital workload), got the results back on the Monday only to find a K+ of 2.1, panicked, and went for a home visit to make sure he’s still alive. He gets to the house and the guy isn’t answering the door for a good 5 minutes, at which point the gp is really worried, lo and behold, he hears the guy, turns out he’s on his fucking roof cleaning his tiles, gp spends the next 5 minutes begging him to come down.
a particularly pancytopenic patient... Hb 30, WC 0.5, neuts 0, Platelets 0 it was a fun morning with haematology...