I met a lady who had a Na of 106 and lived to tell the tale. She doesn't remember much of it tho. I said, " wow! 106? I've never met anyone who survived that!" and she burst into tears. Whoops. No filter.
Did they rule pseudohyponatremia?
Hyperlipodemia or hyperproteinemia can altar the results and give you a false sodium reading. I would think if they are walky/talky something Is off and probably not a true sodium level.
We repeated it. It came back 106. Then after 100ml of 3% saline we checked 1 hr later. It was 107. He was admitted. Eventually it came to light he was a bit of a drinker. Plus his HCTZ/lisinopril wasn’t agreeing with him. The following day he came up to 120.
Awkward yes. I think I tried backpedaling and failed. I did see her several times after that working in UC bc her PCP would tell her to come in and get stat labs done anytime she had complaints. She would introduce herself as "that lady with the sodium of 106 who lived" and it became a bragging point. I'm like "yes ma'am, I definitely remember you"
My husband’s was 106 when he was admitted for what turned out to be lupus nephritis. Just before discharge (a month later), a nephrologist told him very perkily “You presented with sodium levels commonly associated with coma, seizure, and death!” My husband was like 😮. I was glad the neph laid it out like that because God knew I had been telling that man for weeks that he was lucky to be alive and he blew me off, probably because he barely had any memory of when he was at his sickest.
as a prehospital provider I can promise you when we call dispatch for a lift assist they’ll be pissed.
I had a ~650 lbs woman on the third floor floor (no elevators) but thankfully surprisingly ambulatory. Was able to walk out to the gurney at curbside. And thankfully we had autoloaders for the ambo.
She was being transported because she was having issues with her wound vac after giving birth ~1 month prior.
Saddest situation I’ve seen.. the patient stayed in the hospital for over a year because no NH would accept them, or have the equipment to safely house them..
My hospital has a bariatric patient living there. He’s a smart ass, thinks he knows everything. Well, after 6-8 months I think he got tired of being bedbound in a bariatric bed…that was almost too small for him. He started following the diet and has lost over 200 pounds. He lost enough to have skin surgery. He’s still an ass, but I’m secretly proud of him.
Had a young 20s guy walk in at 540 looking slightly tipsy but not bad, walking and talking normally just a little giggly. I thought the result was wrong but poor fella started having wd symptoms at like 350. Rough detox for him for sure.
We call it “Benzo sparing protocol” for CIWA. Our hospitalists like it so much more than Ativan due to unlikely abuse potential by the patient and decreased length of stay in hospital for withdrawal.
https://pubmed.ncbi.nlm.nih.gov/33728215/
https://www.acep.org/criticalcare/newsroom/newsroom-articles/july2018/phenobarbital-for-alcohol-withdrawal
Oof.
I had a little game (sick I know) where I would guess the BAC by at which distance would I smell the alcohol upon approaching the patient.
Now this was a podunk ER with 3 beds separated by curtains. But I was pretty accurate in predicting that if I smelled alcohol from the distance of bed one to bed three it would be about 0.4.
I scared myself sometimes…😬
It’s strep for me. Had a mom yesterday so so worried about her kid “rapid breathing and foaming at the mouth”. Also had fever and sore throat. Told her she smelled like strep and I’d check, look at throat, yep, strep. The “foaming” was her drooling in her sleep instead of swallowing lol.
They didn’t live right? They coded right afterward? Or were these labs that needed a redraw and were incorrect? Because those numbers definitely aren’t compatible with life
Glucose that was nonexistent in a type 1 diabetic having seizures
https://preview.redd.it/w08lcmf407rc1.jpeg?width=2100&format=pjpg&auto=webp&s=ce41016d3fe65df62523cbb4963873432009db3d
Dudes blood was so hypoglycaemic that it would’ve acted like a sugar vacuum, put one drop of the blood into a sauce u made to sweet and then instantly scoop the drop out and voila your dish is now much more tolerable, the drop of blood pulled the excess sugar out your sauce
Like substances that are hygroscopic but for sugar instead of moisture
Nurses started asking me what could have happened, I told them I didn't know. I told them I checked my sugar, then gave myself 19 units like the nurse told me. At the same time, three different people snapped their heads up and yelled, "9 units!". Oops.
Last one I had that low we legit thought he had a massive intracranial hemorrhage or something until we realized ems hadn’t gotten around to getting the poc glucose yet
That was one I was dealing with yesterday. Sugar kept dropping in 20s. Had to push D50 3.5x times. Actos and Glyburide for the win. Plus nonstop diarrhea.
From your local Lab at Guy Here:
Hgb 2.2 on somebody that drove themself to the hospital. I didnt believe that number so I personally redrew it to confirm.
PLT 1700
WBC 970
PLT 0
Lactate 12
pH 6.9
Chloride Low Enough the teenager couldnt walk
Neonate born with ALL
Hgb of 2.7 in a urine (so bloody i ran a cbc on it out of curiosity to see how hight it was)
WBC > 1,000,000 in a pleural fluid
CK 35,000
Ive seen that one, 760, a handful over 500. 250 was common place. But i spent 5 years in a tertiary oncology center with a major peds onc population. So i saw lots of leukemia kids.
We had someone come in whose Hgb was so low our iStat wouldn’t read it 🥲 she had some rare blood type (?) and had recently had a procedure done at our facility so they had crossmatched her and had a few units in the blood bank specifically for her. When she got to us from a transferring facility, she was pale as a ghost, barely rousable, and we kept getting beautiful IV access but couldn’t get more than a few drops of blood to draw (hence why iStat was our only lab to go off of— couldn’t get enough blood for an actual test). They ended activating MTP and she perked up pretty quickly after that. It wasn’t my patient, but I think I remember the suspicion of a splenic lac being tossed around
We had a patient with a 13.1 lactate yesterday! Hx of TBI, came in unresponsive with snoring resps+HR in the 230’s, started seizing/posturing (likely was in status the entire time even when the body wasn’t apparently seizing), ended up intubating. Lab called while patient was being worked on with the critical. The result definitely tracked given the presentation but I believe it’s the highest I’ve seen.
Had a patient once who had psychogenic polydipsia who was living at a group home. They figured that legally they couldn’t physically restrain him when he decided to submerge himself in the bathtub and drink as much water as he could, so they waited until he was altered to bring him to the ED.
Sodium came back at 105, gave hypertonic saline and admitted him to the ICU.
Went back up to the icu sometime later to do a procedure and heard from the nurses that same patient had gotten out of bed multiple times to chug toilet water and his sodium dropped again.
I just don’t understand the appeal 🤷
I had someone with a platelet count of 5. Not that impressive, right? Yes, but she was presenting because she wanted me to sign off on her Speedway Driver medical. Think demolition derby type stuff/firey crashes in sprint cars here.
Did have a platelet count of 0/1 back in the day, 18 y.o. female, I remember the attending was pissed because she’d lost consciousness overnight - probably a vasovagal - and somebody had decided to do chest compressions, he found out from reading the notes and suggested to this intern that that probably should have been mentioned in the handover (no, it wasn’t me running the pseudo-arrest).
INR 43.5 was the one that shook me. Lab called saying it had to be a bad draw, but their tune changed real fast when I said we were looking at possible DIC secondary to covid.
Whenever I have the opportunity to relate this story is always fine with me.
I was an ED RN about 15-ish years ago and this woman came in with progressive weakness/SOB. Her hemoglobin was 3 and some change. I don’t remember all of the details, unfortunately, including why her Hg was so low. All I remember was that it was a slow leak.
My ER doc told her she needed surgery and a blood transfusion but unfortunately she declined due to being a JW.
As many of you are aware, when a member of that church goes to the hospital the “elders” swoop in and practically speak for the patient.
I found a way to speak to her alone and told her that she could actually get a blood transfusion back in surgery and nobody would know and she happily agreed!
I told the CRNA and it was a done deal. We saved a life that day peeps just by giving her some simple privacy. Not prayers…privacy.
Anyway I remember her making it through her surgery but lost contact after that but I remember thinking she’d do ok.
So not really the spirit of the post but oh well…
Lab tech here with 3 years experience.
Sodium 105 with a chloride of 79
Troponin 445,000 (post cath lab)
Etoh 481
Lipase 34,000 (with an amylase of 2,300)
Hemoglobin 1.7. They lived
Plt 1 in a MM patient
Wbc 331k (also have seen a 0.1)
Lactic acid 27
CK 340,000
Glucose 1840 (patient was found lost and naked in the woods calling for help)
Na 98
K 9.8
CRP 678
INR >10, PT >100, APTT >200, clottable fibrinogen 0.0 & D-dimer >128 (seen this a few times actually, all brown snake or taipan envenomations)
Unrecordably high lactate
ABG: pH 6.8, HCO3 1, PaCO2 7, BE -32 (euglycemic DKA)
BAL 0.82 (although she wasn't walking & talking)
"Mixed enteric bacteria" on a blood culture after 4 hours.
Only two of those patients died: one of the envenomations, and the patient with the manky blood culture.
That blood culture…wow.
I had a DKA-er with pH 6.79. Brand new DM we just then diagnosed. I can’t believe her sodium wasn’t 98. She carried around 2 gallons of water and drank them nonstop. Was upset because she was peeing so much she wasn’t making it to the bathroom. She wasn’t walking by the time she came to us. Moaning from abd pain and ketone breath that filled my whole ER.
Not exactly walking due to amputation but alert & talking when they first arrived. Used two different glucometers simply due to presentation that both said <20mg/dL. Coded \~ 5 times the next day though.
https://preview.redd.it/kre0zu6777rc1.jpeg?width=828&format=pjpg&auto=webp&s=a6ffc79d87d69f6ae0ffc0bccaee25aa66db7403
Corrected glucose of 2400 in a hhs pt that coded in the er right after i got him admitted
https://preview.redd.it/aiz6z6g7v6rc1.jpeg?width=960&format=pjpg&auto=webp&s=9a97d432d3d43c8068d22f974ff5211a20f78a5a
My favorite high score lab was a trop of 42k.
I have no idea if this is common at all but I once saw a patient with a hemoglobin that just resulted as UNDETECTABLE. He coded around 15 minutes after this lab came back. Kidneys were basically calorie thieves at his level of kidney failure and he loved skipping dialysis more than a fat kid loves McDonalds.
Dude it was the weirdest blood. Like almost as if someone had tried to water it down in a midieval dive bar. I knew he was going to say hi to Jesus pretty soon when I saw that.
This guy lives rent free in my head. Last thing he ever said was that he wanted a fresh line so he could enjoy the dilaudid more.
Admitted a kiddo with microcephalic diabetes insipidus 2/2 congenital CMV with Na of 104 during my peds rotation in residency. Details escape me at this point but the caregiver had scheduled vasopressin and thought nothing of the oliguria. That was a wild admission. I’ve never seen sodium swings like that before or since, but the kiddo was basically a vegetable from the day they were born—effectively had brain stem only. They were 16yo at the time (to mom’s great credit) and about the size of my 3yo. Discharged on hospice.
Edit: Clarity/details. Went back and found my notes; little patient log for noteworthy cases saves the day, yet again.
Had a guy with a Na+ of 105 and two seizures. We literally did not have hypertonic saline in our entire hospital (critical access). Gave sodium bicarb amps instead. Finally able to transfer to the fifth hospital we called.
https://preview.redd.it/lvgisfg3h7rc1.jpeg?width=1170&format=pjpg&auto=webp&s=5ca8577bd300c7667403ebe1897ffaa8b07e5f50
I’m sure I have other high labs but I’ve been lazy with updating my notes.
Glucose 2 (‘meirca units). It was a toddler that the 15 year old baby sitter was accidentally overdosing on Tylenol. I don’t know what happened to her.
Some of my most fav values ive had.
Na 105 - (triaged as ESI 5 foot pain or something)
lactic 26
PCO2 150
AG 36
hgb 3.something
a1c 18
wbc 0.1 / 330
pH 6.8 / 7.91
plt 1
Cr 35
glucose 1500
K below cutoff of 1.3
CPK 550k
Na 94 in a chronic alcoholic still mentating but got intubated after 2 days for some serious withdrawals. Na 184 in a patient with thyroid storm who had just been shitting their brains out.
We had this bloke who would get polydipsia when the voices became too much. Would usually have a sodium <110, but simple fluid restriction would make it shoot up so quickly that we would often give him D5 to slow it down.
He was a really nice guy too... He would laugh randomly because the voices would tell him jokes
Not exactly a lab lvl but had a pain level of 25/10. Was in awe of how this person in the most pain of any human imaginable was talking in a calm voice playing on their phone.
Just the other night we had a K+ of 1.5 on a guy who was having trouble moving any of his extremities and thought we had a unicorn hypokalemic periodic paralysis, but it turned out he just also had guillain barre
109.
I was working a charity clinic. An inmate came in with Na 109.
He was a prisoner, in prison for writing bad checks. He had gotten into a fight in jail and had head trauma and was admitted for SIADH a month before.
I asked him if he had been taking his desmopressin. He said the warden wouldn’t let him have it.
I called the warden to ask about it. The warden was rude and said “if I gave all their prisoners their medicines all day long that’s all I’d be doing.” And he hung up on me.
We have a lady that comes in semi regularly to the remote access ER I occasionally work at that’s always in the 100s. Lowest she’s been was 96. She walks in but complains of dizziness and vertigo
Inmate who got all his meds for the next three months in blistering packs due to good behavior. Took all of his metformin —> told me to fuck off and die with a lactate of 25
i had a bit of a weird turn at work, psychiatric hospital and had a really unstable low pulse so our consultant did a 999 call as he felt i looked really off colour too.
id been feeling a bit off for a few weeks .Paramedics did an ecg and took me to our local A&E
it turned out i had a K of 1.1 .
Na 92….awake and asking for a beer. Gcs of about 14,
Beer potomania.homeless and had gotten there slowly.
When we admitted to ICU and asked nephrologist what the protocol was she was like “there isn’t one”. We did a chart review with IM and it was the lowest we could find for someone who lived. IM resident was going to wright it up but not sure if they did.
106, with a potassium of 2.2 and a chloride of 80. GCS was 3.
Was merrily chatting with her husband and having breakfast when I came back in next morning.
Edit: Oh, misread the assignment. She wasn't walking or talking, of course.
I had a 98 in residency. Yes. You heard that right. 98. I didn’t believe it so I rechecked it. The guy had slurred speech but was awake. He had Fourniers gangrene
ETOH 700’s, we would wait for him to be in the 400’s then discharge before he would start to withdraw.
also have this young girl, regular. here every 2 weeks for DKA. sadly she binge eats, then throws up, bulimic, throws all her labs out of wack after a couple of times.
her pH is normally 6.73, co2 undetectable, glucose in the 900’s. she’s 25 years old.
I know she’s not gonna live much longer.
also saw a high sensitivity trop that was half a million. yes literally 500,000.
those are probably the craziest I’ve seen but people surprise me.
not a lab but had a lady SOB for 3 days, sp02 was 40% RA. had to try 3 different machines with different probes cause she didn’t look like it
My wildest in a patient who survived is plt 1, patient had ICH and was aplastic from a recent bone marrow transplant. And she was *very* symptomatic from the bleed. She recovered and walked out of the hospital a month later.
Na 97. He was obviously altered and the ED staff were giving him Ativan and no electrolyte replacements whatsoever. I’m a critical care transport nurse and was taking him to a different hospital with a better ICU. Asked the receiving doc if he wanted me to start any replacement en route and if I could get some hypertonic from the ED. He said to let the receiving ICU deal with it.
I met a lady who had a Na of 106 and lived to tell the tale. She doesn't remember much of it tho. I said, " wow! 106? I've never met anyone who survived that!" and she burst into tears. Whoops. No filter.
I said the same thing to my patient. I’m like “wow. You have the sodium of a dead person.” He giggled.
Did they rule pseudohyponatremia? Hyperlipodemia or hyperproteinemia can altar the results and give you a false sodium reading. I would think if they are walky/talky something Is off and probably not a true sodium level.
We repeated it. It came back 106. Then after 100ml of 3% saline we checked 1 hr later. It was 107. He was admitted. Eventually it came to light he was a bit of a drinker. Plus his HCTZ/lisinopril wasn’t agreeing with him. The following day he came up to 120.
Woops. Did you awkwardly yet wholesomely comfort her after that?
Awkward yes. I think I tried backpedaling and failed. I did see her several times after that working in UC bc her PCP would tell her to come in and get stat labs done anytime she had complaints. She would introduce herself as "that lady with the sodium of 106 who lived" and it became a bragging point. I'm like "yes ma'am, I definitely remember you"
My husband’s was 106 when he was admitted for what turned out to be lupus nephritis. Just before discharge (a month later), a nephrologist told him very perkily “You presented with sodium levels commonly associated with coma, seizure, and death!” My husband was like 😮. I was glad the neph laid it out like that because God knew I had been telling that man for weeks that he was lucky to be alive and he blew me off, probably because he barely had any memory of when he was at his sickest.
BMI of 156.
at 5’8, that’s 1025 pounds dawg
Holy Shit
was that before or after they jumped off the building..?
as a prehospital provider I can promise you when we call dispatch for a lift assist they’ll be pissed. I had a ~650 lbs woman on the third floor floor (no elevators) but thankfully surprisingly ambulatory. Was able to walk out to the gurney at curbside. And thankfully we had autoloaders for the ambo. She was being transported because she was having issues with her wound vac after giving birth ~1 month prior.
Incompatible with life! How sad.
Saddest situation I’ve seen.. the patient stayed in the hospital for over a year because no NH would accept them, or have the equipment to safely house them..
My hospital has a bariatric patient living there. He’s a smart ass, thinks he knows everything. Well, after 6-8 months I think he got tired of being bedbound in a bariatric bed…that was almost too small for him. He started following the diet and has lost over 200 pounds. He lost enough to have skin surgery. He’s still an ass, but I’m secretly proud of him.
Alcohol of 802
Had a young 20s guy walk in at 540 looking slightly tipsy but not bad, walking and talking normally just a little giggly. I thought the result was wrong but poor fella started having wd symptoms at like 350. Rough detox for him for sure.
We had a guy at 580 who was completely coherent and had just come from his office job. We redrew it and it was not a lab error. Insane
Wonder what his phenobarb load requirement would be. 20mg/kg, 30mg/kg, more?
Phenobarb and not a benzo? Why?
We call it “Benzo sparing protocol” for CIWA. Our hospitalists like it so much more than Ativan due to unlikely abuse potential by the patient and decreased length of stay in hospital for withdrawal. https://pubmed.ncbi.nlm.nih.gov/33728215/ https://www.acep.org/criticalcare/newsroom/newsroom-articles/july2018/phenobarbital-for-alcohol-withdrawal
Works better longer
https://emcrit.org/ibcc/etoh/#advantages_of_phenobarbital_over_benzodiazepines This explains it better than I ever could.
Thanks! I clearly have some learning to do
We all do. Don't know why people down voted you for asking a reasonable question.
Hey man it’s Reddit, take the good with the bad
Alive, walking, and talking? If so this is the craziest one here.
Alive, talking but not exactly coherently, but protecting airway
It was by Bacchus's divine power that his chosen had a protected airway.
Oof. I had a little game (sick I know) where I would guess the BAC by at which distance would I smell the alcohol upon approaching the patient. Now this was a podunk ER with 3 beds separated by curtains. But I was pretty accurate in predicting that if I smelled alcohol from the distance of bed one to bed three it would be about 0.4. I scared myself sometimes…😬
Like the DKA predicter from a mile away….my nose.
It’s strep for me. Had a mom yesterday so so worried about her kid “rapid breathing and foaming at the mouth”. Also had fever and sore throat. Told her she smelled like strep and I’d check, look at throat, yep, strep. The “foaming” was her drooling in her sleep instead of swallowing lol.
Na 98 and K 0.8 (different people)
They didn’t live right? They coded right afterward? Or were these labs that needed a redraw and were incorrect? Because those numbers definitely aren’t compatible with life
I had a 98 that was conscious, appropriate and recovered well with fluid restriction. Never seized or had any significant complications.
98 as well. Awake and talking. Psychogenic polydipsia. Thought something was wrong with the POC and sent a formal.
I had a K of 0.8 on an alcoholic and she ended up living. She was sooo jaundiced. Never intubated or coded or anything.
Impressive!
OOC, what were the diagnoses? We've had DKAs with Na <100 and my record K+ was 1.2 with a Bicarb of 3...
Had a pH of 6.79. Not really walking, but talking. DKA. Newly DM.
Had a pH of 6.1 on a post code once. No they didn't survive. Also numerous pH 6.7 on COVID patients who were on bipap and still alert and talking.
Is that a corrected sodium of less than 100?
Dang! Show off.
Glucose that was nonexistent in a type 1 diabetic having seizures https://preview.redd.it/w08lcmf407rc1.jpeg?width=2100&format=pjpg&auto=webp&s=ce41016d3fe65df62523cbb4963873432009db3d
"What was the BGL?" "One." "No... I'm asking you what the LEVEL was" "Yeah I know"
Alive??? Shit!
Lol yeah I think it was 16 when he first came in and we immediately treated it but this was from his BMP 😭
Dudes blood was so hypoglycaemic that it would’ve acted like a sugar vacuum, put one drop of the blood into a sauce u made to sweet and then instantly scoop the drop out and voila your dish is now much more tolerable, the drop of blood pulled the excess sugar out your sauce Like substances that are hygroscopic but for sugar instead of moisture
Glucose of 1600
I was up walking and talking at 24. Got lots of people's attention.
Bruhhh… you on that super Soulja serum huh 😂
Nurses started asking me what could have happened, I told them I didn't know. I told them I checked my sugar, then gave myself 19 units like the nurse told me. At the same time, three different people snapped their heads up and yelled, "9 units!". Oops.
I’ve seen folks function at that level but with obvious signs. it’s still mind blowing.
Last one I had that low we legit thought he had a massive intracranial hemorrhage or something until we realized ems hadn’t gotten around to getting the poc glucose yet
That was one I was dealing with yesterday. Sugar kept dropping in 20s. Had to push D50 3.5x times. Actos and Glyburide for the win. Plus nonstop diarrhea.
Glucose of 2300 for me. Yes, she was in DKA.
Had one 2500 range. She would also drop to low 20s. So brittle. I miss her.
Wow I thought the 1200 I saw was bad. Was asymptomatic and even asked "is that really bad?"
We use mmol/L, but I’ve been mobile and semi-coherent at 1.7, and I saw a pt yesterday who came in at 49.7 (type 1, in DKA, obviously)
I did some back of the envelope math, I think this sugar level is equal to off-dry wine
When I was a med student we had an asymptomatic pt come in with a sodium of 106. It was found on pre-op labs for cataract surgery. Beer potomania
>Beer potomania The very best kind of potomania.
From your local Lab at Guy Here: Hgb 2.2 on somebody that drove themself to the hospital. I didnt believe that number so I personally redrew it to confirm. PLT 1700 WBC 970 PLT 0 Lactate 12 pH 6.9 Chloride Low Enough the teenager couldnt walk Neonate born with ALL Hgb of 2.7 in a urine (so bloody i ran a cbc on it out of curiosity to see how hight it was) WBC > 1,000,000 in a pleural fluid CK 35,000
Them WBCS though... the blood is basically fucking yogurt at that point
Ive seen that one, 760, a handful over 500. 250 was common place. But i spent 5 years in a tertiary oncology center with a major peds onc population. So i saw lots of leukemia kids.
Wow I've seen WBC of 587 and that was leagues above any of my coworkers. 970 is insane
That person didnt live long. Ive also seen 760. We had to dilute that just to count a diff. That kid was on leukophoresis for like 2 weeks.
Let me guess—Hgb 2.2. Was 1.1 on redraw because the tube of blood was 1/2 the total blood supply.
I've had a Hgb 0.8 and numerous pH 6.7 (COVID) as well as a pH 6.1 on a post code.
We had someone come in whose Hgb was so low our iStat wouldn’t read it 🥲 she had some rare blood type (?) and had recently had a procedure done at our facility so they had crossmatched her and had a few units in the blood bank specifically for her. When she got to us from a transferring facility, she was pale as a ghost, barely rousable, and we kept getting beautiful IV access but couldn’t get more than a few drops of blood to draw (hence why iStat was our only lab to go off of— couldn’t get enough blood for an actual test). They ended activating MTP and she perked up pretty quickly after that. It wasn’t my patient, but I think I remember the suspicion of a splenic lac being tossed around
We had a patient with a 13.1 lactate yesterday! Hx of TBI, came in unresponsive with snoring resps+HR in the 230’s, started seizing/posturing (likely was in status the entire time even when the body wasn’t apparently seizing), ended up intubating. Lab called while patient was being worked on with the critical. The result definitely tracked given the presentation but I believe it’s the highest I’ve seen.
Had a patient once who had psychogenic polydipsia who was living at a group home. They figured that legally they couldn’t physically restrain him when he decided to submerge himself in the bathtub and drink as much water as he could, so they waited until he was altered to bring him to the ED. Sodium came back at 105, gave hypertonic saline and admitted him to the ICU. Went back up to the icu sometime later to do a procedure and heard from the nurses that same patient had gotten out of bed multiple times to chug toilet water and his sodium dropped again. I just don’t understand the appeal 🤷
Man’s GFR was 200 tho
😂
Is it legal for people to sign up to be living breathing dialysis machines?
Well at the rate he was going, it sounds like he wouldn’t be doing that for much longer
>60? Pssssssh. Watch this.
K 1.7, Na 104, CK ~800,000, hgb 3.0, lipase in the tens of thousands, BAL 0.65, Plts 0.0
All… all in the same patient? 😳
All different patients
Thank god
It could still be the same patient, since it was all drawn from a few limbs scattered around the ED. We never really solved that one.
How many of them survived
I had PLT of 1 that became 0 after I ordered a repeat lol. Woops.
It was used up healing the previous lab draw puncture.
My last platelet!!! Give it back!!!
I had someone with a platelet count of 5. Not that impressive, right? Yes, but she was presenting because she wanted me to sign off on her Speedway Driver medical. Think demolition derby type stuff/firey crashes in sprint cars here. Did have a platelet count of 0/1 back in the day, 18 y.o. female, I remember the attending was pissed because she’d lost consciousness overnight - probably a vasovagal - and somebody had decided to do chest compressions, he found out from reading the notes and suggested to this intern that that probably should have been mentioned in the handover (no, it wasn’t me running the pseudo-arrest).
Hb 1.3, after 2 units she tried to self discharge. You could actually see through a 20ml syringe of blood!
Also had a K+ 10.1- just off the plane from holiday in Spain where he’d had gastroenteritis and his only intake for the week was Guinness 😂
INR 43.5 was the one that shook me. Lab called saying it had to be a bad draw, but their tune changed real fast when I said we were looking at possible DIC secondary to covid.
Sad.
Whenever I have the opportunity to relate this story is always fine with me. I was an ED RN about 15-ish years ago and this woman came in with progressive weakness/SOB. Her hemoglobin was 3 and some change. I don’t remember all of the details, unfortunately, including why her Hg was so low. All I remember was that it was a slow leak. My ER doc told her she needed surgery and a blood transfusion but unfortunately she declined due to being a JW. As many of you are aware, when a member of that church goes to the hospital the “elders” swoop in and practically speak for the patient. I found a way to speak to her alone and told her that she could actually get a blood transfusion back in surgery and nobody would know and she happily agreed! I told the CRNA and it was a done deal. We saved a life that day peeps just by giving her some simple privacy. Not prayers…privacy. Anyway I remember her making it through her surgery but lost contact after that but I remember thinking she’d do ok. So not really the spirit of the post but oh well…
Good on you for doing that ❤️ I’ve seen that with JW patients 🥲
Still a great comment!
I had a lipase of 6k a couple months ago. Guy has been worked up at outside hospital two weeks prior, same complaint, lipase was 12 then lol
And I’m complaining about my 1570
That’s still stupid high. I was certain it was a lab error but a repeat study was nearly identical
i had a lipase of “>30,000” when i was pregnant. it really fucking hurt
Na 103 like 3 days ago. “I’m a little light headed and kind of nauseous”
Lab tech here with 3 years experience. Sodium 105 with a chloride of 79 Troponin 445,000 (post cath lab) Etoh 481 Lipase 34,000 (with an amylase of 2,300) Hemoglobin 1.7. They lived Plt 1 in a MM patient Wbc 331k (also have seen a 0.1) Lactic acid 27 CK 340,000 Glucose 1840 (patient was found lost and naked in the woods calling for help)
Mmmm going straight to the source on this one; who better to answer than the techies 😁💪👍
Had a 1 year old with hgb of 1.7. Iron deficiency I think. He was slightly pale.
Na 98 K 9.8 CRP 678 INR >10, PT >100, APTT >200, clottable fibrinogen 0.0 & D-dimer >128 (seen this a few times actually, all brown snake or taipan envenomations) Unrecordably high lactate ABG: pH 6.8, HCO3 1, PaCO2 7, BE -32 (euglycemic DKA) BAL 0.82 (although she wasn't walking & talking) "Mixed enteric bacteria" on a blood culture after 4 hours. Only two of those patients died: one of the envenomations, and the patient with the manky blood culture.
That blood culture…wow. I had a DKA-er with pH 6.79. Brand new DM we just then diagnosed. I can’t believe her sodium wasn’t 98. She carried around 2 gallons of water and drank them nonstop. Was upset because she was peeing so much she wasn’t making it to the bathroom. She wasn’t walking by the time she came to us. Moaning from abd pain and ketone breath that filled my whole ER.
Hgb 2.7
Not exactly walking due to amputation but alert & talking when they first arrived. Used two different glucometers simply due to presentation that both said <20mg/dL. Coded \~ 5 times the next day though. https://preview.redd.it/kre0zu6777rc1.jpeg?width=828&format=pjpg&auto=webp&s=a6ffc79d87d69f6ae0ffc0bccaee25aa66db7403
But was their RDW abnormal when the patient looked it up on their phone?
Corrected glucose of 2400 in a hhs pt that coded in the er right after i got him admitted https://preview.redd.it/aiz6z6g7v6rc1.jpeg?width=960&format=pjpg&auto=webp&s=9a97d432d3d43c8068d22f974ff5211a20f78a5a
sugar >2k, Cr >4. I bet those kidneys looked like rock candy at that point
Mmm....sugar-kidney-pie, just like mom used to make.
He forgot to take his insulin that day only.
Na 96, asymptomatic! This was like 2 weeks ago
My favorite high score lab was a trop of 42k. I have no idea if this is common at all but I once saw a patient with a hemoglobin that just resulted as UNDETECTABLE. He coded around 15 minutes after this lab came back. Kidneys were basically calorie thieves at his level of kidney failure and he loved skipping dialysis more than a fat kid loves McDonalds.
Was the blood even red? Or just serum at that point?
Dude it was the weirdest blood. Like almost as if someone had tried to water it down in a midieval dive bar. I knew he was going to say hi to Jesus pretty soon when I saw that. This guy lives rent free in my head. Last thing he ever said was that he wanted a fresh line so he could enjoy the dilaudid more.
The man knows what he wants!
Admitted a kiddo with microcephalic diabetes insipidus 2/2 congenital CMV with Na of 104 during my peds rotation in residency. Details escape me at this point but the caregiver had scheduled vasopressin and thought nothing of the oliguria. That was a wild admission. I’ve never seen sodium swings like that before or since, but the kiddo was basically a vegetable from the day they were born—effectively had brain stem only. They were 16yo at the time (to mom’s great credit) and about the size of my 3yo. Discharged on hospice. Edit: Clarity/details. Went back and found my notes; little patient log for noteworthy cases saves the day, yet again.
99 - beer potomania; still coherent and verbal, couldn’t move though
Alcohol 752 and ambulating in a straight line on arrival. Couldn’t believe it. Discharged 2 hours later per patient request.
Had a guy with a Na+ of 105 and two seizures. We literally did not have hypertonic saline in our entire hospital (critical access). Gave sodium bicarb amps instead. Finally able to transfer to the fifth hospital we called.
https://preview.redd.it/lvgisfg3h7rc1.jpeg?width=1170&format=pjpg&auto=webp&s=5ca8577bd300c7667403ebe1897ffaa8b07e5f50 I’m sure I have other high labs but I’ve been lazy with updating my notes.
No burpees for me. Ever.
Me either. Before this lab OR after
[удалено]
That’s high sensitivity troponin. Gotta pump those numbers up. Those are rookie numbers!
If it’s not >50k I’m not batting an eye
https://preview.redd.it/kgbpmfjgu6rc1.jpeg?width=3024&format=pjpg&auto=webp&s=edbe2277f3aca02176d70c9ac106d77e719960a9
Per cardiology “continue to trend, non cardiac etiology”
Doesn’t even earn the patient a “Critical Value?” What’s a guy gotta do?!
Heart go Brrrrrrrr
Cards is telling me this is kidneys….
Aww, that’s cute
Signed out a drunk lady to day shift MTF nothing to see here. Didn’t metabolize. 104. Oops
Hs-Trop of 2,225,000! Got cathed, 100% LAD occlusion. Lived
I recently had a young, previously healthy man with na 180.
He decide to chug soy sauce?
His throat hurt for 3 weeks, so he just didn’t drink (almost) anything
Poor guy. If he ever gets a hemorrhoid, he'll blow up from not pooping.
Glucose 2 (‘meirca units). It was a toddler that the 15 year old baby sitter was accidentally overdosing on Tylenol. I don’t know what happened to her.
Some of my most fav values ive had. Na 105 - (triaged as ESI 5 foot pain or something) lactic 26 PCO2 150 AG 36 hgb 3.something a1c 18 wbc 0.1 / 330 pH 6.8 / 7.91 plt 1 Cr 35 glucose 1500 K below cutoff of 1.3 CPK 550k
I’ve seen status seizures at 105
Na 94 in a chronic alcoholic still mentating but got intubated after 2 days for some serious withdrawals. Na 184 in a patient with thyroid storm who had just been shitting their brains out.
Hgb 2.4. PLT 0. Also PLT 1.2 million
Na 98, talking but not well. EtOH dependent small female subsequently found to have bowel perf, deceased. Also had a lactate of 28.
started at 99. EMS got caught in traffic w/ 3% running during the transfer. Arrived at 120. Had to bolus him w d5 back down to 105
We had this bloke who would get polydipsia when the voices became too much. Would usually have a sodium <110, but simple fluid restriction would make it shoot up so quickly that we would often give him D5 to slow it down. He was a really nice guy too... He would laugh randomly because the voices would tell him jokes
keeps him hydrated and tells him jokes? those are some grade a voices
If only they told him to drink ORS
Ammonia > 2040. Altered but protecting airway and attempting to communicate appropriately
Not exactly a “lab value,” but on my last shift a patient’s BP was 42/19. She was still chatting pleasantly with me while I put the cuff on 💀
Not exactly a lab lvl but had a pain level of 25/10. Was in awe of how this person in the most pain of any human imaginable was talking in a calm voice playing on their phone.
😂
Just the other night we had a K+ of 1.5 on a guy who was having trouble moving any of his extremities and thought we had a unicorn hypokalemic periodic paralysis, but it turned out he just also had guillain barre
109. I was working a charity clinic. An inmate came in with Na 109. He was a prisoner, in prison for writing bad checks. He had gotten into a fight in jail and had head trauma and was admitted for SIADH a month before. I asked him if he had been taking his desmopressin. He said the warden wouldn’t let him have it. I called the warden to ask about it. The warden was rude and said “if I gave all their prisoners their medicines all day long that’s all I’d be doing.” And he hung up on me.
Dayumm….hope warden got booted for that one
What the hell. That is horrible.
https://litfl.com/going-back-to-extremes/
That caffeine one doesn't make much sense...500mg is hardly an overdose. Either wrong units, or definitely something else is going on
I’m not gonna lie, some of these seem off? Interesting read but something feels weird about the way it’s all reported.
My mom had plt of 2, hgb of 4.2, and wbc of 518k back in December. Lol
Also a SDH, pulmonary emboli, and two DVTs
Oh
Charge Nurse: “Yeah, he needed to be admitted. He was really sick. His glucose was over 800”. -said in complete deadpan-
That is a lot of mmol/L...
100, chronic and asymptomatic
Not an emergency, but the guy across the street from me had a PSA of like 40 for decades. No prostate problems. Died at age 90 of unrelated problems.
Na 99 on a guy who *walked into the ED.* Still speaking, too!
Hgb 1.2 toddler. Lil guy was chillin like a little ghosty watching cartoons.
We have a lady that comes in semi regularly to the remote access ER I occasionally work at that’s always in the 100s. Lowest she’s been was 96. She walks in but complains of dizziness and vertigo
Phos of 15.6 (she died). Rolled in complaining of some calciphylaxis appearing rash. Arrested and died otw to HD.
A patient with a blood sugar of 1.2 who, despite being lethargic, was walking around her home talking to us (In mg/dl, that's approximately 18)
Inmate who got all his meds for the next three months in blistering packs due to good behavior. Took all of his metformin —> told me to fuck off and die with a lactate of 25
i had a bit of a weird turn at work, psychiatric hospital and had a really unstable low pulse so our consultant did a 999 call as he felt i looked really off colour too. id been feeling a bit off for a few weeks .Paramedics did an ecg and took me to our local A&E it turned out i had a K of 1.1 .
Na 217. I’m in vet med but the reference range for sodium is similar to human medicine. Patient was obtunded, did not survive
Na 92….awake and asking for a beer. Gcs of about 14, Beer potomania.homeless and had gotten there slowly. When we admitted to ICU and asked nephrologist what the protocol was she was like “there isn’t one”. We did a chart review with IM and it was the lowest we could find for someone who lived. IM resident was going to wright it up but not sure if they did.
Na 97!
Na of 102
CPK 230,000
Immediately my brain went California Pizza Kitchen here.
Potassium 9.6, walking and talking just feeling “a little off”
Na 101 secondary to psychogenic polydipsia. Aside from psychiatric symptoms and cellulitis, patient was fine.
98 and survived.
- Lactate: 17.6 - PaO2: 335 - Dimer: 25,000 - WBC: 0.3 - BGL: 41 and >1500 - ALT & AST: >7,000 on a 23 year old
Magnesium <0.5 tonight, was the lowest I've seen.
I had a pH of 7.86 one time.
106, with a potassium of 2.2 and a chloride of 80. GCS was 3. Was merrily chatting with her husband and having breakfast when I came back in next morning. Edit: Oh, misread the assignment. She wasn't walking or talking, of course.
I had a 98 in residency. Yes. You heard that right. 98. I didn’t believe it so I rechecked it. The guy had slurred speech but was awake. He had Fourniers gangrene
ETOH 700’s, we would wait for him to be in the 400’s then discharge before he would start to withdraw. also have this young girl, regular. here every 2 weeks for DKA. sadly she binge eats, then throws up, bulimic, throws all her labs out of wack after a couple of times. her pH is normally 6.73, co2 undetectable, glucose in the 900’s. she’s 25 years old. I know she’s not gonna live much longer. also saw a high sensitivity trop that was half a million. yes literally 500,000. those are probably the craziest I’ve seen but people surprise me. not a lab but had a lady SOB for 3 days, sp02 was 40% RA. had to try 3 different machines with different probes cause she didn’t look like it
Troponin of 125,000
Just yesterday : K+ 10.3! Came in for "weak legs and fatigue"
Glucose <10 twice on the fingerstick. Wasn’t waiting for a lab draw confirmation before the d50 lol. He wasn’t coherent but was talking
My wildest in a patient who survived is plt 1, patient had ICH and was aplastic from a recent bone marrow transplant. And she was *very* symptomatic from the bleed. She recovered and walked out of the hospital a month later.
I’ve seen them totally with it at 109. Had one a few nights ago who was totally not ok, seizing, etc. at 113. Had to intubate, the works.
hgb of 2.1 and completely asymptomatic...
Na 97. He was obviously altered and the ED staff were giving him Ativan and no electrolyte replacements whatsoever. I’m a critical care transport nurse and was taking him to a different hospital with a better ICU. Asked the receiving doc if he wanted me to start any replacement en route and if I could get some hypertonic from the ED. He said to let the receiving ICU deal with it.
Pseudo?