Table of critical limits.Critical limits define the boundaries Natural or artificial separations or divisions between adjoining properties that show their limits. Boundaries are used to establish private and public ownership by determining the exact location of the points at which one piece of land is distinguishable from another. of the life-threatening Adj. 1. life-threatening - causing fear or anxiety by threatening great harm; "a dangerous operation"; "a grave situation"; "a grave illness"; "grievous bodily harm"; "a serious wound"; "a serious turn of events"; "a severe case of pneumonia"; "a life-threatening values of laboratory test results. Critical results, also called critical values, are those that fall outside the high and low critical limits. Urgent clinician clinician /cli·ni·cian/ (kli-nish´in) an expert clinical physician and teacher. cli·ni·cian n. notification of critical results is a responsibility of the laboratory. The system of critical value reporting was first implemented in a hospital by George D. Lundberg George D. Lundberg is a physician, board-certified pathologist, and, since February 1999, editor of Medscape . For 17 years prior to joining Medscape Dr. Lundberg served as editor of the JAMA. One month before joining Medscape Lundberg was dramatically fired from JAMA by E. , MD, and first published in MLO MLO Mycoplasma-like organism(s) in 1972. The tables presented here are based on three national surveys by Gerald Gerald - ["Gerald: An Exceptional Lazy Functional Programming Language", A.C. Reeves et al, in Functional Programming, Glasgow 1989, K. Davis et al eds, Springer 1990]. J. Kost
KOST (KOST 103.5 FM) is a radio station licensed to Los Angeles, California with a Soft AC musical format. It is owned by Clear Channel Communications. , MD, PhD, of the University of California, Davis The University of California, Davis, commonly known as UC Davis, is one of the ten campuses of the University of California, and was established as the University Farm in 1905. , Health System. Adapted with permission from his articles,(1-4) the tables summarize sum·ma·rize intr. & tr.v. sum·ma·rized, sum·ma·riz·ing, sum·ma·riz·es To make a summary or make a summary of. sum the critical limits used by 92 responding U.S. medical centers, including 20 trauma centers trauma center n. A medical facility that is designated to treat severe physical trauma as a result of the specialized training of its staff and the availability of appropriate diagnostic and treatment tools. , and 39 responding children's hospitals This is a list of children's hospitals. See also Pediatric Care. International
New South Wales
(statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. (SD) data are presented. The frequency with which critical limits were listed can be found in the original articles. As a rule of thumb, the "mean low" and "mean high" figures may be considered the critical limits for each test listed. Each institution should establish its own set of critical limits and clinician notification policy. Dr. Kost conducted an independent national survey of U.S. medical centers and children's hospitals to determine ionized i·on·ize tr. & intr.v. i·on·ized, i·on·iz·ing, i·on·iz·es To convert or be converted totally or partially into ions. i calcium calcium (kăl`sēəm) [Lat.,=lime], metallic chemical element; symbol Ca; at. no. 20; at. wt. 40.08; m.p. about 839°C;; b.p. 1,484°C;; sp. gr. 1.55 at 20°C;; valence +2. critical limits. (4) His extensive overview of critical limits and patient outcomes appeared in the March 1993 issue of MLO. (1) Readers are also encouraged to review general practice guidelines practice guidelines Medical practice A set of recommendations for Pt management that identifies a specific or range of range of management strategies. See Peer review organization, Practice standards. Cf 'Cookbook' medicine. . (5) The Joint Commission identifies critical values in current National Patient Safety Goals. Those goals are: 1. The hospital defines critical tests and critical results and values. 2. The hospital defines the acceptable length of time between the ordering of critical tests and reporting the results of these tests, whether normal or abnormal abnormal /ab·nor·mal/ (ab-nor´mal) not normal; contrary to the usual structure, position, condition, behavior, or rule. abnormal, adj . 3. The hospital defines the acceptable length of time for reporting the results of routine tests with critical abnormal values or findings. 4. The hospital defines the acceptable length of time between the availability of critical tests and critical results and values and receipt by the responsible licensed caregiver care·giv·er n. 1. An individual, such as a physician, nurse, or social worker, who assists in the identification, prevention, or treatment of an illness or disability. 2. . 5. The hospital collects data on the timeliness of reporting critical test results and critical results and values from routine tests. 6. The hospital assesses the data on the timeliness of reporting critical test results and critical results and values from routine tests and determines whether a need for improvement exists. 7. The hospital takes appropriate action to improve the timeliness of reporting critical test results and critical results and values from routine tests and measures the effectiveness of those actions. The [organization] measures, assesses, and, if needed, takes action to improve the timeliness of reporting, and the timeliness of receipt of critical tests and critical results and values by the responsible licensed caregiver.(6)
Adults (1)
Clinical chemistry Low limit
Test Units Mean (SD) Range
Glucose mmol/L 2.6 (0.4) 1.7 - 3.9
mg/dL 46 (7) 30-70
Potassium mmol/L 2.8 (0.3) 2.5-3.6
Calcium mmol/L 1.65 (0.17) 1.25-2.15
mg/dL 6.6 (0.7) 5.0-8.6
Sodium mmol/L 120 (5) 110-137
[Co.sub.2] content mmol/L 11 (2) 5-20
Magnesium mmol/L 0.41 (0.16) 0.21-0.74
mg/dL 1.0 (0.4) 0.5-1.8
Phosphorus mmol/L 0.39 (0.10) 0.26-0.65
mg/dL 1.2 (0.3) 0.8-2.0
Bilirubin [mu]mol/L - -
mg/dL - -
Chloride mmol/L 75 (8) 60-90
Osmolality mmol/kg 250 (13) 230-280
Urea nitrogen mmol/L - -
mg/dL - -
Uric acid [mu]mol/L - -
mg/dL - -
CSF glucose mmol/L 2.1 (0.6) 1.1-2.8
mg/dL 37 (10) 20-50
Creatinine [mu]mol/L - -
mg/dL - -
Ionized calcium(4) mmol/L 0.82 (0.14) 0.50-1.07
mg/dL 3.29 (0.56) 2.00-4.29
Lactate mmol/L - -
mg/dL - -
Hematology
Hematocrit L/L 0.18 (0.05) 0.12-0.30
Hemoglobin g/L 66 (17) 40-120
Platelets x[10.sup.9]/L 37 (18) 10-100
WBC count x[10.sup.9]/L 2.0 (0.7) 1.0-4.0
PT s - -
PTT s - -
Fibrinogen g/L 0.88 (0.17) 0.50-1.00
Blood gases and [p.sup.H]
[pCo.sub.2] mm Hg 19 (3) 9-25
[p.sup.H] - 7.21 (0.06) 7.00-7.35
[pO.sub.2] mm Hg 43 (6) 30-55
kPa 5.7 (0.8) 4.0-7.3
Clinical chemistry High Limit
Test Mean (SD) Range
Glucose 26.9 (8.0) 6.1 - 55.5
484 (144) 110-1000
Potassium 6.2 (0.4) 5.0-8.0
8.0 (hemolyzed)
Calcium 3.22 (0.22) 2.62-3.49
12.9 (0.9) 10.5-14.0
Sodium 158 (6) 145-170
[Co.sub.2] content 40 (3) 35-50
Magnesium 2.02 (0.82) 1.03-5.02
4.9 (2.0) 2.5-12.2
Phosphorus 2.87 (0.48) 2.26-3.23
8.9 (1.5) 7.0-10.0
Bilirubin 257 (86) 86-513
15 (5) 5-30
Chloride 126 (12) 115-156
Osmolality 326 (18) 295-375
Urea nitrogen 37.1 (21.1) 14.3-107.1
104 (59) 40-300
Uric acid 773 (119) 595-892
13 (2) 10-15
CSF glucose 24.3 (11.4) 13.9-38.9
438 (206) 250-700
Creatinine 654 (380) 177-1326
7.4 (4.3) 2.0-15.0
Ionized calcium(4) 1.55 (0.19) 1.30-2.00
6.21 (0.76) 5.21-8.02
Lactate 3.4 (1.3) 2.3-5.0
30.6 (11.7) 20.7-45.0
Hematology
Hematocrit 0.61 (0.06) 0.54-0.80
Hemoglobin 199 (27) 170-300
Platelets 910 (147) 555-1000
WBC count 37.0 (20.7) 10.0-100.0
PT 27 (9) 14-40
PTT 68 (33) 32-150
Fibrinogen 7.75 (2.63) 5.00-10.00
Blood gases and [p.sup.H]
[pCo.sub.2] 67 (6) 50-80
[p.sup.H] 7.59 (0.03 7.50-7.645
[pO.sub.2] - -
- -
(1.) Adulttable modified with permission by JAMA, Vol. 263, pages
704-707, 1990. CSF, cerebrospinal fluid; WBC, white blood cell; PT,
prothrombin time; PTT, partial thromboplastin time. Qualitative
critical results for adults (1) include the following: For blood bank
and immunology--Incompatible crossmatch, tests positive for syphilis
(RPR or VDRL). For microbiology and parasitology--Positive results
from Gram stain or in culture from blood, cerebrospinal fluid, or body
cavity fluid; positive India ink preparation; positive rapid antigen
detection by agglutination tests for Crypfococcus, group B
streptococci, Haemophilus influenzae b, or Neisseria meningitidis,
positive results from acid-fast bacillus stain or culture; Salmonella,
Shigella, or Campylobacter on stool culture; presence of malarial
parasites. For clinical microscopy and urinalysis-Elevated white blood
cell count in cerebrospinal fluid; presence of malignant cells,
blasts, or microorganisms in cerebrospinal fluid or body fluids;
combination of strongly positive test results for glucose and for
ketones in urine; presence of pathologic crystals (urate, cysteine,
leucine, or tyrosine)on urinalysis. For hematology--Listed frequently
are the presence of blasts on blood smear; new diagnosis or findings
of leukemia; presence of sickle cells (or aplastic crisis). Listed
occasionally are plasma cells, band cells, atypical lymphocytes,
and abnormal reticulocyte count.
(2.) Children and newborn tables modified with permission by
Pediatrics, Vol. 88, pages 597-603, 1991. CSF, cerebrospinal fluid;
WBC, white blood cell; PT, prothrombin time; PTT, partial
thromboplastin time; CH, Children's Hospital; USMC, U.S. Medical
Centers. Qualitative critical results for children (2) include the
following: For hematology--Presence of blasts in the blood smear;
new diagnosis or findings of leukemia; presence of drepanocytes
(sickle cells); atypical lymphocytes, or abnormal reticulocyte count;
abnormal erythrocyte indices (mean corpuscular volume, mean
corpuscular hemoglobin, mean corpuscular hemoglobin concentration).
For clinical microscopy and urinalysis--Elevated white blood cells in
cerebrospinal fluid; presence of malignant cells, blasts, or
microorganisms in CSF or body fluids; combination of strongly positive
test results for glucose and for ketones in urine. For microbiology
and parasitology--Positive results from Gram stain or culture from
blood, CSF, or body cavity fluid; presence of malarial parasites.
Children (2)
Clinical chemistry Low limit
Test Units Mean (SD) Range
Glucose mmol/L 2.6 (0.5) 1.7-3.3
Potassium mmol/L 2.8 (0.3) 2.0-3.5
Calcium mmol/L 1.62 (0.17) 1.25-1.87
Sodium mmol/L 121 (5) 110-130
[C0.sub.2] content mmol/L 11 (2) 6-18
Magnesium mmol/L 0.45 (0.04) 0.41-0.49
Phosphorus mmol/L 0.42 (0.16) 0.16-0.65
Bilirubin [mu]mol/L -- --
Chloride mmol/L 77 (8) 70-90
Osmolality mmol/kg 253 (12) 240-270
Urea nitrogen mmol/L -- --
Uric acid [mu]mol/L -- --
CSF glucose mmol/L 1.7 (0.7) 1.1-2.8
Creatinine [mu]mol/L -- --
Ionized calcium(4) mmol/L 0.85 (0.13) 0.60-1.08
Lactate mmol/L -- --
Albumin g/L 17 (5) 10-25
Ammonia [mu]mol/L -- --
Protein g/L 34 (5) 30-40
CSF protein mg/L -- --
Hematology
Hematocrit L/L 0.20 (0.06) 0.10-0.30
Hemoglobin g/L 69 (13) 50-100
Platelets x[10.sup.9]/L 53 (25) 20-100
WBC count x[10.sup.9]/L 2.1 (0.9) 0.5-3.5
PT s -- --
PTT s -- --
Fibrinogen g/L 0.77 (0.30) 0.20-12.0
Bleeding time min -- --
Blood gases and pH
pC[O.sub.2] mm Hg 21 (6) 15-40
pH -- 7.21 (0.05) 7.10-7.30
p[O.sub.2] mm Hg 45 (7) 30-55
Clinical chemistry High limit
Test Mean (SD) Range
Glucose 24.7 (8.9) 13.9-55.5
Potassium 6.4 (0.5) 5.0-8.0
Calcium 3.17 (0.22) 2.74-3.74
Sodium 156 (5) 150-170
[C0.sub.2] content 39 (3) 33-45
Magnesium 1.77 (0.45) 1.23-3.00
Phosphorus 2.87 (0.39) 2.26-3.23
Bilirubin 257 (68) 86-342
Chloride 121 (5) 115-130
Osmolality 318 (10) 300-330
Urea nitrogen 19.6 (11.4) 3.9-53.6
Uric acid 714 (119) 595-892
CSF glucose -- --
Creatinine 336 (212) 221-884
Ionized calcium(4) 1.53 (0.11) 1.35-1.75
Lactate 4.1 (1.2) 2.4-5.5
Albumin 68 (10) 60-80
Ammonia 109 (50) 35-200
Protein 95 (6) 90-100
CSF protein 1875 (854) 1000-3000
Hematology
Hematocrit 0.62 (0.05) 0.54-0.70
Hemoglobin 208 (29) 170-250
Platelets 916 (220) 600-1500
WBC count 42.9 (25.1) 15.0-100.0
PT 21 (6) 15-35
PTT 62 (21) 40-100
Fibrinogen -- --
Bleeding time 14.0 (4.0) 9.5-20.0
Blood gases and pH
pC[O.sub.2] 66 (23) 50-150
pH 7.59 (0.04) 7.50-7.70
p[O.sub.2] 124 (25) 100-150
Newborn(2) Low limit
Test Facility Units Mean (SD) Range
Glucose CH mmol/L 1.8 (0.4) 1.1-2.8
Potassium CH mmol/L 2.8 (0.4) 2.5-3.7
Modified potassium CH mmol/L 2.8 (0.4) 2.5-3.7
Bilirubin CH [mu]mol/L -- --
Hemoglobin USMC g/L 95 (35) 50-150
Hematocrit USMC L/L 0.33 (0.08) 0.24-0.45
p[O.sub.2] USMC mm Hg 37 (7) 30-50
Newborn(2) High limit
Test Mean (SD) Range
Glucose 18.2 (3.6) 16.7-27.8
Potassium 7.8 (0.5) 6.5-8.0
Modified potassium 6.5 (See ref. 3)
Bilirubin 222 (86) 86-308
Hemoglobin 223 (23) 210-250
Hematocrit 0.71 (0.04) 0.65-0.75
p[O.sub.2] 92 (12) 70-100
References (1.) Kost GJ. Critical limits for urgent clinician notification at U.S. medical centers. JAMA JAMA abbr. Journal of the American Medical Association . 1990;263:704-707. (2.) Kost GJ. Critical limits for emergency clinician notification at United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. children's hospitals. Pediatrics pediatrics (pēdēă`trĭks), branch of medicine dedicated to the attainment of the best physical, emotional, and social health for infants, children, and young people generally. . 1991;88, 597-603. (3.) Kost GJ. Using critical limits to improve patient outcome. MLO. 1993;25(3):22-27. (4.) Kost GJ. The significance of ionized calcium in cardiac cardiac /car·di·ac/ (-ak) 1. pertaining to the heart. 2. pertaining to the cardia. car·di·ac adj. 1. Of, near, or relating to the heart. 2. and critical care. Availability and critical limits at U.S. medical centers and children's hospitals. Arch Pathol Lab Med. 1993; 117:890-896. (5.) Empainicpator K. Critical values: ASCP ASCP American Society of Clinical Pathologists. practice parameter (1) Any value passed to a program by the user or by another program in order to customize the program for a particular purpose. A parameter may be anything; for example, a file name, a coordinate, a range of values, a money amount or a code of some kind. . Am J Clin Pathol. 1997;108:247-253. (6.) Joint Commission on Accreditation of Healthcare Organizations Joint Commission on Accreditation of Healthcare Organizations, n.pr the United States body that accredits healthcare organizations. Joint Commission on Accreditation of Healthcare Organizations (JCAHO/TJC), n. . Available at: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/09_hap_npsgs.htm. Accessed July July: see month. 9, 2008 |
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