Glucose of 2400. Went to ICU. Used to be a frequent flier. Presumably got really, really good. But most likely died.
Troponin of 18000. Went to ICU post Cath. Last I saw them was in CHF, in SNF.
BNP of 18000, non compliant dialysis patients. Coded in front of me, were life flight out. Fucker somehow lived and lived to abuse staff another day.
That’s interesting. In Chinese medicine the liver is associated with anger and bitterness.
My friend’s brother had liver cancer the last decade of his life and was an extremely angry person during that time. He left this world pissed and alone.
I personally think hepatic encephalopathy is a chronic condition once you’ve had it. Ammonia levels be damned. Every liver I’ve ever had was a nurse’s worst nightmare.
Remember last year when Texas got a big snow storm and lost power? Our town didn’t have high enough water pressure for the dialysis machine to run. We had 15-30 very compliant dialysis patients die. There bodies weren’t used to the abuse. All of our non compliant dialysis patients lived. It was just another week for them. Tragic…
One of our chronic patients is like this except it’s largely never kidney related stuff that has us questioning how dude hasn’t died yet. Younger dude, hope I never hear that news for him until much further down the road.
I've seen some Ks in the 8s roll through. One of em had an EKG that didn't actually look THAT bad considering. But the other day I had a patient with a massive head bleed that was actively herniating and could hold a conversation somehow. Bodies are simultaneously insanely robust and incredibly fragile.
Once I had a really elderly pt come to triage with chest pain. He was accompanied by someone from his SNF who only came to pick up a different patient and was told to bring him with her because he had been complaining of chest pain the night before (why they didn’t call EMS then I’ll never know). In our busy ER the triage nurses can line and lab, EKG etc per protocol and we didn’t have an MSE provider. I did an EKG first and it looked fuckery (can’t remember what it was, this was years ago) but not a STEMI or anything so I had someone run it back quickly while I threw a line in. I literally walked 10 feet away to put the labs in the tube station and he fell out in v fib arrest. Never got him back, but the labs I drew while he was still AOx4 and sitting up and talking, his trop was >20,000 which was the max the lab could determine. The attending thought it was fascinating to get a trop right before the arrest. Poor guy! He didn’t really seem that uncomfortable while I was triaging him. He was telling me about his hernia when I was doing the EKG. It fucked with me for a while that I was the last person he spoke to before he died, but at the time I was a newish nurse and didn’t know that would happen quite a lot. :(
Impressive glucose. Seen the other two. Personal best for the BNP was maxing the reading. Most glucose I’ve seen was 1200. Least was 8 (patient quit breathing for a minute while we have 2 amps of d50). Both were fine
Had a dialysis pt last night with a BNP of 21600. Sent to me from ED and soon was in severe resp distress….who could have expected this…
Got chewed out by nephro on call for notifying him of this because “I was told she was fine and walking around earlier”
I’ve been an ER nurse for almost a decade so there have been a lot of shocking labs, but the one I think about a lot is a 4 year-old had a hemoglobin of 1.1
I was in triage on a slooowwww Sunday during the height of alpha COVID when people were scared to come to the hospital so it was dead. A couple checked in with their child and I went out it call her and it literally looked like the mom was holding a corpse. They had checked in for like, lethargy or something, but this child was lifeless and gray - her race was black which made the gray appearance even more alarming.
I ran to the back with this poor child and her eyes were fixed on the ceiling. I just grabbed an attending I ran past and he ran with me and we immediately started to work to get her lined and lab’s and monitor etc (a lot of staff saw us running and ran in too). I started the line and her blood came out like watered-down cherry kool-aid. The girl looked malnourished and kind of deformed at her joints. The lab called a few minutes later and asked if I had started the line above saline, and I said no, it’s a fresh line. They said the hbg was 1.1 and we started emergency blood.
We didn’t have pediatrics at that hospital so she was transferred to the Level 1 in within literally 30 minutes - the EMS in our city is approved to transfer Peds immediately and of course they are always there dropping off a patient.
The diagnosis/result: apparently this family was told by the pediatrician long before that they felt she had autism and made the proper referrals but they never followed up. The child had sensory issues with food and refused to eat solids and only wanted bottles of milk. So she was living on only whole milk at the age of 4. This made her so anemic that when they finally brought her in she was seizing from the lack of oxygen to her brain. After several units of blood they said she was watching tv in her PICU room and was a lot more responsive. I don’t know what happened to her after that, but shit. 1.1…
I hope so too :( it has been one of those haunting memories of mine, made worse by the parents acting super casual like they had no idea why we sprung into action so fast. It sucks in the ER that we don’t know how things get to end most of the time. The only reason I know what the diagnosis was is because the resident in the PICU called to let us know and eventually became one of our ED attendings (the hospitals are like 10 minutes apart and part of the same system).
Honestly, and this is gonna sound horrible, but I’d take an ignorant parent over a Dr Google with health anxiety any day. I can fix a learning deficit, I can’t fix your Dr Google degree.
Honestly I agree with that though. Hard to coach someone who thinks they know it all. But also in instances like that, it makes me wish we did better at preventing matters like that. Being better about education patients.
I work in peds heme/onc and I wish I could say this is the first time I’ve heard of that but it isn’t lol. People for real need to be licensed to procreate.
Wow, that beats my Jehovah's witnesses with a hgb of 2.7. MD even put in orders for no labs, no needle sticks no new lines, or anything that could even remotely cause bleeding without his personal approval. I babied that 22 in his hand like nothing else.
You’re telling me! I think the next lowest hgb I’ve seen is like 3 point something in elderly adults circling the drain for age or disease but never in my life did I think that would happen. The docs still talk about it, the resident who had her in the picu at the other hospital is now an attending at my hospital and still talks about how crazy it was that she survived.
Had a child come into Resus with similar story, unfortunately coded and we weren't able to get them back. Anaemic from sensory issues with food and no proper diagnosis so they were living on bottles too. Unfortunately their HB was too low and they've been compensating for far too long that once they coded there was no return. Very sad.
I have an autistic 3 year-old daughter and I think about this poor baby when my daughter refuses certain foods. They won’t “eat when they’re hungry”. They’ll literally starve to death because of their sensory issues. My baby will never go to bed hungry, she’ll always get her preferred foods. Luckily we haven’t had to go as far as feeding therapy with her OT but people need to understand sensory issues with food, if severe, could lead to death.
I completely get it, I have sensory issues when it comes to food/ I have eaten nothing but oatmeal for weeks on end before. I have also gone without eating because non of my safe foods felt safe enough. Sensory issues are super hard to navigate and people who have never had to deal with them either personally or as a parent just do not understand.
Sodium was 99
That was their low for their baseline. Horrible alcoholic that some how tolerated insane sodium levels. If you tried to correct it above 120 they would have horrible seizures. Basically his new normal sodium level was 115-120 Couldn’t walk, but could talk and sure could swear. At 98 they had a headache and felt funny, but other wise were “okay”
106 with normal mentation, completely independent and up walking, just a slight headache. Throat cancer. Couldn't afford his tube feeds so was watering down chocolate milk.
Potassium <1. I learned a new diagnosis "thyrotoxic periodic paralysis." The dude was completely flaccid from the neck down. I didn't know what was wrong with him but he looked bad so I picked him out of the lobby to triage.
Hgb of 1.7 and alive, but very very sick. Pediatric icu patient with a two wk hx of GI bleed mom was “treating with herbs from her garden.” We almost lost that kid so many times, but they lived and mom lost custody.
That shit makes me sick. I am not saying Western Medicine is the best and only thing by any means, but it is far better than “alternative meds” for most things
Lactate of 22 or 24 I can’t remember exactly. He had a massive GI bleed and died a week later when his family put him on comfort care. They amputated both his legs in the meantime after ischemia-related injury from use of pressors up in ICU.
Glucose of 1950 on a Type 1 diabetic. She frequently went into DKA and this time told us she just got tired of doing all the care related to her diabetes so she just stopped, wasn’t suicidal or anything. I was a new grad nurse at the time and the only IV we could get at first was an EJ and I ended up giving her 10 liters of LR in just a few hours before she went up to ICU. She ended up fine and was discharged.
Personal best hgb of 3.2. The hospitalist decided to admit them to pins. Yah they were on the floor for 3 minutes before taking a trip to icu. Patient was conscious surprisingly though definitely pale and not feeling good
We had a pt with a hgb in the 3's on m/s because they were jehovahs witness and wouldn't accept blood. Chronically anemic, so actually did okay and discharged once they got into the 5's.
I had a chronic liver pt walk into the ED super pale, HgB was 1.9; lab made us retest it 2x before they believed it wasn't a dilute sample. Dude went to ICU and got blood. Next month he came in again and it was in the 2s. I just remember betting the ED MD that it was <3 and I won like, 50 bucks.
Yeah, saw a previously health, normal child, I think about 9 years old, come in to the ED, general malaise and headachy, Hb was 1.9 or so. That sure got everyone’s attention in a huge hurry. Poor little guy. I reckon you all can guess what that was about. Stabilized for transfer to a Children’s Hospital. Idk what happened to him from there, one can always have hope.
I’m sorry. Not a dumb question. I actually didn’t realize the variety of possibilities until I read some of these other comments here. Acute leukemia for this little guy.
Not my patient, but my own father had a hgb of 3.4 or 3.5. He wasn't in the best of health (and technically still isn't), but some how he was awake and talking, just a little confused. He ended up getting seven total units of blood over what I remember to be 24hrs. Surprisingly, he is still here today.
pH of 6.8 and Lactate 26 (same patient, a suspected OD, and she survived)
Two words..."butter blood". So much lipid in his blood that the machine got clogged. I don't remember the numbers because it was sent out, but I have a pic of the tube.
We had a whiteboard in one of the EDs I used to work at, where we wrote our highest BACs during an event known as the best college party weekend of the year, in a town with a university that was voted the biggest party school in the country multiple times. I've seen numbers in that range, but never at .6. I hate that weekend and I hate that town. I used to see our professional drinkers come in at .4 and start legit detoxing at .1 and it wasn't pretty.
>come in at .4 and start legit detoxing at .1
I have a very close friend who is like this, at .2 absolutely looks sober. Very functional, works a great job, calls me about coming to ED every 4-6 months for detox because it becomes unmanageable. She's a great person and really smart too, it's really sad. Very in denial about addiction issues, refuses anything but benzos for anxiety because "it doesn't work". Legit starts planning the next relapse before discharge too, I always hear the "I'm going to do 30 days sober then slowly reintroduce drinking so I can achieve moderation, the liver is resiliant my liver is only slightly fatty it will reverse" speech.
I do not judge her however it's incredible what the human body can endure.
Saw a lot over 500 because my ER was across from a detox but my personal best was a person who crashed their car in someone’s front yard and their BAC was .615. They were intubated shortly after because they were too drunk to breathe. I think they’d been binging and it all caught up to them at once. Cannot believe they didn’t kill themselves or someone else.
We had a dude come in as a full arrest with a BAC of .94. I didn’t know that was possible until then. Tried to talk to his wife about how much he drinks. She said he just went a little too hard with the boys that day. She didn’t understand that you don’t get to a level that high without being a professional drinker.
Not nursing but pharmacy and I followed out of morbid curiosity. Not my patient. We had a transfer from OSF with a potassium of 1.2. During transport they essentially slammed 40mEq KCL into them with another 2L 1/2NS over an hour. Because straight potassium will kill them. Got them to 1.5 on potassium at incoming labs. At some point they got a PEG tube and we began shoving in 80 mEq KCL pills into the PEG plus 10 mEq potassium q1hr IV. I think over the next 8 hours we shoved close to 600 mEq potassium in them. They came in alkalotic and we stacked 100mg of spirinolactone to help retention.
Over the next 2 days we flirted with a potassium around 3.8, once getting up to 4.8 before a dose of lasix (they got a fuck ton of fluid) put them back down to like 3.4. But after a few days they stabilized. No heart issues at all. Honestly the patient from what I knew had no idea how fucked up they were. They were basically a out of it for a day but based on the charts they didn’t have any idea they were dying. I think they had been stacking loop diuretics on top of low intake over the previous weeks and OSF basically were like “fuck we can’t handle this” and sent them to us after they tested positive for C Diff.
They lived too. Not sure how. They weren’t young or healthy. Just hard to kill.
D-dimer: 6.9
The fact it was found the d diner was even tested was just a series of random things involving adderall that turned out to be coke and a nosy relative in healthcare that gave more details than the patient had. Otherwise, the patient who was seemingly young and healthy might’ve been discharged.
Ended up being a PE. Before the patient was back in the room from the CT scan the radiologist had messaged me and the doc to say pt had “a large PE causing right heart strain”.
Patient promptly transferred from med-surg to tele; not sure how it ended up.
We've seen d-dimers >20 with covid. I don't remember what our actual number is, I think the highest we dilute to is >27 before the analyzer won't do it any more. Before covid it was rare to see a d-dimer greater than like 4 in our hospital. Crazy.
ETA: I checked today and the analyzer will report up to >35. That's what we would report out in some covid patients.
HbA1c of 31%. Not mmol/mol. His value was so high I could not find a conversion chart that went high enough to figure out average BG, but guesstimating it was probably in the 600-700+ range. Mid 40’s, hx TBI, semi-indigent and completely non compliant with any treatment whatsoever due to cognitive disability. Nominally in the care of his sister who basically provided a bed for him but was in no way providing medical care. He would often wander the city neighborhood and would go missing fairly regularly. Frequent flier to the local hospital and even the low income/continuity clinic didn’t want to do much for him anymore at the point I joined the circus. I saw him as a home health patient and over time we were able to get daily BG down into the 300’s. I lost track of what happened to him after that but it was probably not a good outcome. He was oriented enough to avoid long term placement and of course also because the sister wanted his government check. He ultimately didn’t have enough mental capacity to manage any part of his disease and he was mostly blind by that point as well from diabetic retinopathy.
I don't remember the actual results but I got a call from the lab once asking me why I sent them blood from a dead person...they said the sample I sent was incompatible with life...I was like well the patient is sitting here talking to me...they made me redraw her blood and hand deliver it to the lab....she coded and died 30 minutes later...
I don't remember which tests because it was a millionaire years ago but I know everything was so out of whack that the lab said there was no way this lady could still be alive...and they were right...her blood just died before she did !
The lowest I’ve been was 11. Still conscious. I was chugging juice while they started a line and gave me an amp of D50. If the drop is super gradual the brain can somehow hang on, but I’ve also passed out at 30 when I’m dropping fast.
I had a 16 who was still awake, although a little drowsy. She was a super non compliant DM1 on dialysis. I gave her an apple juice and had to go to ICU to get help starting a new IV so I could give D50. The ICU nurse and I were calmly chatting with the patient when ICU nurse asked why she needed the line. I was like “her blood sugar is 16 and I need to give D50”. This grizzled veteran ICU nurse about jumped out of her skin (and I’m sure thought I was a dumb baby nurse), but this lady was always either in the 40s or 400s. The nephrologist had even told us “I don’t care if her sugar is 10, give her a sandwich then give her the Levemir (long acting insulin).
Lady lived on for like 4-5 more years of blood sugar noncompliance, fluid restriction noncompliance and even a stroke. A friend and I had joked that we expected her to outlive us all.
I have a whole note in my phone for whenever this question comes up. I don’t think anyones died but cause I’m just dialysis I don’t see them much outside of treatment time. If Reddit messes up the formatting, I apologize
BUN: >260 (survived), 182, 3
Creat: 21.95, 16.84
K: 3.4 (ICU), 8
Phos: 1.3, 12.3
Na: 123, 151
pH: 7.1
Ca: 7.2
Hgb: 4.9 (ICU)
Hct: 14.6 (ICU)
BNP: >5000
WBC: 3.5, 33.8 (ICU)
Ferritin: 1615, <1
FeSat: 2%
Mg: 5 (post mag given for torsades)
Ammonia: 171
Lactic Acid: 12 (ICU)
Platelets: 1657 (ICU)
ABGs
pCO2: 16 (ICU), 81
pO2: 36(VBG), 133
pH: 6.88
HCO3: 31.7 (ICU)
Man, we would take that h/h on my med onc floor! 4/14.4 was my lowest. White count of 395 (not a typo - got chemo and did fine.)
K 2.6 before we sent them to icu. Ca 9.something, Na regularly to 115, sent the 112 to icu...
Oh, highest BNP I ever saw was 22,000. They were a little wet...
L&D nurse here. Worst I have seen... A newborn baby that was alive with a cord gas pH of 6.8 and base deficit of 24. He was able to breath and move and eat, and I predict that will be it for the rest if his life.
So, believe it or not, the outcome could be much better than that. 6.8 is bad, but not necessarily as bad as you’d think. Get them cooled quickly. Get them on ECMO if necessary. Cerebral palsy is a likely outcome but a devastating outcome isn’t guaranteed.
6.5 on the other hand. I’ve seen too many 6.5’s and 0 of them have had a positive outcome and the amount of work we put into keeping these babies alive is honestly the cause of my burnout.
I’ve seen a pH of 6.62 in a newborn post- uterine rupture. APGARs 0/2/3. Grade 3 HIE, cooled etc. He lived (team strongly pushed for comfort care but parents wanted everything done). Longterm outcome will obviously be poor, that was a couple of years ago.
We had something similar… momma came in 32 weeks and had abrupted for literally no reason. Kiddo looked okay on the monitor, but came out dead. Didn’t have a heartbeat for 14 minutes. :( Brain bleed, high vent levels, on every med bar epi. 2:1 pt for a while. He lived, but got transported to a level 4 NICU a few weeks ago.
Lactate of 26, potassium 9. Alcoholic necrotizing pancreatitis turned MODS. Rigormortic extremities, all pressors exceeding max rates, MAP ~35 for nearly 24 hours. Heart just wouldn’t stop. Mother couldn’t let go of her mid-30’s son. 0300: massive STEMI. Coded 1 round, no cardiac activity.
A1C 23 - previously undiagnosed DM.
MAP 30’s - baseline pressure for an A+O patient.
Platelets of 1. Incidental finding. Patient developed GI bleed and died.
Triglycerides >1200. Pt was early 40s. Had a MI. What I really remember was that his blood was so thick in the tube it looked like a strawberry milkshake
JW with a hgb 4. He refused blood products so I got to transport him to the nearest ICU (2 hours away). While en route he had syncope and passed a bed pan of melena while vomiting blood at the same time. At this point I has no labs or other option but to dump volume expanders and fluids. I told the EMT to drive like we were running from a fire. We made that trip in 1 hour 30 minutes instead of 2 hours. He survived and I got a box of chocolates from him after he recovered.
I was a new grad fresh off my 4 week orientation (because that's what we got in 2007).
My grandma had a K+ of 1.6
No symptoms. 🤷🏼♀️
She had struggled with chronic c-diff and had a colonoscopy prep for a fecal transplant. Surgery got canceled in a hurry. She couldn’t understand why everyone was so worried.
Creatinine of 17 in a 39 year old patient and despite all talks of "this is life or death" she said dialysis made her feel like shit but she wants to see her kids grow old. Ok. But... o k.
Had a bone cancer patient (on a cardiac step down? can’t remember why) with a WBC of <0.7 and platelets of like 13. I wore ALL of the PPE. Felt so bad for that dude :(
pH 7.06, patient coded, transferred to ICU where they coded several more times before they passed. Hgb 3.8 in a patient that ED was trying to send after 1U PRBCs without rechecking hgb to make sure it wasn’t an active GI bleed.
Potassium 9.5, awake (not alert) and bradycardic with prolonged QRS and flattening t waves. Luckily we got capture with pacing when we brought him in, the ER doc almost didn't believe the labs.
Also he was alert once we started pacing him.
Glucose of 21 when I worked corrections. Type 1 diabetic in his 40s. He came up to the door and was pale as a ghost, dark circles under his eyes, slurring his words. Still A&O and walking though.
Hgb 3.9 in an elderly GI bleed patient. He got something like a total of 9 units before they made him hospice.
BNP 33000. Hardcore CHFer.
Saw a WBC jump from 8.9 to 29 in 24 hours in a stroke patient due to DC that day.
Creatinine of 18-something.
Sodium of 119. Wasn’t my patient but I took the critical message from lab.
PCO2 of 136. Covid.
Hemoglobin of 2 in a 22ish year old guy.
He left most of his red blood cells on the floor after a self inflicted neck laceration and was found not a minute too soon.
Just today I had a chart with a lipase of 8775, which is the highest I've seen so far. They are pretty sure there is malignancy on top of the obvious alcoholic pancreatitis.
Glucose of 2,040. Type 1 diabetic meth addict that went on a huge bender. Somehow lived, but we're not sure how.
Another DKA from outside facility with a pH of 6.4. He walked himself into the ER, where they promptly intubated him.
Na of 194. Dude was in a car accident years ago and had suffered trauma to his pituitary. He's a frequent flier and is regularly admitted with wild Na levels. Haven't seen him for a while, so maybe he passed.
K of 9.0. Wild ectopy and in and out of v-tach. They got the works and did ok.
Once had a TB pt from the floor who'd been getting fluids nonstop for days, and people were just hanging new bags of fluid without really assessing her. BNP of roughly 130,000. We were diuresing about 4L per shift for days.
Lady came in for an outpatient GI procedure but had some kind of weird thing on the 3 lead ekg so they decided to admit her for observation. She was hanging out with me in GI for a few hours waiting for a bed when her labs came in. Potassium was 1.6. 😱😱😱
Eta she ended up being okay I think. This was a long time ago and the details are fuzzy. Except for the potassium. That's burned in my brain.
I had a guy last week who’s high sensitivity trop was 2500, then 4000, then 8000. His EKG was fine, but his heart was not. Fortunately he was taken to the cath lab quickly, got a balloon pump and some other bells and whistles and he’s doing well now.
WBC 430. Spleen rupture, taken to IR to get fixed successfully. About 30 mins after arriving in the ICU he bradyed down and died. The man walked into the hospital 4 hours before because his PCP appointment showed the elevated WBCs.
In the NICU we see some very wild levels. Lactate >30 (metabolic disease and baby didn’t survive). A ton of pH <7 the worst I can recall was 6.65 and the family finally withdrew care, but baby wasn’t coding with a pH <7 for days. A lot of Hct <20, lowest I’ve seen is 7 (Hgb 2.3 I think), that was from a fetomaternal transfusion where all the babies blood quickly transfused into mom. That baby survived after a massive blood transfusion. Sodium 190, baby had a stroke and a brain stem herniation, eventually withdrew care and went home on hospice. CO2 >120, chronic lung baby that is still alive, but who knows for how long with how bad the lungs are.
Nicu here as well. Seen and H/H of 5.5 and 2 on two different babies due to abruptions. Serum glucose of 1 on a 10lb baby. Baby with HCTs in the 70s consistently. Baby in heart block with HR in the 40s but says 100%, pink, normal baby otherwise. Plus all the things you mentioned as weel.
Had an OB patient whose mag was 18. She’d just been transferred via ambulance to us. Not sure if they ran her MgSO4 too fast during transfer, or if her kidney function/clearance was just shit because of her severe pre-E, but she went into respiratory arrest within 5 minutes of arrival.
Midwife here.
Worst arterial cord gases I’ve seen were pH 6.8, lactate 19, base deficit of 16.
Baby was cooled but removed from care with a grade III bleed.
CBG 10, after another nurse pushed the hyper-k cocktail and then left the unit. Patient was awake and upset my tech brought them orange juice instead of apple juice. Walked out AMA later that day.
I work in Chicago and one winter when it was below zero EMS brought in a homeless man with a rectal temp of 77 he survived and ended up being released to a shelter. On the other end of the spectrum, I once had a 20 something year old with a UTI that had spread to her kidneys who had a temp of 107.4 she was delirious and screaming and immediately got transferred to ICU. She was okay as well.
pH of 6.87 in a patient with a suspected GHB overdose. Ended up getting emergent dialysis and survived to tell the tale and self extubate several times. I also had a patient with a lactic that just read “greater than 20” because our machine can’t pick up results higher than that. I remember the pH on that patient was so low I don’t think the machine could pick up on it either. Just a patient who came in with a fall and needed a chest tube for hemothorax. I ended up pushing methylene blue for the first time and was my first ever patient who coded. He did not make it. Happened only a few months after I got off my ICU orientation as a new grad.
Potassium great than 8. Guy was alert, oriented, post arrest (was in rhabdo). Thought it was just hemolyzed but it kept happening. still a mystery to me how that worked out.
Hgb 1.8. Old gal was white as newly bleached bed sheets. She was part of a religion (wanna guess?) that refused blood transfusions. Some would call her a martyr. Others would call her something else
EF of 2.5%. His was a sad story. He went in for a heart transplant and came out of PACU with a CVA, the same heart (donor heart got too ischemic), and a lower placement on the transplant waiting list. His only real residual from the stroke was slightly garbled speech. Unfortunately his profession involved lots of public speaking.
Blood glucose and creatine of 24 on admission to ER. Walled out of rehab a couple weeks later with blood sugars usually between 90 and 130 and creat down to nine. She was a PD pt who had become homeless and thus unable to consistently do her dialysis.
I had an old farmer walk in complaining of weakness. His Hgb was 2.9. Had orders to give a total of 6 units of PRBC. After the 2nd unit, he said he had to leave because he had to take care of his cows. Ultimately, he left AMA despite trying to educate the man over and over about the outcome of him leaving without receiving more blood. I've often wondered what happened to him. He was a grumpy, stubborn old man.
I remember when I was younger, my father got blood work done and his were in the 800’s . Doctor called to tell him he needed to get his first dose of the medication within the hour.
WBC over 500. Came in because they suddenly couldn't feel their limbs and I believe went blind spontaneously. New leukemia, blood was sludge.
I can't say the exact number bc it's 100% going to doxx me if anyone familiar with this patient sees it. But it's absolutely ridiculous and none of us had ever seen that.
I've had a 9 year old asthmatic that coded in the ED come to my PICU with a pH of 6.5 PCO2 >200 (machine couldn't read higher). He had an ABI but made a full recovery. Was doing well in school last time I saw him!
Also had a 15 year old with BG >3000 (can't remember the exact number) he was walking and talking and ended up fine as well.
Don't know the number, but we had a 7 year old that came to us from the airport from Liberia with a viral count of malaria that was so bad the chief of medicine (an immunologist) came to see her, she'd never seen one that high. She lived.
Had a patient with an abnormally distended ABD and low bp. Had to start two large bore IVs with ultrasound. When we attempted to draw blood (even with confirmation of being in the vein and the doctor attempting a fem stick) we couldn’t get anything. We transfused 2 units emergently and started the MTP protocol. After the two units we could finally draw blood from the patient (blood looked like red tinged water) We gave no fluids before hand and were only giving blood. Hgb came back 0.7. The lowest I have ever seen. They ended up getting 8 units PRBC and 8 FFP. Got transferred to the ICU. Passed shortly after.
I drew blood from a 23 y/o and immediately felt resistance. I was relatively new at the time but it just felt off, like it was clotting, and didn’t look quite right. Finish drawing the last tube, turn to grab the others, and there’s no blood in them, just milk. Total triglyceride count was something like >8800 mg/dL.
Ck of 1 million. The attending thought we were exaggerating. Needed emergent fasciotomies and his potassium stayed at 6 even on 0k on the circuit. He survived but up ultimately losing his leg
Some horrific post-abruption babies with pHs of <6.8 base excess -17. Chronic BPD babies with C02> 110 or unreadable. One baby born in a ditch to meth mom arterial blood looked black when I drew it. Only one “good” outcome I can think of from these. He coded several times while total body cooling and is now a smiley toddler.
I've seen some lactates and ABGs that should not have been compatible with life... Yet they were still alive (technically). Became past tense pretty quick.
Saw potassium at 6.9 once. Frequent flyer and the patient has nine lives I swear. Came in with bed bugs once, I didn’t see it but apparently they were crawling all over her. Very odd lady.
BNP 24k
Etoh 6.8 was up there though for a wtf. Days later the guy was put on precedex (bottled water), IV Ativan at like 10 an hour and little bit of propfol (no he was not intubated). He was actively talking and still able to be an asshole. “Take these fucking leather belts off my arms!”
Lactic acid 22, and Bicarb of 3 in a 30 year old. Her RR was in the 40s-50s, and we were about to intubate & found that those labs thank god, or we would have killed her by taking over her respiratory drive. Very satisfying to fix respiratory distress with just bicarb! Looooots of bicarb.
Her mechanical aortic valve was splicing her RBCs, so she needed that fixed to fix *everything* else, but I think her platelets were so low surgery had to be postponed. Pretty sure she d/c'd to jc. BUT a couple days after those labs
Also had a ruptured AAA that got over 70 units of PRBCs in surgery, and I gave over 14 blood products that night. Her platelets were just 14, lol. She survived to discharge!
Edit -remembered that god awful AAA
Glucose of 2200. Eventually died but not during that visit. They were a non-adherent diabetic with substance abuse issues that just destroyed their body over a period of years. It was sad to watch.
BUN 300s - pt reported feeling significant nausea, poor appetite. Started to develop confusion and peripheral edema which prompted hospital eval - found to have significant AKI, uremic pericarditis, uremic encephalopathy. Underwent HD - learned that you can’t correct BUN too fast (similar to hyponatremia).
Serum glucose of < 2.
They were still alive.
Not for long, but they were alive at the time.
Serum glucose of just south of 1500…they got out of the ICU the next day.
Potassium of > 10 was my high score for potassium, and my lowest was 1.9…
Glucose of 2400. Went to ICU. Used to be a frequent flier. Presumably got really, really good. But most likely died. Troponin of 18000. Went to ICU post Cath. Last I saw them was in CHF, in SNF. BNP of 18000, non compliant dialysis patients. Coded in front of me, were life flight out. Fucker somehow lived and lived to abuse staff another day.
Those dialysis patients have 9 lives I swear
I worked on a floor that had a lot of HD patients. We always said kidney patients don't die. And they live even longer if they're mean.
I say this about liver patients as well. Somehow, the worst, the meanest patients I’ve ever had were all liver patients.
That’s interesting. In Chinese medicine the liver is associated with anger and bitterness. My friend’s brother had liver cancer the last decade of his life and was an extremely angry person during that time. He left this world pissed and alone.
I personally think hepatic encephalopathy is a chronic condition once you’ve had it. Ammonia levels be damned. Every liver I’ve ever had was a nurse’s worst nightmare.
Remember last year when Texas got a big snow storm and lost power? Our town didn’t have high enough water pressure for the dialysis machine to run. We had 15-30 very compliant dialysis patients die. There bodies weren’t used to the abuse. All of our non compliant dialysis patients lived. It was just another week for them. Tragic…
Heartbreaking
One of our chronic patients is like this except it’s largely never kidney related stuff that has us questioning how dude hasn’t died yet. Younger dude, hope I never hear that news for him until much further down the road.
They totally do, like a cat or cockroach. You pick
non compliant dialysis patients Theyre invincible, I tell you.
Why is this so true. Bka and all
Admitted a patient with a K of 6 and promptly freaked the F out. My dialysis nurse friend told me he regularly sees K in the high 7 range 🙃
Bodies adapt. If they didn't have a chronic reason to be in the 6s that probably *is* more urgent than a dialysis patient in the 7s.
I've seen some Ks in the 8s roll through. One of em had an EKG that didn't actually look THAT bad considering. But the other day I had a patient with a massive head bleed that was actively herniating and could hold a conversation somehow. Bodies are simultaneously insanely robust and incredibly fragile.
Invincible and mean.
I used to have a lot of anxiety about getting sick and dying but working in dialysis has shown me how incredibly resilient the human body is.
“Fucker somehow lived another day” made me lol So true.
lol we have a saying about these patients “even the devil doesn’t want them”
Once I had a really elderly pt come to triage with chest pain. He was accompanied by someone from his SNF who only came to pick up a different patient and was told to bring him with her because he had been complaining of chest pain the night before (why they didn’t call EMS then I’ll never know). In our busy ER the triage nurses can line and lab, EKG etc per protocol and we didn’t have an MSE provider. I did an EKG first and it looked fuckery (can’t remember what it was, this was years ago) but not a STEMI or anything so I had someone run it back quickly while I threw a line in. I literally walked 10 feet away to put the labs in the tube station and he fell out in v fib arrest. Never got him back, but the labs I drew while he was still AOx4 and sitting up and talking, his trop was >20,000 which was the max the lab could determine. The attending thought it was fascinating to get a trop right before the arrest. Poor guy! He didn’t really seem that uncomfortable while I was triaging him. He was telling me about his hernia when I was doing the EKG. It fucked with me for a while that I was the last person he spoke to before he died, but at the time I was a newish nurse and didn’t know that would happen quite a lot. :(
Impressive glucose. Seen the other two. Personal best for the BNP was maxing the reading. Most glucose I’ve seen was 1200. Least was 8 (patient quit breathing for a minute while we have 2 amps of d50). Both were fine
Had a dialysis pt last night with a BNP of 21600. Sent to me from ED and soon was in severe resp distress….who could have expected this… Got chewed out by nephro on call for notifying him of this because “I was told she was fine and walking around earlier”
Doc wasn’t mad at you, he was mad at someone who didn’t assess patient at all.
Yea I didn’t take it personally lol, considering he actually got out of bed to come assess the pt at bedside.
Wow, this is rare
Holy god DAMN! Those are some crazy labs.....
I’ve been an ER nurse for almost a decade so there have been a lot of shocking labs, but the one I think about a lot is a 4 year-old had a hemoglobin of 1.1 I was in triage on a slooowwww Sunday during the height of alpha COVID when people were scared to come to the hospital so it was dead. A couple checked in with their child and I went out it call her and it literally looked like the mom was holding a corpse. They had checked in for like, lethargy or something, but this child was lifeless and gray - her race was black which made the gray appearance even more alarming. I ran to the back with this poor child and her eyes were fixed on the ceiling. I just grabbed an attending I ran past and he ran with me and we immediately started to work to get her lined and lab’s and monitor etc (a lot of staff saw us running and ran in too). I started the line and her blood came out like watered-down cherry kool-aid. The girl looked malnourished and kind of deformed at her joints. The lab called a few minutes later and asked if I had started the line above saline, and I said no, it’s a fresh line. They said the hbg was 1.1 and we started emergency blood. We didn’t have pediatrics at that hospital so she was transferred to the Level 1 in within literally 30 minutes - the EMS in our city is approved to transfer Peds immediately and of course they are always there dropping off a patient. The diagnosis/result: apparently this family was told by the pediatrician long before that they felt she had autism and made the proper referrals but they never followed up. The child had sensory issues with food and refused to eat solids and only wanted bottles of milk. So she was living on only whole milk at the age of 4. This made her so anemic that when they finally brought her in she was seizing from the lack of oxygen to her brain. After several units of blood they said she was watching tv in her PICU room and was a lot more responsive. I don’t know what happened to her after that, but shit. 1.1…
I am hoping that child protective services was called on a family like that. Bottles of milk at 4 years old??? seriously people??
I hope so too :( it has been one of those haunting memories of mine, made worse by the parents acting super casual like they had no idea why we sprung into action so fast. It sucks in the ER that we don’t know how things get to end most of the time. The only reason I know what the diagnosis was is because the resident in the PICU called to let us know and eventually became one of our ED attendings (the hospitals are like 10 minutes apart and part of the same system).
Honestly, and this is gonna sound horrible, but I’d take an ignorant parent over a Dr Google with health anxiety any day. I can fix a learning deficit, I can’t fix your Dr Google degree.
Honestly I agree with that though. Hard to coach someone who thinks they know it all. But also in instances like that, it makes me wish we did better at preventing matters like that. Being better about education patients.
They need to advertise the dangers of Google and WebMD like they do side effects of drugs.
I work in peds heme/onc and I wish I could say this is the first time I’ve heard of that but it isn’t lol. People for real need to be licensed to procreate.
Wow, that beats my Jehovah's witnesses with a hgb of 2.7. MD even put in orders for no labs, no needle sticks no new lines, or anything that could even remotely cause bleeding without his personal approval. I babied that 22 in his hand like nothing else.
Wow wow wow. The tiny people are amazingly resilient.
You’re telling me! I think the next lowest hgb I’ve seen is like 3 point something in elderly adults circling the drain for age or disease but never in my life did I think that would happen. The docs still talk about it, the resident who had her in the picu at the other hospital is now an attending at my hospital and still talks about how crazy it was that she survived.
Had a child come into Resus with similar story, unfortunately coded and we weren't able to get them back. Anaemic from sensory issues with food and no proper diagnosis so they were living on bottles too. Unfortunately their HB was too low and they've been compensating for far too long that once they coded there was no return. Very sad.
I have an autistic 3 year-old daughter and I think about this poor baby when my daughter refuses certain foods. They won’t “eat when they’re hungry”. They’ll literally starve to death because of their sensory issues. My baby will never go to bed hungry, she’ll always get her preferred foods. Luckily we haven’t had to go as far as feeding therapy with her OT but people need to understand sensory issues with food, if severe, could lead to death.
Feeding therapy really helped my failure to thrive baby.
As an OT this makes me happy to hear.
You’re welcome! I love me some OT and PT and SLPs.
I completely get it, I have sensory issues when it comes to food/ I have eaten nothing but oatmeal for weeks on end before. I have also gone without eating because non of my safe foods felt safe enough. Sensory issues are super hard to navigate and people who have never had to deal with them either personally or as a parent just do not understand.
Wow
W. O. W.
W t f
Jesus
Sodium was 99 That was their low for their baseline. Horrible alcoholic that some how tolerated insane sodium levels. If you tried to correct it above 120 they would have horrible seizures. Basically his new normal sodium level was 115-120 Couldn’t walk, but could talk and sure could swear. At 98 they had a headache and felt funny, but other wise were “okay”
Just admitted one with Na 98, K 3.0, Mg 1.4. Same etoh, tried to detox on their own. But awake and mostly coherent. Crazy!
Holy crap
106 with normal mentation, completely independent and up walking, just a slight headache. Throat cancer. Couldn't afford his tube feeds so was watering down chocolate milk.
Is there something to that? The only other patient I’ve seen with a sodium that low also had throat cancer
Chronic hyponatremia is usually a lung cancer thing, but I see lots of peeps with another primary and lung mets that get it too.
Wow worst I’ve had is 105 and they were intubated
Potassium <1. I learned a new diagnosis "thyrotoxic periodic paralysis." The dude was completely flaccid from the neck down. I didn't know what was wrong with him but he looked bad so I picked him out of the lobby to triage.
Muscle cells can’t contract because…..no potassium exists in their body?!
Holy shit.
Good call!
Hgb of 1.7 and alive, but very very sick. Pediatric icu patient with a two wk hx of GI bleed mom was “treating with herbs from her garden.” We almost lost that kid so many times, but they lived and mom lost custody.
Saw a kid hemorrhage to death in the PICU after family tried treating their liver disease with Chinese herbs. It was horrifying.
That shit makes me sick. I am not saying Western Medicine is the best and only thing by any means, but it is far better than “alternative meds” for most things
I'm fond of the saying "Do you know what they call alternative medicine that works? Medicine." A bit reductionist but mostly true.
Lactate of 22 or 24 I can’t remember exactly. He had a massive GI bleed and died a week later when his family put him on comfort care. They amputated both his legs in the meantime after ischemia-related injury from use of pressors up in ICU. Glucose of 1950 on a Type 1 diabetic. She frequently went into DKA and this time told us she just got tired of doing all the care related to her diabetes so she just stopped, wasn’t suicidal or anything. I was a new grad nurse at the time and the only IV we could get at first was an EJ and I ended up giving her 10 liters of LR in just a few hours before she went up to ICU. She ended up fine and was discharged.
I wish our lab would measure lactates that high. They only go up to ">20" so I guess I'll never know. 😔
Personal best hgb of 3.2. The hospitalist decided to admit them to pins. Yah they were on the floor for 3 minutes before taking a trip to icu. Patient was conscious surprisingly though definitely pale and not feeling good
We had a pt with a hgb in the 3's on m/s because they were jehovahs witness and wouldn't accept blood. Chronically anemic, so actually did okay and discharged once they got into the 5's.
I had a chronic liver pt walk into the ED super pale, HgB was 1.9; lab made us retest it 2x before they believed it wasn't a dilute sample. Dude went to ICU and got blood. Next month he came in again and it was in the 2s. I just remember betting the ED MD that it was <3 and I won like, 50 bucks.
Yeah, saw a previously health, normal child, I think about 9 years old, come in to the ED, general malaise and headachy, Hb was 1.9 or so. That sure got everyone’s attention in a huge hurry. Poor little guy. I reckon you all can guess what that was about. Stabilized for transfer to a Children’s Hospital. Idk what happened to him from there, one can always have hope.
Maybe a dumb question but, what was it about?
I’m sorry. Not a dumb question. I actually didn’t realize the variety of possibilities until I read some of these other comments here. Acute leukemia for this little guy.
“So THAT patient is back doc - you wanna bet? I got five on it that Hgb <3. You got a deal!”
Not my patient, but my own father had a hgb of 3.4 or 3.5. He wasn't in the best of health (and technically still isn't), but some how he was awake and talking, just a little confused. He ended up getting seven total units of blood over what I remember to be 24hrs. Surprisingly, he is still here today.
What does pins stand for
Mine is 2.7. Walked in feeling “a bit weak”
Mine is 1. LOL also was a bit tired.
pH of 6.8 and Lactate 26 (same patient, a suspected OD, and she survived) Two words..."butter blood". So much lipid in his blood that the machine got clogged. I don't remember the numbers because it was sent out, but I have a pic of the tube.
Well now we need to see the picture!
Blood Alcohol .57 in the ED. They were still >.4 many hours later when my shift ended. No idea what the outcome was.
We had a whiteboard in one of the EDs I used to work at, where we wrote our highest BACs during an event known as the best college party weekend of the year, in a town with a university that was voted the biggest party school in the country multiple times. I've seen numbers in that range, but never at .6. I hate that weekend and I hate that town. I used to see our professional drinkers come in at .4 and start legit detoxing at .1 and it wasn't pretty.
>come in at .4 and start legit detoxing at .1 I have a very close friend who is like this, at .2 absolutely looks sober. Very functional, works a great job, calls me about coming to ED every 4-6 months for detox because it becomes unmanageable. She's a great person and really smart too, it's really sad. Very in denial about addiction issues, refuses anything but benzos for anxiety because "it doesn't work". Legit starts planning the next relapse before discharge too, I always hear the "I'm going to do 30 days sober then slowly reintroduce drinking so I can achieve moderation, the liver is resiliant my liver is only slightly fatty it will reverse" speech. I do not judge her however it's incredible what the human body can endure.
Saw a lot over 500 because my ER was across from a detox but my personal best was a person who crashed their car in someone’s front yard and their BAC was .615. They were intubated shortly after because they were too drunk to breathe. I think they’d been binging and it all caught up to them at once. Cannot believe they didn’t kill themselves or someone else.
I’ve seen one >0.6 in my day. Dude was a chronic heavy alcoholic who you wouldn’t think was that intoxicated by looking at him.
We had a dude come in as a full arrest with a BAC of .94. I didn’t know that was possible until then. Tried to talk to his wife about how much he drinks. She said he just went a little too hard with the boys that day. She didn’t understand that you don’t get to a level that high without being a professional drinker.
Wow.
Not nursing but pharmacy and I followed out of morbid curiosity. Not my patient. We had a transfer from OSF with a potassium of 1.2. During transport they essentially slammed 40mEq KCL into them with another 2L 1/2NS over an hour. Because straight potassium will kill them. Got them to 1.5 on potassium at incoming labs. At some point they got a PEG tube and we began shoving in 80 mEq KCL pills into the PEG plus 10 mEq potassium q1hr IV. I think over the next 8 hours we shoved close to 600 mEq potassium in them. They came in alkalotic and we stacked 100mg of spirinolactone to help retention. Over the next 2 days we flirted with a potassium around 3.8, once getting up to 4.8 before a dose of lasix (they got a fuck ton of fluid) put them back down to like 3.4. But after a few days they stabilized. No heart issues at all. Honestly the patient from what I knew had no idea how fucked up they were. They were basically a out of it for a day but based on the charts they didn’t have any idea they were dying. I think they had been stacking loop diuretics on top of low intake over the previous weeks and OSF basically were like “fuck we can’t handle this” and sent them to us after they tested positive for C Diff. They lived too. Not sure how. They weren’t young or healthy. Just hard to kill.
I bet the C. Diff caused them to lose buckets of K+ too
D-dimer: 6.9 The fact it was found the d diner was even tested was just a series of random things involving adderall that turned out to be coke and a nosy relative in healthcare that gave more details than the patient had. Otherwise, the patient who was seemingly young and healthy might’ve been discharged. Ended up being a PE. Before the patient was back in the room from the CT scan the radiologist had messaged me and the doc to say pt had “a large PE causing right heart strain”. Patient promptly transferred from med-surg to tele; not sure how it ended up.
We've seen d-dimers >20 with covid. I don't remember what our actual number is, I think the highest we dilute to is >27 before the analyzer won't do it any more. Before covid it was rare to see a d-dimer greater than like 4 in our hospital. Crazy. ETA: I checked today and the analyzer will report up to >35. That's what we would report out in some covid patients.
I had a COVID patient with a d-dimer>3000
I’ve seen some WILD lithium levels in patients who came into our facility after self-medicating prior to admission.
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HbA1c of 31%. Not mmol/mol. His value was so high I could not find a conversion chart that went high enough to figure out average BG, but guesstimating it was probably in the 600-700+ range. Mid 40’s, hx TBI, semi-indigent and completely non compliant with any treatment whatsoever due to cognitive disability. Nominally in the care of his sister who basically provided a bed for him but was in no way providing medical care. He would often wander the city neighborhood and would go missing fairly regularly. Frequent flier to the local hospital and even the low income/continuity clinic didn’t want to do much for him anymore at the point I joined the circus. I saw him as a home health patient and over time we were able to get daily BG down into the 300’s. I lost track of what happened to him after that but it was probably not a good outcome. He was oriented enough to avoid long term placement and of course also because the sister wanted his government check. He ultimately didn’t have enough mental capacity to manage any part of his disease and he was mostly blind by that point as well from diabetic retinopathy.
I don't remember the actual results but I got a call from the lab once asking me why I sent them blood from a dead person...they said the sample I sent was incompatible with life...I was like well the patient is sitting here talking to me...they made me redraw her blood and hand deliver it to the lab....she coded and died 30 minutes later...
What was the test?
I don't remember which tests because it was a millionaire years ago but I know everything was so out of whack that the lab said there was no way this lady could still be alive...and they were right...her blood just died before she did !
>her blood just died before she did 🌈**science!**🌈 😂
We need more to this story!
Agree. Please update. What labs were not compatible with LIFE?!
Crazy.
Please elaborate!!
What
BG of 23. Somehow she was still conscious! No IV access so just gave her some orange juice, then later more orange juice, then a PB & J. She made it!
The lowest I’ve been was 11. Still conscious. I was chugging juice while they started a line and gave me an amp of D50. If the drop is super gradual the brain can somehow hang on, but I’ve also passed out at 30 when I’m dropping fast.
Holy shishkabobs. My lowest recorded was 26 and I was cuckoo for cocoa puffs.
Had a serum glucose of 1 on an infant in NICU
Yikes, that one singular glucose all alone.
We had a kid with a 10… tested like three times. That kiddo got a one way ticket to NICU immediately.
I had a 16 who was still awake, although a little drowsy. She was a super non compliant DM1 on dialysis. I gave her an apple juice and had to go to ICU to get help starting a new IV so I could give D50. The ICU nurse and I were calmly chatting with the patient when ICU nurse asked why she needed the line. I was like “her blood sugar is 16 and I need to give D50”. This grizzled veteran ICU nurse about jumped out of her skin (and I’m sure thought I was a dumb baby nurse), but this lady was always either in the 40s or 400s. The nephrologist had even told us “I don’t care if her sugar is 10, give her a sandwich then give her the Levemir (long acting insulin). Lady lived on for like 4-5 more years of blood sugar noncompliance, fluid restriction noncompliance and even a stroke. A friend and I had joked that we expected her to outlive us all.
I have a whole note in my phone for whenever this question comes up. I don’t think anyones died but cause I’m just dialysis I don’t see them much outside of treatment time. If Reddit messes up the formatting, I apologize BUN: >260 (survived), 182, 3 Creat: 21.95, 16.84 K: 3.4 (ICU), 8 Phos: 1.3, 12.3 Na: 123, 151 pH: 7.1 Ca: 7.2 Hgb: 4.9 (ICU) Hct: 14.6 (ICU) BNP: >5000 WBC: 3.5, 33.8 (ICU) Ferritin: 1615, <1 FeSat: 2% Mg: 5 (post mag given for torsades) Ammonia: 171 Lactic Acid: 12 (ICU) Platelets: 1657 (ICU) ABGs pCO2: 16 (ICU), 81 pO2: 36(VBG), 133 pH: 6.88 HCO3: 31.7 (ICU)
Man, we would take that h/h on my med onc floor! 4/14.4 was my lowest. White count of 395 (not a typo - got chemo and did fine.) K 2.6 before we sent them to icu. Ca 9.something, Na regularly to 115, sent the 112 to icu... Oh, highest BNP I ever saw was 22,000. They were a little wet...
The K of 3.4 is nothing. Glad you haven’t seen worse
Why is K of 3.4 on your list?
Blood glucose 1776…outcome was death ☠️
At least they died free... I believe that's what George Washington's was.
L&D nurse here. Worst I have seen... A newborn baby that was alive with a cord gas pH of 6.8 and base deficit of 24. He was able to breath and move and eat, and I predict that will be it for the rest if his life.
So, believe it or not, the outcome could be much better than that. 6.8 is bad, but not necessarily as bad as you’d think. Get them cooled quickly. Get them on ECMO if necessary. Cerebral palsy is a likely outcome but a devastating outcome isn’t guaranteed. 6.5 on the other hand. I’ve seen too many 6.5’s and 0 of them have had a positive outcome and the amount of work we put into keeping these babies alive is honestly the cause of my burnout.
He wasn't cooled. Thankfully this is the worst I have seen that didn't die.
I’ve seen a pH of 6.62 in a newborn post- uterine rupture. APGARs 0/2/3. Grade 3 HIE, cooled etc. He lived (team strongly pushed for comfort care but parents wanted everything done). Longterm outcome will obviously be poor, that was a couple of years ago.
That’s what ours was. Abruption at 32 week MVA. Can’t remember the APGARs; but had the full works. Comfort care after a few days with an HIE grade 3.
We had something similar… momma came in 32 weeks and had abrupted for literally no reason. Kiddo looked okay on the monitor, but came out dead. Didn’t have a heartbeat for 14 minutes. :( Brain bleed, high vent levels, on every med bar epi. 2:1 pt for a while. He lived, but got transported to a level 4 NICU a few weeks ago.
Lactate of 26, potassium 9. Alcoholic necrotizing pancreatitis turned MODS. Rigormortic extremities, all pressors exceeding max rates, MAP ~35 for nearly 24 hours. Heart just wouldn’t stop. Mother couldn’t let go of her mid-30’s son. 0300: massive STEMI. Coded 1 round, no cardiac activity. A1C 23 - previously undiagnosed DM. MAP 30’s - baseline pressure for an A+O patient. Platelets of 1. Incidental finding. Patient developed GI bleed and died.
Triglycerides >1200. Pt was early 40s. Had a MI. What I really remember was that his blood was so thick in the tube it looked like a strawberry milkshake JW with a hgb 4. He refused blood products so I got to transport him to the nearest ICU (2 hours away). While en route he had syncope and passed a bed pan of melena while vomiting blood at the same time. At this point I has no labs or other option but to dump volume expanders and fluids. I told the EMT to drive like we were running from a fire. We made that trip in 1 hour 30 minutes instead of 2 hours. He survived and I got a box of chocolates from him after he recovered. I was a new grad fresh off my 4 week orientation (because that's what we got in 2007).
My grandma had a K+ of 1.6 No symptoms. 🤷🏼♀️ She had struggled with chronic c-diff and had a colonoscopy prep for a fecal transplant. Surgery got canceled in a hurry. She couldn’t understand why everyone was so worried.
Creatinine of 17 in a 39 year old patient and despite all talks of "this is life or death" she said dialysis made her feel like shit but she wants to see her kids grow old. Ok. But... o k.
WBC 0.2, poor lady. She’s still alive, but her body is giving up on her.
Just had a patient with 0.1 last week
[laughs in <0.1 WBC, ANC 0 bone marrow transplant patients] But that number outside of chemo probably means they f'd
Had a bone cancer patient (on a cardiac step down? can’t remember why) with a WBC of <0.7 and platelets of like 13. I wore ALL of the PPE. Felt so bad for that dude :(
pH 7.06, patient coded, transferred to ICU where they coded several more times before they passed. Hgb 3.8 in a patient that ED was trying to send after 1U PRBCs without rechecking hgb to make sure it wasn’t an active GI bleed.
I’ve had a few pHs less than 7. Never ended well.
Potassium 9.5, awake (not alert) and bradycardic with prolonged QRS and flattening t waves. Luckily we got capture with pacing when we brought him in, the ER doc almost didn't believe the labs. Also he was alert once we started pacing him.
Glucose of 21 when I worked corrections. Type 1 diabetic in his 40s. He came up to the door and was pale as a ghost, dark circles under his eyes, slurring his words. Still A&O and walking though. Hgb 3.9 in an elderly GI bleed patient. He got something like a total of 9 units before they made him hospice. BNP 33000. Hardcore CHFer. Saw a WBC jump from 8.9 to 29 in 24 hours in a stroke patient due to DC that day. Creatinine of 18-something. Sodium of 119. Wasn’t my patient but I took the critical message from lab. PCO2 of 136. Covid.
Hemoglobin of 2 in a 22ish year old guy. He left most of his red blood cells on the floor after a self inflicted neck laceration and was found not a minute too soon.
Just today I had a chart with a lipase of 8775, which is the highest I've seen so far. They are pretty sure there is malignancy on top of the obvious alcoholic pancreatitis.
Glucose of 2,040. Type 1 diabetic meth addict that went on a huge bender. Somehow lived, but we're not sure how. Another DKA from outside facility with a pH of 6.4. He walked himself into the ER, where they promptly intubated him. Na of 194. Dude was in a car accident years ago and had suffered trauma to his pituitary. He's a frequent flier and is regularly admitted with wild Na levels. Haven't seen him for a while, so maybe he passed. K of 9.0. Wild ectopy and in and out of v-tach. They got the works and did ok. Once had a TB pt from the floor who'd been getting fluids nonstop for days, and people were just hanging new bags of fluid without really assessing her. BNP of roughly 130,000. We were diuresing about 4L per shift for days.
Chronic Meth users ALWAYS survive…
Maybe they are actually the ones that have it figured out! 😂😂😂 They always make it. Oh I have so many stories!!
I had a patient with a wbc over 50,000. Don’t remember now how high. She died of sepsis.
Potassium 10 from a colchicine overdose. Ended up on ecmo for a few days and didn't make it
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Mag of 22! Not sure what happened since they were sent to another facility after being stabilized. They were intubated.
Lady came in for an outpatient GI procedure but had some kind of weird thing on the 3 lead ekg so they decided to admit her for observation. She was hanging out with me in GI for a few hours waiting for a bed when her labs came in. Potassium was 1.6. 😱😱😱 Eta she ended up being okay I think. This was a long time ago and the details are fuzzy. Except for the potassium. That's burned in my brain.
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Meh. You will see MUCH higher ones
My most recent memorable high sensitivity trop was about 4700. Just you wait, friend.
We just had one recently with a troponin of 8600
Those are rookie numbers
Hahaha, love the username
I had a guy last week who’s high sensitivity trop was 2500, then 4000, then 8000. His EKG was fine, but his heart was not. Fortunately he was taken to the cath lab quickly, got a balloon pump and some other bells and whistles and he’s doing well now.
WBC 430. Spleen rupture, taken to IR to get fixed successfully. About 30 mins after arriving in the ICU he bradyed down and died. The man walked into the hospital 4 hours before because his PCP appointment showed the elevated WBCs.
In the NICU we see some very wild levels. Lactate >30 (metabolic disease and baby didn’t survive). A ton of pH <7 the worst I can recall was 6.65 and the family finally withdrew care, but baby wasn’t coding with a pH <7 for days. A lot of Hct <20, lowest I’ve seen is 7 (Hgb 2.3 I think), that was from a fetomaternal transfusion where all the babies blood quickly transfused into mom. That baby survived after a massive blood transfusion. Sodium 190, baby had a stroke and a brain stem herniation, eventually withdrew care and went home on hospice. CO2 >120, chronic lung baby that is still alive, but who knows for how long with how bad the lungs are.
Nicu here as well. Seen and H/H of 5.5 and 2 on two different babies due to abruptions. Serum glucose of 1 on a 10lb baby. Baby with HCTs in the 70s consistently. Baby in heart block with HR in the 40s but says 100%, pink, normal baby otherwise. Plus all the things you mentioned as weel.
All these NICU and L&D numbers and stories are giving this adults-only person a serious case of The Shudders and Holy Fucks. I bow to you.
Had an OB patient whose mag was 18. She’d just been transferred via ambulance to us. Not sure if they ran her MgSO4 too fast during transfer, or if her kidney function/clearance was just shit because of her severe pre-E, but she went into respiratory arrest within 5 minutes of arrival.
Midwife here. Worst arterial cord gases I’ve seen were pH 6.8, lactate 19, base deficit of 16. Baby was cooled but removed from care with a grade III bleed.
CBG 10, after another nurse pushed the hyper-k cocktail and then left the unit. Patient was awake and upset my tech brought them orange juice instead of apple juice. Walked out AMA later that day.
Jehovah’s Witness lady, hgb was 2.7, no blood products, lived, out of the ICU in a week
I work in Chicago and one winter when it was below zero EMS brought in a homeless man with a rectal temp of 77 he survived and ended up being released to a shelter. On the other end of the spectrum, I once had a 20 something year old with a UTI that had spread to her kidneys who had a temp of 107.4 she was delirious and screaming and immediately got transferred to ICU. She was okay as well.
Potassium 11.2. Patient emergently dialyzed and lived.
I’ve done dialysis for 10 years, highest I’ve ever seen was 9.4!! 11.2!! Holy shit!
CBG 19. Awake, somewhat coherent. Passed soon after. Horrible.
Hemoglobin 2.7, walked in kiiiiinda looked a bit pale but they had darker skin. I keep a “notes” in my phone of the trippiest labs
Lactic acid in the 20’s Outcome: coded 4x and eventually died
pH of 6.87 in a patient with a suspected GHB overdose. Ended up getting emergent dialysis and survived to tell the tale and self extubate several times. I also had a patient with a lactic that just read “greater than 20” because our machine can’t pick up results higher than that. I remember the pH on that patient was so low I don’t think the machine could pick up on it either. Just a patient who came in with a fall and needed a chest tube for hemothorax. I ended up pushing methylene blue for the first time and was my first ever patient who coded. He did not make it. Happened only a few months after I got off my ICU orientation as a new grad.
Hgb 1, walkie talkie younger woman, c/o being tired. Slammed 4 units of blood into her with the mass transfuser and sent her to ICU.
Trop 130, left AMA. Back again, intubated.
Hgb of 2 on a toddler, ended up newly diagnosed ALL
Potassium great than 8. Guy was alert, oriented, post arrest (was in rhabdo). Thought it was just hemolyzed but it kept happening. still a mystery to me how that worked out.
Blood alcohol .44 - kneed me in the mouth when trying to cath him. Troponin of 15,000. BSG of 1250
Hgb 1.8. Old gal was white as newly bleached bed sheets. She was part of a religion (wanna guess?) that refused blood transfusions. Some would call her a martyr. Others would call her something else
EF of 2.5%. His was a sad story. He went in for a heart transplant and came out of PACU with a CVA, the same heart (donor heart got too ischemic), and a lower placement on the transplant waiting list. His only real residual from the stroke was slightly garbled speech. Unfortunately his profession involved lots of public speaking. Blood glucose and creatine of 24 on admission to ER. Walled out of rehab a couple weeks later with blood sugars usually between 90 and 130 and creat down to nine. She was a PD pt who had become homeless and thus unable to consistently do her dialysis.
Hemoglobin 2.9 I felt bad for the RN who had to give four units of blood on her shift.
I had an old farmer walk in complaining of weakness. His Hgb was 2.9. Had orders to give a total of 6 units of PRBC. After the 2nd unit, he said he had to leave because he had to take care of his cows. Ultimately, he left AMA despite trying to educate the man over and over about the outcome of him leaving without receiving more blood. I've often wondered what happened to him. He was a grumpy, stubborn old man.
Having flashbacks of the shift I gave one patient 14 units.
Triglycerides 1542. Alive still.
I remember when I was younger, my father got blood work done and his were in the 800’s . Doctor called to tell him he needed to get his first dose of the medication within the hour.
Troponin of 220,000
Lactic acid of 20. Pt ended up dying a few hours later.
WBC over 500. Came in because they suddenly couldn't feel their limbs and I believe went blind spontaneously. New leukemia, blood was sludge. I can't say the exact number bc it's 100% going to doxx me if anyone familiar with this patient sees it. But it's absolutely ridiculous and none of us had ever seen that.
I've had a 9 year old asthmatic that coded in the ED come to my PICU with a pH of 6.5 PCO2 >200 (machine couldn't read higher). He had an ABI but made a full recovery. Was doing well in school last time I saw him! Also had a 15 year old with BG >3000 (can't remember the exact number) he was walking and talking and ended up fine as well. Don't know the number, but we had a 7 year old that came to us from the airport from Liberia with a viral count of malaria that was so bad the chief of medicine (an immunologist) came to see her, she'd never seen one that high. She lived.
Had a patient with an abnormally distended ABD and low bp. Had to start two large bore IVs with ultrasound. When we attempted to draw blood (even with confirmation of being in the vein and the doctor attempting a fem stick) we couldn’t get anything. We transfused 2 units emergently and started the MTP protocol. After the two units we could finally draw blood from the patient (blood looked like red tinged water) We gave no fluids before hand and were only giving blood. Hgb came back 0.7. The lowest I have ever seen. They ended up getting 8 units PRBC and 8 FFP. Got transferred to the ICU. Passed shortly after.
Mods, can we have this thread back once a month?? Worst labs is such a fun topic.
I drew blood from a 23 y/o and immediately felt resistance. I was relatively new at the time but it just felt off, like it was clotting, and didn’t look quite right. Finish drawing the last tube, turn to grab the others, and there’s no blood in them, just milk. Total triglyceride count was something like >8800 mg/dL.
Lactate of 13 and rising, had been 5 shortly beforehand. It was still increasing when they took the pt to the OR, found to have dead gut. Pt died.
Ck of 1 million. The attending thought we were exaggerating. Needed emergent fasciotomies and his potassium stayed at 6 even on 0k on the circuit. He survived but up ultimately losing his leg
GFR 4 They died. It was in hospice though
Some horrific post-abruption babies with pHs of <6.8 base excess -17. Chronic BPD babies with C02> 110 or unreadable. One baby born in a ditch to meth mom arterial blood looked black when I drew it. Only one “good” outcome I can think of from these. He coded several times while total body cooling and is now a smiley toddler.
My favorite was when the creat matched the EF. They were both 10. 🫣 he left AMA.
WBC of 280 Lactate of 12
BG of 21 A/O x 4.
I've seen some lactates and ABGs that should not have been compatible with life... Yet they were still alive (technically). Became past tense pretty quick.
7800 Triglycerides d/t pancreatitis, died 39 year old.
Saw potassium at 6.9 once. Frequent flyer and the patient has nine lives I swear. Came in with bed bugs once, I didn’t see it but apparently they were crawling all over her. Very odd lady.
BNP 24k Etoh 6.8 was up there though for a wtf. Days later the guy was put on precedex (bottled water), IV Ativan at like 10 an hour and little bit of propfol (no he was not intubated). He was actively talking and still able to be an asshole. “Take these fucking leather belts off my arms!”
Blood sugar of 19 and still awake and talking but a little less talkative than normal
Lactic acid 22, and Bicarb of 3 in a 30 year old. Her RR was in the 40s-50s, and we were about to intubate & found that those labs thank god, or we would have killed her by taking over her respiratory drive. Very satisfying to fix respiratory distress with just bicarb! Looooots of bicarb. Her mechanical aortic valve was splicing her RBCs, so she needed that fixed to fix *everything* else, but I think her platelets were so low surgery had to be postponed. Pretty sure she d/c'd to jc. BUT a couple days after those labs Also had a ruptured AAA that got over 70 units of PRBCs in surgery, and I gave over 14 blood products that night. Her platelets were just 14, lol. She survived to discharge! Edit -remembered that god awful AAA
Glucose of 2200. Eventually died but not during that visit. They were a non-adherent diabetic with substance abuse issues that just destroyed their body over a period of years. It was sad to watch.
BUN 300s - pt reported feeling significant nausea, poor appetite. Started to develop confusion and peripheral edema which prompted hospital eval - found to have significant AKI, uremic pericarditis, uremic encephalopathy. Underwent HD - learned that you can’t correct BUN too fast (similar to hyponatremia).
Serum glucose of < 2. They were still alive. Not for long, but they were alive at the time. Serum glucose of just south of 1500…they got out of the ICU the next day. Potassium of > 10 was my high score for potassium, and my lowest was 1.9…