ER Hall of Fame

[Cytarabine]

HGB 1.8 in a neonate w/initial presentation of a hemolytic anemia. Came in super toxic, but made it out of the PI and was looking pretty great when they went to the floor, hopefully didn't sustain much anoxic injury

Na of 208 in a neuro-devastated kid. Don't remember their exact dx, think cystic encephalomalacia 2/2 meningitis. Kid lived without a change in fxn... but was a vegetable before and after the incident, so. yeah.

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[Cytarabine]

Took care of a pt 2 weeks ago who had a BMI of 147.

These patients drain my energy so bad. Have had 3 w/a BMI >90, haven't broken the 100 mark yet... much less by 50%

 

[StephBee]

Other record was an Na of 189. Brain dead patient, we dropped that down to 155 in like 8 hours with D5 at a rate of like 1300/hr so we could actually declare them brain dead. Organs were donated thankfully

 

[Spinach Dip]

Took care of a pt 2 weeks ago who had a BMI of 147.

That's got to be pushing 1000 pounds.

Wow.

 

[gutonc]

I'm too lazy to search the whole thread but I had a (admittedly non-ED) patient with a Na of 103.

Extensive stage small cell lung cancer. More or less asymptomatic from the HypoNa.

I sent her home on hospice that day and expected that she wouldn't survive long enough for hospice intake to make it to her (they arrived 3 hours later). Almost 3 months later, I got a call from hospice asking if it was OK if they discharged her temporarily so that she could fly to Hawaii for her son's wedding. She made it back to town and died before I got the "admit to hospice" order signed and faxed back to them.

 

[DocEspana]

Calcium: 3.8
Ionized Calcium: 0.9
Phos: 14.2

A mostly asymptomatic teenager who presented for fatigue and a fungal nail infection. EKG was totally normal. The endocrinologist stated he had seen calcium lower than that, but never in an asymptomatic patient and that he had NEVER seen a phos that high in anyone who was still alive. Turns out she has polyendocrine failure and *apparently* candida can trigger this in people. The first part is clear from her inpatient labs. The second part sort of seems like a reach since they are referencing a phenomenon seen only a handful of times in case reports that dont prove correlation or causality of the candida infection to the endocrinopathy.

 

[DocEspana]

Other record was an Na of 189. Brain dead patient, we dropped that down to 155 in like 8 hours with D5 at a rate of like 1300/hr so we could actually declare them brain dead. Organs were donated thankfully

I got 183 Na on my braindead patient here. But the family refuses to accept that they are brain dead, so we've slowly titrated them back down to the 150's.

 

[StephBee]

I got 183 Na on my braindead patient here. But the family refuses to accept that they are brain dead, so we've slowly titrated them back down to the 150's.

That's the worst . Mine was sadly a 25 yo kid, and he was our 3rd in 2 weeks. Bad batch of heroin going around, we had something like 8 ODs in 2 weeks.

 

[swamprat]

Blood etoh 574 in one of our regulars and was still conversing... Errr, sorta. Well let's just say he wasn't completely comatose.

 

[winkleweizen]

ETOH 638, but he definitely was not conversing.

 

[Daiphon]

ETOH 638, but he definitely was not conversing.

Had a 538 who was clinically sober once... my well meaning intern turned an uncomplicated cellulitis (gave IV ABx to load, so sent some labs - including ethanol because of his drinking history) into a complicated MICU admission. d=)

 

[WinslowPringle]

Tbili 50.7 mg/dL. Pt was neon. Survived out of the ED, died in MICU several weeks later.
Hgb 0.8. Pt did not survive.

 

[link2swim06]

A different type of a record....pt bas had over 200 cxrs done in the ER in the past year alone. Probably a total of 1,000 cxrs total, over the course of our EMR.

Happens when you swallow stuff..

 

[Docinthetrenches]

Blood sugar (lived)- 2400
Blood Alcohol (and lived) - 732
Potassium (lived but arrested) - 10.1, (died) - 0.9
CPK - 300,000
Sodium (died) - 201, (died) - 97

 

[EDParallax]

Cpk 440,000. 11 yo female with thigh pain and red pee.

 

[WilcoWorld]

CPK > 500,000 in an inmate who'd decided to put his time to good use and started doing squats all day, every day, until his urine resembled a strong batch of Kool Aid.

 

[Apollyon]

CPK > 500,000 in an inmate who'd decided to put his time to good use and started doing squats all day, every day, until his urine resembled a strong batch of Kool Aid.

12 years ago, had an inmate that said he did "deep knee bends" for 8 hours, and his CK was 100k. I think that my patient was beaten with a rubber hose.

Inmates give good reasons for trauma; there was a guy last year that had an open zygomatic fracture. The cause? An elbow playing soccer. He would not let that one go.

 

[WilcoWorld]

12 years ago, had an inmate that said he did "deep knee bends" for 8 hours, and his CK was 100k. I think that my patient was beaten with a rubber hose.

Inmates give good reasons for trauma; there was a guy last year that had an open zygomatic fracture. The cause? An elbow playing soccer. He would not let that one go.

"Snitches get stitches."

 

[Apollyon]

"Snitches get stitches."

However, one guy was open about a "sock and lock" (a Master Lock in an issued sock, used as a ballistic weapon). Now, when I ask the following inmates if it was a "lock and sock", most just laugh a bit, and not nervously.

 

[GatorCHOMPions]

Recently had a patient with CK 700,000. The initial ED CK was 9k with AKI (Cr 3.3) in an otherwise healthy young patient who was "agitated" and admitted to doing MDMA. Initial temp was 106. At the time ICU didn't want to take the patient. Then lactate came back at 40 a little while later and they took him. That peaked CK didn't show up until close to 24 hours after presentation.

 

[deleted547339]

A different type of a record....pt bas had over 200 cxrs done in the ER in the past year alone. Probably a total of 1,000 cxrs total, over the course of our EMR.

Happens when you swallow stuff..

We must have their cousin....lol

 

[cbrons]

Na+ 97
(Bartter syndrome) this from over the summer

 

[gutonc]

A call I got from the ED at one of the hospitals my Hem/Onc group covers:
WBC - 947.9K

Platelets were 96K

When your WBC is 10x your platelets, something has gone horribly wrong.

She left AMA.

 

[Arcan57]

A call I got from the ED at one of the hospitals my Hem/Onc group covers:
WBC - 947.9K

Platelets were 96K

When your WBC is 10x your platelets, something has gone horribly wrong.

She left AMA.

At that level you'd like to see her fighting infections that aren't even in her body yet.

 

[dav86]

Lipase: 1,600,000

Intern asked me (as an R2) is that bad....I told him to move the patient to our high acuity side. Pt was admitted to ICU. Don't know if he lived.

 

[Hamhock]

I got 183 Na on my braindead patient here. But the family refuses to accept that they are brain dead, so we've slowly titrated them back down to the 150's.

You are checking serial labs on a dead person? You are treating dead people in your hospital?
HH

 

[gutonc]

At that level you'd like to see her fighting infections that aren't even in her body yet.

If only those white cells were doing something useful.

 

[Arcan57]

If only those white cells were doing something useful.

Surprised she hadn't stroked out at that point.

 

[gutonc]

Surprised she hadn't stroked out at that point.

They were all lymphocytes. CLL. Rare to get leukostasis in that setting.

She was symptomatic from her hemoglobin of 6 though. That's what brought her in.

 

[DocEspana]

You are checking serial labs on a dead person? You are treating dead people in your hospital?
HH

Was a picu rotation and the family was orthodox Jewish and didn't believe in brian death as a diagnosis. It was a multiple day discussion as to how exactly to decrease care, particularly against parent wishes

 

[Psai]

A call I got from the ED at one of the hospitals my Hem/Onc group covers:
WBC - 947.9K

Platelets were 96K

When your WBC is 10x your platelets, something has gone horribly wrong.

She left AMA.

Even the other way around is bad

 

[BoardingDoc]

Was a picu rotation and the family was orthodox Jewish and didn't believe in brian death as a diagnosis. It was a multiple day discussion as to how exactly to decrease care, particularly against parent wishes

How did that work out?

 

[deleted245139]

Flash pulmonary edema, shortness of breath, cariogenic shock and an ECG with aVR elev, diffuse depression. 100% circ. Her trop peake at 449. IABP and still kicking.

 

[Boatswain2PA]

I'm sure it isn't a world record, but an ETCo2 of 88 after we pulled out about half of a chicken that was in his throat for about 40 minutes. Got ROSC, ETCo2 trended down to 45, and he survived the flight to tertiary care where he died.

 

[gutonc]

I'm sure it isn't a world record, but an ETCo2 of 88 after we pulled out about half of a chicken that was in his throat for about 40 minutes. Got ROSC, ETCo2 trended down to 45, and he survived the flight to tertiary care where he died.

So...definitely a win?

 

[Boatswain2PA]

So...definitely a win?

Who said anything about a win? Of course it isn't a win, but it rarely is when someone comes in without a pulse (however the prior patient also came in without a pulse and she is now home with her husband and kids neurologically intact!)

But this thread is about worse lab values & such...an EtCO2 of 88 is pretty high!

 

[sheepae]

Pan-positive UDS...several times (W Philly)

19yo G9P4 presented w/ vaginal discharge

WBC >1 mil presented w/ SOB...he lived after leukopheresis

 

[DocEspana]

What is the record for chloride?

I got <50 on two consecutive tests. Somehow, someway, where my lab would not give me a value for their 'standard' blood test, my point of care device did off of the ABG. 46.

amusingly the gap is only 17 because the patient has a VERY high co2 value and relatively low Na+ K+. In other words he is *compensated* for this chloride. (or maybe its backwards and the lack of chloride is compensated for this metabolic alkalosis? tests are still pending).

 

[p1acebo]

What is the record for chloride?

I got
amusingly the gap is only 17 because the patient has a VERY high co2 value and relatively low Na+ K+. In other words he is *compensated* for this chloride. (or maybe its backwards and the lack of chloride is compensated for this metabolic alkalosis? tests are still pending).

Pretty damn low, alcoholic? Vomiting?

What was the chief complaint that prompted the patient to come in?

 

[JacobMcCandles]

Pretty damn low, alcoholic? Vomiting?

What was the chief complaint that prompted the patient to come in?

"My chloride's low"...probably.

 

[DocEspana]

Pretty damn low, alcoholic? Vomiting?

What was the chief complaint that prompted the patient to come in?

no alcohol use. No vomiting. Came in for hand spasming for the last week. And the hand spasms were pretty frequent.

 

[gutonc]

"My chloride's low"...probably.

You laugh, but I legit had a patient in clinic yesterday who's only abnormal finding on her chem panel was a slightly low chloride level. She started off the visit with "I looked up the symptoms of low chloride and I have this, that and the other of them, you need to give me something to get my chloride up to fix that". I suggested she eat more salt. Fingers crossed she fires me, but I'm quitting anyway, so whatever.

 

[thegenius]

tell her to eat chloride. She won't have the chance to fire you.

 

[wareagle726]

It needs to be raw HCl. That way it fully dissociates.

 

[The Knife & Gun Club]

Pretty damn low, alcoholic? Vomiting?

What was the chief complaint that prompted the patient to come in?

Chronic CO2 retainer? Like bad OSA or COPD? Taking a bunch of laxities?

My guess would be too much CO2 rather than losing Cl, since it’s tough to lose chloride unless it’s through the GI tract or with exogenous diuretics. At least that’s my understanding.

Or maybe a tumor? I bet there’s a weird endocrine tumor that could do that, although I have no idea which it would be.

 

[Dred Pirate]

last week- digoxin level of 25 - pt took 90 tablets in an OD attempt - it was successful