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Critical Values at University of Colorado Hospital

CRITICAL VALUES LIST

CRITICAL TESTS

Critical tests are called to the caregiver regardless of the result obtained. The Clinical Laboratory does not currently define any tests as "critical."

CRITICAL VALUES

Click here to review the University of Colorado Hospital "Critical Results/Values Notification and Documentation" policy.

TEST

LOW
Less than: <

Less than or equal to: ≤

HIGH
Greater than: >

Greater than or equal to: ≥

Absolute Neutrophil Count
See table below for Oncology exceptions.

<1.0 x 109/L

 

Acetaminophen

 

≥40.0 ug/mL

AFB Culture or Smear, Cerebrospinal Fluid

 

Positive

Amikacin trough

 

>10 ug/mL

Antibody, red blood cell, unexpected and clinically significant, STAT and surgical blood transfusions

 

Positive

Antithrombin III Activity

<20 U/dL

 

APTT

 

>119.9 seconds

Bicarbonate (HCO3), arterial blood gas

≤12 mmol/L

≥40 mmol/L

Bilirubin, total (newborns 0-1 month)

 

≥20.0 mg/dL

Blood Culture

 

Positive

Blood culture, blood product associated with transfusion reaction

 

Positive

Blood parasites (Malaria, Babesia, Microfilaria, Trypanosomes, etc.)

 

Positive

Calcium

<6.0 mg/dL

>12.0 mg/dL

Carbamazepine

 

≥15.0 ug/mL

Carboxyhemoglobin

 

≥12%

CO2

≤9 mmol/L

≥40 mmol/L

CO2, total (tCO2), arterial blood gas

≤12 mmol/L

≥40 mmol/L

Coagulation Factor Activities ( II, V, VII, VIII, IX, X, XI, XII and vWF)

<20 U/dL

 

Cryptococcal Antigen

 

Positive

Culture, following sources:

  • Any source (Acanthamoeba, Naegleria, Balamuthia, Nocardia, partial acid fast organisms only)
  • Blood
  • CSF
  • Eye (Gram negative rod only)

 

Positive

Cyclosporine

 

>400 ng/mL

Digoxin

 

≥3.0 ng/mL

Ethanol

 

≥400 mg/dL

Ethylene glycol

 

≥3 mg/dL

Factor Inhibitors

 

>0.5 U/mL

Fibrinogen       

<100 mg/dL

 

Gentamicin trough

 

≥2.00 ug/mL

Gentamycin peak

 

≥12.0 ug/mL

Gentamycin random

 

≥12.0 ug/mL

Glucose

≤40 mg/dL

≥500 mg/dL

Gram Stain, following sources:

  • Body fluids (ascites, CSF, paracentesis, peritoneal)
  • Tissues (brain, epidural, eye, heart)
  • Specimens submitted from Surgery
  • Blood products associated with  transfusion reaction

 

 Positive

Hematocrit
See table below for Oncology  exceptions.

<24 %

>60%

Hemoglobin
See table below for Oncology exceptions.

<8 gm/dL

>20 gm/dL

Heparin Associated Platelet Antibodies

 

Positive

Heparin Level

 

>1.2 U/mL

INR

 

≥6.0

Ionized Calcium

≤0.75 mmol/L

≥1.66 mmol/L

Isopropanol

 

5 mg/dL

Ketones (infants under 6 months old)

 

3+

Lidocaine

 

>9 ug/mL

Lithium

 

> 1.5 mmol/dL

Low Molecular Weight (LMW) Heparin Level

 

≥1.7 U/mL

Magnesium

≤1.2 mg/dL

≥6.0 mg/dL

Methanol

 

>5 mg/dL

Methemoglobin

 

≥3.0%

Methotrexate

 

24 Hour: >5 µmol/L

48 hour: >0.5 µmol/L

pCO2

≤20 mmHg

≥70 mmHg

PCR, following sources (viruses):

  • CSF
  • Blood (HSV, VZV, Parvovirus, Enterovirus)
  • Amniotic
  • Peritoneal
  • Pleural fluid
  • Eye including conjunctiva, aqueous vitreous
  • BAL (CMV, EBV, VZV)
  • Tissue biopsy other than skin

 

Positive

Pentobarbital

 

>50 ug/mL

PH, Arterial

≤7.200

≥7.600

Phenobarbital

 

≥50.0 ug/mL

Phenytoin

 

≥30.0 ug/mL

Phenytoin, Free

 

≥4.0 ug/mL

Phosphorus

≤1.0 mg/dL

 

Plasminogen

<20 U/dL (>6 months)

<10 U/dL (0-6 months)

 

Platelets
See table below for Oncology exceptions.

<50 x 109/L

>600 x 109/L

PO2, Arterial

≤39 mmHg

 

Potassium

≤2.5 mmol/L

≥6.4 mmol/L

Propylene glycol


≥5 mg/dL

Protein C Activity

<20 ug/dL (>4 years)

<10 ug/dL (0-4 years)

 

Protein C Clot

<20 ug/dL

 

Protein S Clot

<20 ug/dL

 

Protein S Free

<20 ug/dL

 

Protein S Total

<20 ug/dL

 

Reducing Substances (infants under 6 months old)

 

Positive

Salicylate

 

≥40.0 mg/dL

Sirolimus

 

>30 ng/mL

Sodium

≤120 mmol/L

≥160 mmol/L

Tacrolimus

 

>25 ng/mL

Theophylline

 

≥30.0 ug/mL

Thiocyanate

 

>50 ug/mL

Tobramycin trough

 

≥2.0 ug/mL

Transfusion reaction investigation, hemolytic

 

Positive

Triglycerides

 

≥1500 mg/dL

Triglycerides (Dermatology Clinic only)

 

≥800 mg/dL

Valproic Acid

 

≥150.0 ug/mL

Vancomycin, random and peak

 

≥80.0 ug/mL

Vancomycin, trough

 

≥35.0 ug/mL

Viral culture, following sources:

  • CSF
  • Blood
  • Amniotic
  • Peritoneal
  • Pleural
  • Eye (conjunctiva, aqueous vitreous)
  • Tissue biopsy other than skin

 

Positive for CMV, HSV, VZV, or Enterovirus

Viral culture, source BAL

 

Positive for CMV, HSV, or VZV

WBC
See table below for Oncology exceptions.

<1.5 x 109/L

>30 x 109/L

Critical Values - Oncology Patients Only

Results called when criteria met Results are always called
WBC ANC Platelets Hemoglobin Hematocrit
<1.5 x 109/L <1.0 x 109/L <25 x 109/L <7 gm/dL <21%
>30 x 109/L   >600 x 109/L >20 gm/dL >60%

 

WBC and ANC (Absolute Neutrophil Count) are called to Oncology healthcare providers when:

  1. It is the first time the critical value is detected on the patient.
  2. The patient has not had a similar critical value within the previous 24 hours.
  3. The test was not ordered in the previous 24 hours.
  4. Previous result within 24 hours was not a critical value. (The patient's result has changed from a critical value to a non-critical value, then back to a critical value.)

Positive test results considered significant, but not defined as critical will be called to the care provider on the same day that the results are available. These results are:

  • D-dimer (Outpatients only; excludes patients in Emergency Department) ≥ 500 ng FEU/mL
  • Positive AFB smears
  • Positive AFB cultures other than M. gordonae
  • Positive Coccidioides immitis, Blastomyces dermatidis, or Histoplasma capsulatum DNA probes
  • Positive cultures for bacteria and fungus from body fluids and tissues (normally sterile sites)
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