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Critical & Sensitive Values


The Clinical Laboratory Improvement Act of 1988 (CLIA) mandates that each laboratory establish critical values for selected tests. The regulations state,"the laboratory must develop and follow written procedures for reporting imminent life-threatening laboratory results, and immediately alert the physician, hospital or laboratory that ordered the test.

Definitions: Critical levels vary from expected values enough to represent a life threatening pathophysiologic state requiring immediate medical attention. Critical results will be called immediately following the completion of the assay.

If specimen integrity is in question, critical results are called and a new specimen should be collected immediately.

Assay

Critical Value

Expected time to
Notify Provider

Acetaminophen, serum

Bilirubin, pediatric

Blood culture

Blood gas, pCO2

Blood gas, pH

Blood gas, pO2

BUN

Calcium, ionized

Calcium, total, serum

Carbamazepine

CO2 (Bicarbonate), serum

Creatinine, serum

CSF culture or stain

Digoxin

Glucose, serum

Hematocrit

Hemoglobin, blood

Lactate

Magnesium (Non OB)

Phenobarbital

Phenytoin

Platelet Count

Potassium

Prothrombin time (INR)

PTT (APTT, activated partial thromboplastin time)

Salicylate

Sodium, serum

Synovial fluid culture or stain

Theophylline  

Troponin T

Valproic acid

Vancomycin, peak

Vancomycin, trough

WBC, blood

>30.0 mcg/mL

>20.0 mg/dL

Positive

<25 or >50 mmHG

<7.21 or >7.59

<50 mmHG

>100 mg/dL

<0.76 or >1.61

<6.0 or >12.9 mg/dL

>20

<11 or >40 mmol/L

>5.0 mg/dL

Positive

>2.0 ng/mL 

<40  or >450 mg/dL

<25.1 or >75.0

<8.1 gm/dL

>36 mg/dL

<1.0 or >3.9

>60 mcg/mL

>30 mcg/mL

<50 or >900

<3.2 or >5.8 mmol/L

>5.5 INR

>140 seconds

>30 mg/dL

<120 or >160 mmol/L

Positive

>30 mcg/mL

>0.03 ng/mL

>150 mcg/mL

>80 mcg/mL

>20 mcg/mL

<1.0 or >50.0 K/mcL (0-7days of age)

<1.0 or >30.0 K/mcL        (>7 days of age)

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CRITICAL VALUES FOR DIALYSIS

The Critical Value list above also applies to dialysis patients.

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Assay

Critical Value

Expected time to
Notify Provider

BUN

Calcium

CO2

Creatinine

Potassium

Sodium

Phosphorous

>100.0 mg/dL

<7.0 or > 12.0 mg/dL

<15 or >40 mmol/l

>15 mg/dl

<3.0 or >6.0 mmol/l

<125 or >155 mmol/l

<2.4 or > 7.5 mg/dl

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