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Critical/Panic Values of Blood Chemistry, Hematology, Urine, Hormones and Serology

March 5, 2024Chemical pathologyLab Tests

Table of Contents

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  • Critical/Panic Values
      • What are the Panic or critical values?
    • What are common Critical/Panic Values?
    • Critical/Panic Values

Critical/Panic Values

What are the Panic or critical values?

  1. This is the list of the critical or panic values that need immediate action.
  2. Critical values may indicate prompt clinical intervention and treatment.
  3. These critical values are also called action values or automatic call-back values.
  4. Should inform the hospital or the requesting doctor.
Critical/Panic Values: Laboratory critical values and policy

Critical/Panic Values: Laboratory critical values and policy

What are common Critical/Panic Values?

Laboratory test Normal values High Critical or panic value  Clinical effect of high-value  Low Critical or panic value  Clinical effects of low value
Chemical pathology Critical/panic values
 
Ammonia 11 to 36 µmol/L (15 to 50 µg/dL) >40 µmol/L Indicate hepatic damage None  
Amylase 25 to 125 U/L >200 U/L Indicate  acute pancreatitis None  
Lipase <160 U/L >500 U/L Indicate pancreatitis  
Arterial pCO2 35 to 45 mm Hg >75 mm Hg <20 mm Hg  
Arteria pO2 (adult) 80 to 105 mm Hg None <40 mm Hg  
Arterial pO2 (newborn) 60 to 70 mm Hg >92 mm Hg <37 mm Hg  
Arterial pH 7.35 to 7.45 >7.59 <7.10  
Bicarbonate (HCO3) 22 to 26 meq/L >40 meq/L Respiratory issues <6.0 meq/L Acidosis
Serum chloride (Cl) 98 to 106 mmol/L >120 mmol/L

Dehydration, hyperventilation,

Renal tubular acidosis

<70 mmol/L Vomiting, Diarrhea, Diabetic acidosis
Blood glucose level 65 to 110 mg/dL >450 mg/dL Hyperglycemiamia <40 mg/dL Hypoglycemia
Blood urea nitrogen (BUN) 7 to 18 mg/dL >100 mg/dL Uremia 2 mg/dL
Serum Calcium total 8.6 to 10 mg/L >13 mg/dL Cardiotoxicity, arrhythmias, and coma <6 mg/dL Tetany
Phosphorus 2.7 to 4.5 mg/dL (0.87 to 1.45 mmol/L) None <1.1 mg/dL
Serum creatinine 0.6 to 1.3 mg/dL >10 mg/dL Renal failure Decreased Renal disease, urinary tract obstruction, nephrotoxic drugs
Serum Potassium (K) adult 3.5 to 5.3 meq/L >7.0meq/L Arrhythmia <2.8 meq/L Arrhythmia
Serum potassium (K)  newborn <8.5 meq/L <2.5 meq/L
Serum Sodium (Na+) 135 to 145 meq/L >155 meq/L Cardiovascular collapse <120 meq/L weakness, neurologic symptoms
Magnesium 1.3 to 2.1 meq/L > 15 meq/L Cardiac arrest and respiratory paralysis <1.0 meq/L Tetany
Uric acid Male= 3.5 to 7.2 mg/dL Female=2.6 to 6.0 mg/dL High level Gout, renal failure Decreased level Fanconi syndrome, Wilson’s disease, liver disease
CK-MB <5% of the total or 5 ng/mL >5% or ≥10 µg/L Acute myocardial infarction None
Bilirubin (Total) 0.2 to 1.0 mg/dL
  1. >12 mg/dL in adults
  2. >15 mg/dL in newborn
  1. Jaundice
  2. Kernicterus
Cholesterol <200 mg/dL (adults) >240 mg/dL
LDL-cholesterol <100 mg/dL >160 mg/dL Atherosclerosis
HDL-cholesterol 40 to 60 mg/dL <40 mg/dL Heart diseases
Triglycerides <150 mg/dL >500 mg/dL Heart diseases
Hormones
T4 (in adults) Total 4.6 to 12 µg/dL >18.0 µg/dL
T4 (in newborn) >18.0 µg/dL <3.5 µg/dL
Hematology Critical/panic values
Hemoglobin (Hb)

Male = 10 to 17 g/dL

Female = 11.5 to 15.5 g/dL

>20 g/dL Polycythemia <7 g/dL Anemia
Hematocrit (Hct)

Male = 39% to 49%

Female = 33% to 43%

>60 vol% <20 vol%
Platelets count (adult) 130,000 to 450,000/cmm >1,000,000/cmm Thrombocytosis <50,000/cmm
Platelets count (pediatric) >100,000/cmm Thrombocytosis <20,000/cmm Thrombocytopenia
White blood cells (WBC) 3100 to 9000/cmm >30,000/cmm Leucocytosis <2000/cmm Leucopenia
Fibrinogen 200 to 400 mg/dL >700 mg/dL <100 mg/dL
Prothrombin time (PT) 11 to 14 seconds >30 seconds None
INR 1.0 to 1.5 >4.5 Bleeding tendency
Activated partial thromboplastin time (APTT) 25 to 38 seconds >100 seconds None
CD4+ lymphocytes 500 to 1000 cells/cmm <500 cells/cmm

Critical/Panic Values

Urine Critical/panic values
Parameters Interpretations
Black or brown urine Blood
Red urine (negative occult blood) Porphyria
Blood-positive (negative RBCs) Myoglobinuria
Glucose Strongly positive for:

  1. Glucose
  2. Ketones
Abnormal crystals
  1. Cysteine
  2. Leucine
  3. Tyrosine
  4. Urates
Urine culture Colony count >50,000/mL
Serology Critical/panic values
high-sensitivity CRP >3.5 mg/L Acute inflammation = >10 mg/L
Coomb’s test Positive direct and indirect
Serum test Positive for:

  1. Syphilis
  2. Hepatic virus profile
  3. AIDS
Blood crossmatch Positive
Rh-positive baby in Negative mother Immediate report for Rh-Gham (Rh-IgG)
Cerebrospinal fluid (CSF) Critical/panic values
Parameters Low value High value
Glucose <80% of the blood value
Protein None >45 mg/dL
White blood cells None >10/cmm
Special stain for bacteria positive Positive
Malignant cells Positive Positive
Microbiology (Bacteriology) Critical/panic values
Parameters Result
Gram stain If positive on any body fluids
Blood cultures Positive
AFB stain Positive from any site
Antigen detection Positive
India ink preparation from CSF Positive
Bone marrow smear positive for:

  1. Malaria
  2. Microfilaria
  3. Leishmaniasis
Surgical biopsy material Positive for pathogenic bacteria
Respiratory  culture Positive for pathogenic bacteria
Antigen detection Positive for:

  1. Group B streptococci
  2. Cryptococcus
  3. Haemophilus pneumoniae
  4. Streptococcus pneumoniae
  5. Neisseria meningitides
Bronchial washings
  1. Pneumocystis
  2. Fungal infection
  3. Viral cytopathic changes
Stool culture Positive for:

  1. Salmonella
  2. Shigella
  3. Vibrio
  4. Yersinia
  5. Campylobacter
Amniotic fluid critical/panic values
Parameters Result
Color This may be:

  1. Yellow color:
    1. Yellow due to increased bilirubin level
    2. fetal ascitic fluid contamination
    3. Maternal urine in accidental mother urinary bladder injury
    4. Yellow-brown from meconium
  2. Green color:
    1. It is due to biliverdin
  3. Red to brown color:
    1. Due to RBCs or Hb
    2. fetal Hb
  4. Bright red color:
    1. Intrauterine hemorrhage
    2. Intrauterine hemolysis
  5. Brown color:
    1. It is due to oxidized Hb from degenerated RBCs
  6. Brown-black:
    1. It is due to fetal maceration
Bilirubin level It is due to hemolytic disease of the newborn
Lecithin/sphingomyelin ratio <2.0
Chromosomal abnormalities
  1. Trisomy in Down syndrome
  2. Cri du chat syndrome
  3. Klinefelter’s syndrome
  4. Turner’s syndrome
Metabolic disorders
  1. Gaucher disease
  2. Fabry disease
  3. Niemann-Pick disease
  4. Gangliosidosis

Note: You may find some differences in the normal values in different books and references.

Possible References Used
Go Back to Chemical pathology

Comments

Trupti nandire Reply
January 25, 2023

Save to my account

Dr. Riaz Reply
January 25, 2023

You can subscribe to labpedia.net.

Dio Brando Reply
November 13, 2023

Thanks a lot, I appreciate so

Dr. Riaz Reply
November 13, 2023

Thanks.

Shridhan Reply
March 5, 2024

Useful values. Please review pediatric thrombocytosis value.

Dr. Riaz Reply
March 5, 2024

Critical values for pediatric group are the same as adult values.

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