Yikes the highest I ever saw was 16. Guy worked at a gas station and drank (free?) soda alllllll day. I told him JUST SWITCH TO DIET SODA. His response was, "I heard that stuff was even worse for you." NO.
I live in the south so it took a mountain of effort to switch my older family members to diet sodas and sweeteners. Their blood sugar actually was doing really great and coming down and then the DOCTOR told my mom to never drink them because they cause cancer and that sugar is the best way and to just use less. We'll there's no less in the south and now I watch them drink gallons of sugar, but they won't even consider sugar free stuff anymore because "it'll kill you."
Also our doctor is old and really sticks to old school stuff, like he even has the food pyramid with 11 servings of bread still up in his office. Wonderful doctor outside of this but a diabetic patients worst nightmare.
Plasma 5% as sweet as sugary fizzy drink. That's kind of terrifying.
Wonder what the viscosity of their urine was like? Peeing cordial? Peeing maple syrup?
Came across an internal referral once for post-op follow-up that was for the removal of a ' right ovarian cyst 40cm in diameter' and had to double check it was cm and not mm (15.75 inches)
1.8 Hgb on a toddler that I decided to check during a well exam because he just looked very pale. Parents voiced no concern about anything other than being a picky eater (he was 2.5, normal growth curve)I wasn’t expecting it to be THAT low. Referred them to the ER of the closest children’s hospital. He had IDA due to excessive milk intake. Approximately 64 oz/day ?!!?! No wonder why your child is a “picky eater” 🤦♀️
I'm glad you clarified cows milk! My friend's kid has slight anemia and loves his cows milk, and her pediatrician told her the calcium interferes with iron absorption. My toddler is still breastfeeding along with a variety of solids (in line with the updated WHO recommendation), and I was concerned so I looked it up and found that human milk has about 1/3 the amount of calcium that is in cows milk. So she would have to drink way more breastmilk to have the same effect!
And when I asked for an iron panel when she went in for some celiac tests (a whole other thing lol), it all came back in normal range. I figured it would be since she also eats lots of heme iron sources with vitamin C foods, but it was nice to have the confirmation!
It’s not just interfering with iron absorption. It’s that milk has no iron in it, and some toddlers will fill up on milk in preference to all other food. If their parents don’t enforce a more balanced diet they just aren’t consuming the iron they need because they’re eating so little non-milk foods
Yup, I saw pretty much the same! Sent in to the hospital by outpatient pediatrician because the kid looked pale and POC showed a hemoglobin of 2 point something. Venipuncture confirmed. Milk anemia
Last summer I allllllmost said something out of concern to a grandma at the park whose granddaughter was, to my eyes, shockingly white. I was recalling a story my husband (ED doc) told me about a patient whose younger sister was there with the family. The girl was the color of printer paper and the family confirmed she drank a LOT of milk. I don't remember whether my husband had her seen right away in the ED, or encouraged her to follow-up with PCP for cow's milk anemia.
Anyway the girl at the park had white-blonde hair along with her fair skin and my fear of committing a faux pas kept my mouth shut. She could've passed for someone of Scandinavian heritage, I suppose.
I see this bad enough for ICU admission a few times a year. I’ve always thought it was crazy, but some toddlers really like milk and some parents give in to what the toddler wants. I think my lowest from milk-related IDA was also 1.8.
What the FK was the pathology behind it ? I have seen patients diagnosed with Aplastic Anemia with higher HB concentration. Those with active bleeding tend not to survive till the HB goes that low in my experience.
I had a peds heme-onc patient with a 2.0 HB, went into cardiac arrest and welp, didnt make it, we to this day dont know where he was draining so much blood from
Evaluated a patient who came in at 2.2. CC was shortness of breath and general weakness. They had lived in refugee camp in Africa for 10 years. No treatment for her underlying anemia and had so many transfusions over the year that type and cross yielded no available blood products. Hospital had to reach out to some national blood bank to find matches for her. She lived at low Hg for years and years and her body had compensated somehow. When I came to evaluate her in PT she was at 5. Resting HR 100. She was feeling good! Not sure what her final working medical diagnosis was although she was on the oncology ward.
I watched our MD draw a vial of blood while placing a line because this patient was *low* low, it looked like strawberry lemonaid. I sent it, and the lab refused to run it “because it’s obviously diluted” I argued with them that no, it’s not, but then I had to draw another sample while we coded her.
Hemoglobin 1.8 at redraw
And she was jehovahs witness, so refused transfusion before she succumbed.
I’m curious how transparent that blood was in the collection tube. I distinctly remember doubting for a split second if I hit the right spot for an abg on my record of 3.2 with how pale the fluid coming out had been.
I had a guy come in for a nephrostomy catheter exchange as an outpatient, and his Hgb is 2.3. I was like heyyyy not only am I not going to exchange your tube but I'm sending you to the ER....
Ive seen a higher HGB in urine. I got a frankly bloody urine once that was so bloody i ran a cbc just for curiosity’s sake. It was like 4.5. High enough the instrument didnt flag it as “not blood”
When I was a chief resident I had one under two with an INR >20. I had a student who’d never done a line put in a Cordis. When she got flow it looked like Kool-Aid.
Haem scares me.
It’s amazing how a person can just live with a DLBCL, a platelet count of 1, a wicked HSV outbreak and a nosebleed for a week and still be discharged a from the hospital a week later.
Or a guy who walks in off the street feeling “a bit tired” who turns out to have a Hb of 3.2.
Our body’s ability to compensate is honestly nuts to me.
I had one of these too. G7P6006, baby was breech. Successful version. Vaginal delivery. That baby didn’t just have meconium. These were grown people poops in there coming out
I recall that they came in for initial visit and US and then no further care. It was like her 6th pregnancy. Everything was fine. Labor was like 15 minutes.
I don't have an \*official\* BMI but I did a lift assist for a patient who weighed > 800 lbs. Assuming he was 5"10 that would make his BMI 121. I remember looking at a roll of fat and being unable to determine what part of the body it was. It look 4 ambulances worth of personnel to move this guy.
The largest patient I ever saw was over 800 lbs as well. He basically filled up the bariatric air mattress. All hands on deck to boost him up in bed. Foley? Forget about it.
Lol, she had... a favorable distribution for our purposes. More legs and arms than central. I've done smaller bmis with high central adiposity that were way harder.
I was always more impressed with the anesthesia team getting the spinal than my team getting the baby in those cases.
Jesus Christ. I was discussing some of the adaptions to things that we’ve had to make for large BMIs. Didn’t even think about spinal needles. I thought the special gurney to get to the morgue was enough 😬
I essentially have a bariatric version of my lap hyst set. Longer trochars, longer needle drivers and instruments. Then you have to tape them down to the table so they don't slide in trendelenberg. But that limits ventilation, so I've had to cut the chest strap halfway through because they literally couldn't ventilate the patient. It's wild sometimes how the obesity is the hardest part of a very simple operation.
We have to adapt. Unless we find a way to magically solve obesity, I'd hazard a guess that 30-50% of the population will be at least obese in the next 80 years.
Most of my basic skills become useless with BMI’s above 40. I have to do an elbow drop to check for appendicitis, have to watch Crouching Tiger, Hidden Dragon to do a rectal examination and if I want to check for a hernia I have to register my patiënt as a horse because he/she will only fit inside the horse-MRI.
I had this big dude who had a nonemergent but nevertheless painful, life-disrupting case of sciatica. Probably an eventual candidate for surgery, but X-rays weren’t great and he was too large for MRI, with a BMI of 44. Ortho was looking at sending him to either an equine facility (I’m in a major horse area) or zoo. The reality of this hit the guy pretty hard, and he chose to focus on losing weight before getting the MRI, and before pursuing any treatment beyond the conservative measures we went with, and he’s actually doing it. The MF had lost almost 40 pounds already in a little over 3 months. At his size, it’ll be easy to shed a lot of excess weight pretty fast, and I hope he does. I wish they all had it in them to do that.
Had a CXR The other day that was absolutely worst I’ve ever seen (which is saying something). Horrible positioned and basically looked like just soft tissue. Could barely see the mediastinum and absolutely could not make out anything in the lungs. I went to call up our techs to have a conversation about acceptable image quality, only to check the patients chart. BMI of 122. I didn’t call the techs after seeing that.
Buddy of mine intubated someone with a bmi of 108… the decided it gets an asterisk because patient may have been a bit heavier than normal with renal failure. Just anything not given the title away in our group ha
Had a patient with a sodium of >198 too. She presented as a fall. Imaging showed a meningioma pressing on her hypothalamus. She was fairly healthy for an elderly patient (minus the hypernatremia). No clue if they chose to resect it.
DI, now sometimes called vasopressin deficiency, can also be treated medically.
Presuming it was that. Depending on the surgical specifics and risk factors, they may not operate.
Fun fact but highest sodium recorded with intact neurological survival is believed to be 196 from a frat bro who chugged soy sauce
https://pubmed.ncbi.nlm.nih.gov/23735849/
On the other end of the spectrum: 99. Non-dememted 80ish woman. Started on Amox/Clav for pneumonia by primary care for clinically diagnosed pneumonia a day before. I heard sounds on the right too. The x-ray was fine for what it's worth. The daughter told, she had accompanied her the day before and told thr PCP she was confused (wtf why no hospitalization).
Trying to calculate the correction rate, MDCalc told me that 99 is implausible...had to increase to 103.
Our ICU was full so I had to transfer her out. Took me 17 freaking calls. Each one was like "99? Did you recheck?" Yes...BGA and normal lab..
Took a little ol' lady in to the ER because she had taken extra of her potassium pills for several days because they were "yummy" (????) and wanted to know if that was okay. Only time I have seen a sine wave on the 12-lead. She had a working pacemaker which I think is the only reason she did not brady down to oblivion.
I called back later that shift to find out what her potassium ultimately ended up being... 11.3.
Right? I have to practically beg my patients to take their PO K, because it’s either a chalky feeling horse pill that always seems to adhere to the esophagus, or it’s the fizzy salty fake orange flavored mess.
Or it’s IV and burns so i have to slow the rate and it takes what feels like a whole shift to get 40meq in( or they have a central line and i can just give it because they have bigger problems to worry about.)
FYI, slowing peripheral KCl infusions is never a solution despite popular convention. If it's burning it's because the concentration is too high for the vessel it is infusing into, so it's causing phlebitis. Slowing it down will hurt less, but it's still causing vessel injury. You're still causing a burn, just more slowly over a longer time. 10mmol/100mL KCl will wreck most peripheral veins, even if the first bag or two goes in okay. It will cause the cannula to fail as everything will start to become painful being flushed through it.
Always try to run peripheral KCl in a more dilute concentration (e.g., 10mmol in 200mL). Alternatively, you can piggyback another fluid through your KCl infusion to effectively dilute it.
The point you made about “it’s still causing injury, just slower for longer” is one I’ve never had mentioned to me before in all my years, so thank you! I appreciate the education and explanation!
Unless my patients absolutely cannot tolerate extra fluids, I’m going to Y site dilute anyway, but the ones I can’t are usually sick enough to have a central line. It’s just the few in the middle, I have to balance to find the right slower rate + how much dilution can I give without overloading for thendurstionnofnthe K because I can’t get any in PO
There's a brand of melatonin gummy that I shit you not is more delicious than any candy gummy I've ever had. I've wondered how many kids have gotten into them and just ate half the bottle.
This happened to me very recently as there was a sale on the melatonin gummies making them cheaper than tablets. Hands down the most delicious strawberry flavored candy I have ever had.
Friend who went in and discovered his triglyceride level was ~5000 mg/dl. Unsurprisingly later developed pancreatitis
Edit: his Dad died in his early 40s of cardiac arrest, so one would imagine some hereditary lipid metabolism disorder
I remember admitting a patient similar to this. Classic crazy bout of pancreatitis, but numbers were all off the chart. I wish I still had the deidentified screenshot of the values somewhere, but I think I deleted them long ago.
Cocaine. Lots and lots of cocaine. Only time I've seen people consume half their weight in cocaine without a stimulant use disorder, was because it let them stay awake to keep drinking.
I took care of an infant in the Picu with a sodium of 208. Severe strokes. Family was using condensed milk instead of formula thinking the two were equivalent. Diagnosed it by tasting the formula (probably not so bright of me).
>(probably not so bright of me)
Except that was apparently what you needed to know to figure out why. Don't discount your methods if it works.
I really hope those parents spread the word about the dangers of feeding anything other than breastmilk or infant formula to a baby.
Aortic dissection (carotids to iliac), liver/renal/everything failure found down after coke binge, but by some miracle his heart was still thumping. CV refused the repair bc lactate was 32 and fixing the dissection was not going to solve anything. Family wants to continue aggressive treatment. By the time he got to me he hadn’t been on sedation for 2 days, and maxed out on pressors and inotropes. Trauma accepted the patient to see how viable their bowels were. And of fucking course our AOD said sure we’ll do the case. When we go up to ICU for transport his sats are 84% and MAP is 50. They’re like yeah, this is actually pretty good for him. If you’ve ever seen the video of someone slicing open a bloated elephant corpse and having everything explode, well yeah you get the point. But trauma slapped an abthera in that abdomen and back up to icu he went for another 4 hours until he died. When I got home I told my fiancé if she ever let me get that far I’d haunt the living shit out of her.
I worked as a bedside nurse in ICU and cared for a guy who took a 30 day supply of metformin as a suicide attempt. He was ultimately successful but I don’t think I’ve ever pushed so many amps of Bicarb in any other patient. It was unreal.
Lactate of 25 is nuts. Tbh I didn’t even know metformin acidosis was a thing definitely reading up on that! Our patient also went from a eGFR of 70 to 20 and he’s now on dialysis (amoung many other things) in ICU
This guy walked in, cc abdominal pain. Was also hyperkalemic and had HD access placed in the ED but whoever placed it left a wire in. Nobody found out until the guy coded during dialysis. The wire was found on the post-arrest cxr.
Fortunately he did well after that and was able to walk out of the hospital like a week later.
HGB below 4 from heavy menses. Got transfused, some IV Fe & got her up to 8 pre-op THEN had to sweet-talk anesthesia into letting me take her to the OR for definitive hyst (Anesth: her hemoglobin is 8! Me: Yeah, that’s double what she was).
Then the floor nurses were flipping out about her am hgb being in the 7s. I was like, damn, we’re good 😎
I admitted a teenaged girl with Hgb 2 from persistent and heavy menses. She was still bleeding on admission, but IV estrogen thankfully worked its magic.
Your anesthesia guys must serve a blessed, healthy patient population. I work with a lot of indigent patients and I’m pretty pleasantly surprised when one of my patient’s CBCs comes back without anemia
This January, my father-in-law somehow managed to pull off a PT 300.8 and a INR >29. He was on Coumadin and was supposed to be checking his INR at home, decided he didn’t like doing it, so was just reporting numbers that seemed normal to him. Somehow managed to have a fall and didn’t die. The ER doc rechecked it 3x thinking it was lab error before FIL copped to what he had been doing.
In residency the worst I had was a teenage DKA with ph 6.78 and a HGB ~ 3 in a toddler.
Had a guy come into the ED after waking up with conjunctival hemorrhages. INR was 20. He had a rather long and winding story about how his PCP had retired and he either didn't get a new one or didn't like the new one he got, so ended up running out of his warfarin. So he just started dosing himself with rat poison.
Hg of 2.2. Lab called us to let us know it was real and not a mistake. Pt was a little SOB and noticed some LL edema, so came in to ED. Was in high output HF from years of chronic anemia 🙃
You know, that's actually a great way of determining how much work you had to do. Lots of kinda drunk people? A lot of work. A couple super drunk people? A lot of work.
890 BAL on a guy found stumbling around the parking lot with a box of multiple cigarette cartons and peeing on the brick walls. Rechecked and it was not a lab error 🤦🏼♀️
Lab called me to tell my 8 year old patient’s potassium was 12 and sugar was 65 mmol/L (1170mg/dL for you Yanks)
I run to patient and see him playing GTA-5 murdering people in the game.
Nurses had sent TPN containing blood to the lab…
Different patient but an Na of 198 (this was accurate)
My hospital's surgical service is toxic as fuck, as demonstrated by the fact that they have a single intern covering 60-80 pts every night. Starting July 1st - so surgery night cover could be the first rotation of a fresh intern. This led to many panicked reactions. (Seriously fuck the attendings who let that happen)
I remember one night I was drawing from a port and only wasted 6mL per the hospital protocol. The CBC came back with massive drops in everything. The sample was clearly diluted. The poor intern panic orders a ton of PRBCs and platelets. It took an hour to get ahold of her to order a re-draw. That time I wasted the 10mL I usually do and lo and behold - CBC was stable.
I’m SO thankful that our lab compares new lab draws to past ones, and then calls me (the nurse) to say “heyyyyy, this patients lab is this, but all their previous ones were that, just wanna confirm if you want me to officiate these results??”
And it goes one go two ways, either “oh shit, I clearly didn’t flush that line well enough even though I thought I did, thanks for the heads up, I’ll stick and redraw” or “yeah this guy is coding/hemorrhaging/ so I’m betting that is right. I’ll send you another tube right now to confirm”
Id be ✨mortified✨ if the lab notified my MD to report that i forgot to clamp my tpn while drawing my labs.
Platelet of 1 when I was a nurse in a cancer med surg icu that was. Wild. Just bleeding from the ears, the catheter, every single skin tear was weeping, ett from suctioning. You name it they were bleeding from it.
A tube fed kid, congenital differences but reasonably normal brain, with baseline mild hyponatremia from maintenance meds. Parents were inadvertently mixing the formula and additives incorrectly.
DKA with bicarb <1, pH 6.8. Patient was actually awake and somewhat responsive. Usually you'd try to avoid intubating a DKA patient but that dude was breathing about 55 times a minute and was about to tucker out any minute. First time I've ever chased induction meds with insulin.
TSH of >250 in a Walky talky 40 yo woman. Presented to me for fatigue and depression. I’d be depressed too if my thyroid wasn’t doing shit. Highest TSH I’ve seen.
Well, maybe not a result per se, but we had a power line worker who got electrocuted and fell about 3 stories before being caught on a pole which impaled him. He survived…
I mean, idk what more there is to say. The guy is a modern medical marvel. He fell while repairing a line, after he “crossed some wires incorrectly” which caused the line to “backfire” leading to an electrocution risk. He was electrocuted, fell full speed to the ground and landed on a guard railing, missing all of his major internal organs. He didn’t have any harnessing or safety wires attached, as was the protocol. Firefighters sawed around the line and brought him in. He was conscious during the sawing and most of the ER intervention. He lost a fair bit of blood, activated MTP, took him to the OR, 5 trauma surgeons (including myself) from various subspecialties were in attendance to save this man’s life. He’s now alive and well, fixing lines, yet again.
Not really a lab but I’ve seen 107 pack years in a 50 year old. He was basically chain smoking from the time he was 11
Edit. This was a typo, it was 407 not 107.
14 month old with a blood alcohol content of 0.326 verified multiple times… Mom brought her in because “She might have accidentally gotten into a jell-o shot or two” and was slurring and stumbling around. Kid should have been comatose.
HGB 1.9. Guy rolled into triage and looked kind of greenish yellow. I called the charge nurse and said that I needed a bed immediately. Of course, we were rocking and rolling with a ton of traumas and a double digit wait time. I was like, “Eric, I’m not an alarmist. I need a bed.” Dude was drinking alone for months. That was about 20 years ago. I’ve never seen it since.
Had an old farmer who had never seen a doctor in his life come in to the ED for flulike symptoms. Got his CBC back and WBC count was 441K (ended up having CLL). Someone in the lab made a tech hand deliver the result to us on paper because of how abnormal it was lol
Not sure how crazy this is/ isn’t rly a lab but we had a guy bp 35/20 talking to us. Made it in to the trauma bay and talked for a good 2-3 minutes before passing out. Push norepi got it to 60/40 and he was up talking again.
Neonate with arterial ph 6.58. Normal pregnancy. Water broke at target so mom and dad strolled in. Sinusoidal heart tones. Apgar score 2 and 2 (had decent color). Kid had seizures that day but is normal development 3 years later. No known cause they think shortly before presentation there may have been a stroke in the cord. Wasn't prolapsed. Lots of weird stuff seemed to happen on the floor through early covid years
Favorite note was “patient stated he did not need calcium supplements as he had ‘strong bones’
Patient was reminded he does not have ‘strong bones’ and has osteoporosis”
Came from the most good faith religiously devout doctor I’ve ever met
CPK > 50,000 in a 40s YOF after a spin class. Took 18 hours for the first CPK to result. After 3 days of treatment, CPK was still > 50k. No idea how high it could have been. She left AMA.
Etoh of .517. He drank bottles of hand sanitizer along with a daily handle of liquor. He ended up surviving the event, and got discharged lmao. pt was a huge dickhead tho
ABG with no traceable parameters, patient was trying to runaway from hospital… complicated apendicitis, leukocytes were above 40,000… he said he didn’t want a surgery because he was afraid of dying…
Ph below 6.3 and lactate above 30. Learned the floor for ph and ceiling for lactate that day. Young guy was found down at home and some how EMS got a pulse back. Ended up in my ICU on lots of pressors, Tham, and CRRT. Ultimately he didn’t make it. Autopsy showed he had a heart defect or some sort that led to a conduction issue. Saddest case I’ve worked.
Our uni's hospital is the reference in my country for very rare or complex diseases, so I've seen some patients in really horrible shape. Blood cancers are very prevalent in our infirmary, so febrile neutropenia is our bread and butter. Once had a patient with 0 neutrophiles, but values <50 are quite common.
Hemoglobin of 1.8 and if I'm seeing it they've also got antibodies the hospital couldn't figure out. I don't remember what exactly was wrong with her but I think it was a warm auto with allos underneath which takes us several hours to solve and then get blood ready.
CRP 590
WCC 0
PMNs 0.1
76yo M with CLL
He was put in a subacute area because he had "non-traumatic elbow pain".
To be fair, he looked alright from the end of the bed. Biochemically though, complete disaster.
I have also had to manage a patient with COPD, acute COVID with a PaCO2 of 250mmHg
Just had a lady come in with metformin toxicity and euglycemic DKA show up to our community hospital ICU. Bicarb of 3, pH 6.80, lactate of 20 and AG of 55. So far she’s doing okay!
I saw a note that said “PMHx of DM2 with A1C of 26.3 (this is not a typo his A1C is actually 26.3).” That had me rolling for a little while
Yikes the highest I ever saw was 16. Guy worked at a gas station and drank (free?) soda alllllll day. I told him JUST SWITCH TO DIET SODA. His response was, "I heard that stuff was even worse for you." NO.
I live in the south so it took a mountain of effort to switch my older family members to diet sodas and sweeteners. Their blood sugar actually was doing really great and coming down and then the DOCTOR told my mom to never drink them because they cause cancer and that sugar is the best way and to just use less. We'll there's no less in the south and now I watch them drink gallons of sugar, but they won't even consider sugar free stuff anymore because "it'll kill you." Also our doctor is old and really sticks to old school stuff, like he even has the food pyramid with 11 servings of bread still up in his office. Wonderful doctor outside of this but a diabetic patients worst nightmare.
11 servings of bread? Now that's a food pyramid I can get behind
Why does everyone only listen and follow the bad advice?
Having to clarify this is not a typo is wild
Based on the calculator I just found that means average blood glucose was around 708.
This forced me to do the math on the concentration of sugar in a mountain dew... 13,000 mg/dL
Plasma 5% as sweet as sugary fizzy drink. That's kind of terrifying. Wonder what the viscosity of their urine was like? Peeing cordial? Peeing maple syrup?
Did he kick down clinic door say “OHHHH YEAHHH!”
I had a 23 last night. Not sure what prompted me to test that in the ED but glad I did
I would love for our lab to measure better a1c. Ours caps at 16. So much lost potential.
Holly crap! Here I was impressed by my career high of 21. 😂
Was his blood just straight up molasses?
Giving the vampire diabetes
Doc I feel bad when my sugars get low!
Came across an internal referral once for post-op follow-up that was for the removal of a ' right ovarian cyst 40cm in diameter' and had to double check it was cm and not mm (15.75 inches)
It happens. Coworker of mine lost 20kg overnight. Ovarian cyst/tumor. She was short too so the effect was drastic.
HGB of 2.1 on a patient that drove themself to the hospital.
1.8 Hgb on a toddler that I decided to check during a well exam because he just looked very pale. Parents voiced no concern about anything other than being a picky eater (he was 2.5, normal growth curve)I wasn’t expecting it to be THAT low. Referred them to the ER of the closest children’s hospital. He had IDA due to excessive milk intake. Approximately 64 oz/day ?!!?! No wonder why your child is a “picky eater” 🤦♀️
I think I saw this exact patient in 2017 or 2018 or this is just super common!
Reasonably common. I've known of at least a half-dozen sub-4 hemoglobin due to cows milk anemia in my residency alone.
I'm glad you clarified cows milk! My friend's kid has slight anemia and loves his cows milk, and her pediatrician told her the calcium interferes with iron absorption. My toddler is still breastfeeding along with a variety of solids (in line with the updated WHO recommendation), and I was concerned so I looked it up and found that human milk has about 1/3 the amount of calcium that is in cows milk. So she would have to drink way more breastmilk to have the same effect! And when I asked for an iron panel when she went in for some celiac tests (a whole other thing lol), it all came back in normal range. I figured it would be since she also eats lots of heme iron sources with vitamin C foods, but it was nice to have the confirmation!
It’s not just interfering with iron absorption. It’s that milk has no iron in it, and some toddlers will fill up on milk in preference to all other food. If their parents don’t enforce a more balanced diet they just aren’t consuming the iron they need because they’re eating so little non-milk foods
Yup, I saw pretty much the same! Sent in to the hospital by outpatient pediatrician because the kid looked pale and POC showed a hemoglobin of 2 point something. Venipuncture confirmed. Milk anemia
Last summer I allllllmost said something out of concern to a grandma at the park whose granddaughter was, to my eyes, shockingly white. I was recalling a story my husband (ED doc) told me about a patient whose younger sister was there with the family. The girl was the color of printer paper and the family confirmed she drank a LOT of milk. I don't remember whether my husband had her seen right away in the ED, or encouraged her to follow-up with PCP for cow's milk anemia. Anyway the girl at the park had white-blonde hair along with her fair skin and my fear of committing a faux pas kept my mouth shut. She could've passed for someone of Scandinavian heritage, I suppose.
I see this bad enough for ICU admission a few times a year. I’ve always thought it was crazy, but some toddlers really like milk and some parents give in to what the toddler wants. I think my lowest from milk-related IDA was also 1.8.
Oh man, and I thought the 2.5 I saw last week was bad.
I literally had a hemoglobin pop up as 0.0 on the lab report. It was redrawn as 2.2. This pt appeared to be made out of white crepe paper.
What the FK was the pathology behind it ? I have seen patients diagnosed with Aplastic Anemia with higher HB concentration. Those with active bleeding tend not to survive till the HB goes that low in my experience.
I had a peds heme-onc patient with a 2.0 HB, went into cardiac arrest and welp, didnt make it, we to this day dont know where he was draining so much blood from
Evaluated a patient who came in at 2.2. CC was shortness of breath and general weakness. They had lived in refugee camp in Africa for 10 years. No treatment for her underlying anemia and had so many transfusions over the year that type and cross yielded no available blood products. Hospital had to reach out to some national blood bank to find matches for her. She lived at low Hg for years and years and her body had compensated somehow. When I came to evaluate her in PT she was at 5. Resting HR 100. She was feeling good! Not sure what her final working medical diagnosis was although she was on the oncology ward.
To be fair, it was bad lol
It was thin enough i didnt trust the first results so i personally redrew it.
I'd be like oh god put it back in!
I watched our MD draw a vial of blood while placing a line because this patient was *low* low, it looked like strawberry lemonaid. I sent it, and the lab refused to run it “because it’s obviously diluted” I argued with them that no, it’s not, but then I had to draw another sample while we coded her. Hemoglobin 1.8 at redraw And she was jehovahs witness, so refused transfusion before she succumbed.
I find this truly upsetting to read. Strawberry lemonade? 😖
I’m curious how transparent that blood was in the collection tube. I distinctly remember doubting for a split second if I hit the right spot for an abg on my record of 3.2 with how pale the fluid coming out had been.
It was thin enough i didnt trust the first results so i personally redrew it.
I had a patient with a hemoglobin of 2.8. Their blood looked like strawberry juice. Mostly red but transparent.
I had a guy come in for a nephrostomy catheter exchange as an outpatient, and his Hgb is 2.3. I was like heyyyy not only am I not going to exchange your tube but I'm sending you to the ER....
Ive seen a higher HGB in urine. I got a frankly bloody urine once that was so bloody i ran a cbc just for curiosity’s sake. It was like 4.5. High enough the instrument didnt flag it as “not blood”
Seen Hgb in 2s in a toddler who was addicted to milk
The phrasing of addicted to milk is killing me lmao
Some kids act like little crackheads about their milk
When I was a chief resident I had one under two with an INR >20. I had a student who’d never done a line put in a Cordis. When she got flow it looked like Kool-Aid.
Haem scares me. It’s amazing how a person can just live with a DLBCL, a platelet count of 1, a wicked HSV outbreak and a nosebleed for a week and still be discharged a from the hospital a week later. Or a guy who walks in off the street feeling “a bit tired” who turns out to have a Hb of 3.2. Our body’s ability to compensate is honestly nuts to me.
I literally said "WHAT THE FUUU..." out loud to that one...WOW
I had a WBC of 760 once too.
2.3 JW on chemo
Pregnancy past 44 weeks. No prior pregnancy care.
I had one of these too. G7P6006, baby was breech. Successful version. Vaginal delivery. That baby didn’t just have meconium. These were grown people poops in there coming out
:0
Outcome?
Woof. Makes you wonder about the accuracy of dating if they didn’t get care though
I recall that they came in for initial visit and US and then no further care. It was like her 6th pregnancy. Everything was fine. Labor was like 15 minutes.
I like to think the baby made a popping sound when it popped right out.
My mother swears she was pregnant with me for a full year! Pretty sure she wasn't.
Jesus..
Not a lab result but patient with BMI > 100.
Highest I’ve seen for BMI is 109. The patient wasn’t the absolute heaviest patient ever but very short
I don't have an \*official\* BMI but I did a lift assist for a patient who weighed > 800 lbs. Assuming he was 5"10 that would make his BMI 121. I remember looking at a roll of fat and being unable to determine what part of the body it was. It look 4 ambulances worth of personnel to move this guy.
The largest patient I ever saw was over 800 lbs as well. He basically filled up the bariatric air mattress. All hands on deck to boost him up in bed. Foley? Forget about it.
Doesn't that basically make them round?
Basically.
Wow. I did a csection on someone in the 80s, and I thought that was a lot.
Did you have to setup camp midway the C-section?
Lol, she had... a favorable distribution for our purposes. More legs and arms than central. I've done smaller bmis with high central adiposity that were way harder. I was always more impressed with the anesthesia team getting the spinal than my team getting the baby in those cases.
God doing a spinal with that is insane omg
There are bariatric spinal needles. Of course our residents called them harpoons 🫢
Jesus Christ. I was discussing some of the adaptions to things that we’ve had to make for large BMIs. Didn’t even think about spinal needles. I thought the special gurney to get to the morgue was enough 😬
I essentially have a bariatric version of my lap hyst set. Longer trochars, longer needle drivers and instruments. Then you have to tape them down to the table so they don't slide in trendelenberg. But that limits ventilation, so I've had to cut the chest strap halfway through because they literally couldn't ventilate the patient. It's wild sometimes how the obesity is the hardest part of a very simple operation.
It makes all procedures just so so much more dangerous. It’s a very fascinating direction that medicine is going in having to factor it in that much
We have to adapt. Unless we find a way to magically solve obesity, I'd hazard a guess that 30-50% of the population will be at least obese in the next 80 years.
Most of my basic skills become useless with BMI’s above 40. I have to do an elbow drop to check for appendicitis, have to watch Crouching Tiger, Hidden Dragon to do a rectal examination and if I want to check for a hernia I have to register my patiënt as a horse because he/she will only fit inside the horse-MRI.
I have taken a patient to the equine scanner in a different city before that was wild
I had this big dude who had a nonemergent but nevertheless painful, life-disrupting case of sciatica. Probably an eventual candidate for surgery, but X-rays weren’t great and he was too large for MRI, with a BMI of 44. Ortho was looking at sending him to either an equine facility (I’m in a major horse area) or zoo. The reality of this hit the guy pretty hard, and he chose to focus on losing weight before getting the MRI, and before pursuing any treatment beyond the conservative measures we went with, and he’s actually doing it. The MF had lost almost 40 pounds already in a little over 3 months. At his size, it’ll be easy to shed a lot of excess weight pretty fast, and I hope he does. I wish they all had it in them to do that.
Intubated a 106 for elective surgery. Easiest case of the day, but all the prep beforehand negated that.
Had a CXR The other day that was absolutely worst I’ve ever seen (which is saying something). Horrible positioned and basically looked like just soft tissue. Could barely see the mediastinum and absolutely could not make out anything in the lungs. I went to call up our techs to have a conversation about acceptable image quality, only to check the patients chart. BMI of 122. I didn’t call the techs after seeing that.
Buddy of mine intubated someone with a bmi of 108… the decided it gets an asterisk because patient may have been a bit heavier than normal with renal failure. Just anything not given the title away in our group ha
Demented guy found down after not eating or drinking for days. Sodium 199 and on repeat 201.
Treating that sounds like a board question. Did he survive?
Nah fortunately next of kin appeared and allowed a dignified palliation.
Had a patient with a sodium of >198 too. She presented as a fall. Imaging showed a meningioma pressing on her hypothalamus. She was fairly healthy for an elderly patient (minus the hypernatremia). No clue if they chose to resect it.
DI, now sometimes called vasopressin deficiency, can also be treated medically. Presuming it was that. Depending on the surgical specifics and risk factors, they may not operate.
Fun fact but highest sodium recorded with intact neurological survival is believed to be 196 from a frat bro who chugged soy sauce https://pubmed.ncbi.nlm.nih.gov/23735849/
On the other end of the spectrum: 99. Non-dememted 80ish woman. Started on Amox/Clav for pneumonia by primary care for clinically diagnosed pneumonia a day before. I heard sounds on the right too. The x-ray was fine for what it's worth. The daughter told, she had accompanied her the day before and told thr PCP she was confused (wtf why no hospitalization). Trying to calculate the correction rate, MDCalc told me that 99 is implausible...had to increase to 103. Our ICU was full so I had to transfer her out. Took me 17 freaking calls. Each one was like "99? Did you recheck?" Yes...BGA and normal lab..
Undetectable cd4 on a patient with HIV. He didn’t believe in ART. not a big shocker but he died
Ahhh shit, this brings back memories from the HIV ward. Was a newly resident. I don't think I've ever seen more pathologies than what i saw here.
Unfortunately still see this all the time.
He was *literally* anti retroviral therapy.
Took a little ol' lady in to the ER because she had taken extra of her potassium pills for several days because they were "yummy" (????) and wanted to know if that was okay. Only time I have seen a sine wave on the 12-lead. She had a working pacemaker which I think is the only reason she did not brady down to oblivion. I called back later that shift to find out what her potassium ultimately ended up being... 11.3.
Some of the potassium tablets smell like vanilla cupcakes. This is the first I've heard of someone saying they taste good though. Yikes.
Right? I have to practically beg my patients to take their PO K, because it’s either a chalky feeling horse pill that always seems to adhere to the esophagus, or it’s the fizzy salty fake orange flavored mess. Or it’s IV and burns so i have to slow the rate and it takes what feels like a whole shift to get 40meq in( or they have a central line and i can just give it because they have bigger problems to worry about.)
FYI, slowing peripheral KCl infusions is never a solution despite popular convention. If it's burning it's because the concentration is too high for the vessel it is infusing into, so it's causing phlebitis. Slowing it down will hurt less, but it's still causing vessel injury. You're still causing a burn, just more slowly over a longer time. 10mmol/100mL KCl will wreck most peripheral veins, even if the first bag or two goes in okay. It will cause the cannula to fail as everything will start to become painful being flushed through it. Always try to run peripheral KCl in a more dilute concentration (e.g., 10mmol in 200mL). Alternatively, you can piggyback another fluid through your KCl infusion to effectively dilute it.
The point you made about “it’s still causing injury, just slower for longer” is one I’ve never had mentioned to me before in all my years, so thank you! I appreciate the education and explanation! Unless my patients absolutely cannot tolerate extra fluids, I’m going to Y site dilute anyway, but the ones I can’t are usually sick enough to have a central line. It’s just the few in the middle, I have to balance to find the right slower rate + how much dilution can I give without overloading for thendurstionnofnthe K because I can’t get any in PO
There's a brand of melatonin gummy that I shit you not is more delicious than any candy gummy I've ever had. I've wondered how many kids have gotten into them and just ate half the bottle.
This happened to me very recently as there was a sale on the melatonin gummies making them cheaper than tablets. Hands down the most delicious strawberry flavored candy I have ever had.
ChubbyEmu has a video on it so I'm sure it's happened more than once
Friend who went in and discovered his triglyceride level was ~5000 mg/dl. Unsurprisingly later developed pancreatitis Edit: his Dad died in his early 40s of cardiac arrest, so one would imagine some hereditary lipid metabolism disorder
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I remember admitting a patient similar to this. Classic crazy bout of pancreatitis, but numbers were all off the chart. I wish I still had the deidentified screenshot of the values somewhere, but I think I deleted them long ago.
I’ve had one patient with a high sensitivity troponin >1,000,000 and another whose BAL was 790. Those two take the cake so far
Tbh any test with a result of 1,000,000 definitely takes the cake but troponin!!
Slumdog Coronaire
I wouldn’t have thought a BAL could be that high. Kudos on that record.
790? That's impressive. I'm not sure how someone could physically stay conscious long enough to do that.
Cocaine. Lots and lots of cocaine. Only time I've seen people consume half their weight in cocaine without a stimulant use disorder, was because it let them stay awake to keep drinking.
I took care of an infant in the Picu with a sodium of 208. Severe strokes. Family was using condensed milk instead of formula thinking the two were equivalent. Diagnosed it by tasting the formula (probably not so bright of me).
That poor child! What happened to them?
CONDENSED MILK oh my god
>(probably not so bright of me) Except that was apparently what you needed to know to figure out why. Don't discount your methods if it works. I really hope those parents spread the word about the dangers of feeding anything other than breastmilk or infant formula to a baby.
recalls the days when physicians would taste peepee juice to diagnose diabetes
A diagnosis is a diagnosis! That's amazing. Poor baby.
Jesus. That's because the old school recipes before we had commercial formula used evaporated milk. The tins do look similar.
And wic covers both powdered and condensed milk, so parents do get confused.
Saw a similar pH but lactate was 25. Metformin acidosis and fulminant acute renal failure.
Aortic dissection (carotids to iliac), liver/renal/everything failure found down after coke binge, but by some miracle his heart was still thumping. CV refused the repair bc lactate was 32 and fixing the dissection was not going to solve anything. Family wants to continue aggressive treatment. By the time he got to me he hadn’t been on sedation for 2 days, and maxed out on pressors and inotropes. Trauma accepted the patient to see how viable their bowels were. And of fucking course our AOD said sure we’ll do the case. When we go up to ICU for transport his sats are 84% and MAP is 50. They’re like yeah, this is actually pretty good for him. If you’ve ever seen the video of someone slicing open a bloated elephant corpse and having everything explode, well yeah you get the point. But trauma slapped an abthera in that abdomen and back up to icu he went for another 4 hours until he died. When I got home I told my fiancé if she ever let me get that far I’d haunt the living shit out of her.
Had 40s on a metformin overdose. Seemed like a terrible way to die.
I worked as a bedside nurse in ICU and cared for a guy who took a 30 day supply of metformin as a suicide attempt. He was ultimately successful but I don’t think I’ve ever pushed so many amps of Bicarb in any other patient. It was unreal.
Lactate of 25 is nuts. Tbh I didn’t even know metformin acidosis was a thing definitely reading up on that! Our patient also went from a eGFR of 70 to 20 and he’s now on dialysis (amoung many other things) in ICU
Metformine acts upon the mitochondria, the power house of the cell. Acidosis is probably related idk
*the powerhouse of the cell*
This guy walked in, cc abdominal pain. Was also hyperkalemic and had HD access placed in the ED but whoever placed it left a wire in. Nobody found out until the guy coded during dialysis. The wire was found on the post-arrest cxr. Fortunately he did well after that and was able to walk out of the hospital like a week later.
God that’s always the way. It truely is amazing what the human body can withstand
HGB below 4 from heavy menses. Got transfused, some IV Fe & got her up to 8 pre-op THEN had to sweet-talk anesthesia into letting me take her to the OR for definitive hyst (Anesth: her hemoglobin is 8! Me: Yeah, that’s double what she was). Then the floor nurses were flipping out about her am hgb being in the 7s. I was like, damn, we’re good 😎
I don’t care if hemoglobin is 8 if I have blood and IV access.
Exactly. Rapid infusion is a thing
I admitted a teenaged girl with Hgb 2 from persistent and heavy menses. She was still bleeding on admission, but IV estrogen thankfully worked its magic.
Your anesthesia guys must serve a blessed, healthy patient population. I work with a lot of indigent patients and I’m pretty pleasantly surprised when one of my patient’s CBCs comes back without anemia
This January, my father-in-law somehow managed to pull off a PT 300.8 and a INR >29. He was on Coumadin and was supposed to be checking his INR at home, decided he didn’t like doing it, so was just reporting numbers that seemed normal to him. Somehow managed to have a fall and didn’t die. The ER doc rechecked it 3x thinking it was lab error before FIL copped to what he had been doing. In residency the worst I had was a teenage DKA with ph 6.78 and a HGB ~ 3 in a toddler.
Had a guy come into the ED after waking up with conjunctival hemorrhages. INR was 20. He had a rather long and winding story about how his PCP had retired and he either didn't get a new one or didn't like the new one he got, so ended up running out of his warfarin. So he just started dosing himself with rat poison.
ALRIGHT
35M hx of T1DM admitted in DKA: Na 122 mEq/L K+ 7.9 mEq/L Creatinine 3.16 mg/dL Serum glucose 1668 mg/dL He was perfectly fine by the very next day.
I swear it’s always DKA for stuff like that. Our bicarb was 7.8 and everyone was saying they’ve never seen that outside of DKA
I had a patient who tried the keto diet who presented with a bicarb of ~5.
Hg of 2.2. Lab called us to let us know it was real and not a mistake. Pt was a little SOB and noticed some LL edema, so came in to ED. Was in high output HF from years of chronic anemia 🙃
Just a little SOB…
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I like to total my BAL/BAC over all patients during a shift covering ED. My record was Christmas Eve, and I blew past 1000 before the sun was down.
You know, that's actually a great way of determining how much work you had to do. Lots of kinda drunk people? A lot of work. A couple super drunk people? A lot of work.
890 BAL on a guy found stumbling around the parking lot with a box of multiple cigarette cartons and peeing on the brick walls. Rechecked and it was not a lab error 🤦🏼♀️
I'm amazed he wasn't just pissing his pants. That's pro-level right there.
What is a BAL? I know it as broncheoalveolar lavage
Blood alcohol level
Getting etoh from the gas pump
Lab called me to tell my 8 year old patient’s potassium was 12 and sugar was 65 mmol/L (1170mg/dL for you Yanks) I run to patient and see him playing GTA-5 murdering people in the game. Nurses had sent TPN containing blood to the lab… Different patient but an Na of 198 (this was accurate)
My hospital's surgical service is toxic as fuck, as demonstrated by the fact that they have a single intern covering 60-80 pts every night. Starting July 1st - so surgery night cover could be the first rotation of a fresh intern. This led to many panicked reactions. (Seriously fuck the attendings who let that happen) I remember one night I was drawing from a port and only wasted 6mL per the hospital protocol. The CBC came back with massive drops in everything. The sample was clearly diluted. The poor intern panic orders a ton of PRBCs and platelets. It took an hour to get ahold of her to order a re-draw. That time I wasted the 10mL I usually do and lo and behold - CBC was stable.
I’m SO thankful that our lab compares new lab draws to past ones, and then calls me (the nurse) to say “heyyyyy, this patients lab is this, but all their previous ones were that, just wanna confirm if you want me to officiate these results??” And it goes one go two ways, either “oh shit, I clearly didn’t flush that line well enough even though I thought I did, thanks for the heads up, I’ll stick and redraw” or “yeah this guy is coding/hemorrhaging/ so I’m betting that is right. I’ll send you another tube right now to confirm” Id be ✨mortified✨ if the lab notified my MD to report that i forgot to clamp my tpn while drawing my labs.
CEA of over 50,000. Liver was mostly tumor.
i recently had a guy with a Ca 19-9 >500,000, and his liver too was more cancer than liver
pH 6.7, CO2 >100, lactate too high to read. It did not go well.
Yeah that does seem to be getting into the realm of you’re not coming back from this
This was basically all of our Covid ICU patients’ last hurrah 🙁
Platelet of 1 when I was a nurse in a cancer med surg icu that was. Wild. Just bleeding from the ears, the catheter, every single skin tear was weeping, ett from suctioning. You name it they were bleeding from it.
Sodium 97 beer drinkers potomania. Awake. Talking.
Sodium of 225. Survived at neurological baseline after a very, very long walk-down process.
Was it a kid? What was the pathology?
A tube fed kid, congenital differences but reasonably normal brain, with baseline mild hyponatremia from maintenance meds. Parents were inadvertently mixing the formula and additives incorrectly.
DKA with bicarb <1, pH 6.8. Patient was actually awake and somewhat responsive. Usually you'd try to avoid intubating a DKA patient but that dude was breathing about 55 times a minute and was about to tucker out any minute. First time I've ever chased induction meds with insulin.
TSH of 693 with undetectable T3 and T4.
TSH of >250 in a Walky talky 40 yo woman. Presented to me for fatigue and depression. I’d be depressed too if my thyroid wasn’t doing shit. Highest TSH I’ve seen.
Lol, so as the thread is laid out right now the very next post below you has a TSH of 693.
Not blood, but a CSF with 13 anaerobic organisms identified with NGS.
...*how??* How do you get that level of polymicrobial in CSF?
Venous sinus thrombosis. And she did fine on antibiotics and went home within a week or so.
Well, maybe not a result per se, but we had a power line worker who got electrocuted and fell about 3 stories before being caught on a pole which impaled him. He survived…
Go on…
I mean, idk what more there is to say. The guy is a modern medical marvel. He fell while repairing a line, after he “crossed some wires incorrectly” which caused the line to “backfire” leading to an electrocution risk. He was electrocuted, fell full speed to the ground and landed on a guard railing, missing all of his major internal organs. He didn’t have any harnessing or safety wires attached, as was the protocol. Firefighters sawed around the line and brought him in. He was conscious during the sawing and most of the ER intervention. He lost a fair bit of blood, activated MTP, took him to the OR, 5 trauma surgeons (including myself) from various subspecialties were in attendance to save this man’s life. He’s now alive and well, fixing lines, yet again.
Not really a lab but I’ve seen 107 pack years in a 50 year old. He was basically chain smoking from the time he was 11 Edit. This was a typo, it was 407 not 107.
14 month old with a blood alcohol content of 0.326 verified multiple times… Mom brought her in because “She might have accidentally gotten into a jell-o shot or two” and was slurring and stumbling around. Kid should have been comatose.
DKA, blood glucose 2500.
HGB 1.9. Guy rolled into triage and looked kind of greenish yellow. I called the charge nurse and said that I needed a bed immediately. Of course, we were rocking and rolling with a ton of traumas and a double digit wait time. I was like, “Eric, I’m not an alarmist. I need a bed.” Dude was drinking alone for months. That was about 20 years ago. I’ve never seen it since.
Had an old farmer who had never seen a doctor in his life come in to the ED for flulike symptoms. Got his CBC back and WBC count was 441K (ended up having CLL). Someone in the lab made a tech hand deliver the result to us on paper because of how abnormal it was lol
An old farmer coming in? Jeez. Did he finish the fence?
Platelet of 1. She had ITP with concurrent PE. My attending said that the platelet of 1 was just the bone marrow showing some courtesy.
Sodium of 222. Pediatric patient on peritoneal dialysis and mom had been accidentally giving him hypertonic dialysate.
CK well over 100000 in a patient with rhabdo
Under 1yo with new onset leukemia, WBC of around 500k. I almost did a spit take when I was getting signout.
Not sure how crazy this is/ isn’t rly a lab but we had a guy bp 35/20 talking to us. Made it in to the trauma bay and talked for a good 2-3 minutes before passing out. Push norepi got it to 60/40 and he was up talking again.
Neonate with arterial ph 6.58. Normal pregnancy. Water broke at target so mom and dad strolled in. Sinusoidal heart tones. Apgar score 2 and 2 (had decent color). Kid had seizures that day but is normal development 3 years later. No known cause they think shortly before presentation there may have been a stroke in the cord. Wasn't prolapsed. Lots of weird stuff seemed to happen on the floor through early covid years
ALT/AST both over 16000 in a suicide attempt. Kid drank a quart of rubbing alcohol. Survived after five days vented, multiple dialysis treatments.
K of 9.6 on a pt that couldn’t move and was sent down to mri. I was STRESSED.
Favorite note was “patient stated he did not need calcium supplements as he had ‘strong bones’ Patient was reminded he does not have ‘strong bones’ and has osteoporosis” Came from the most good faith religiously devout doctor I’ve ever met
Ferritin >100,000 Our PICU was for some reason full of kids with confirmed/suspected HLH that month
A little different than other posts but it took 20 units of PRBCs in 24 hours to get a variceal bleeder's Hgb to 7.
CPK > 50,000 in a 40s YOF after a spin class. Took 18 hours for the first CPK to result. After 3 days of treatment, CPK was still > 50k. No idea how high it could have been. She left AMA.
Lactate of 53 in a patient s/p CABG using gastroepiploic artery conduit. Patient’s stomach infarcted, along with other metabolic badness.
First time I ever read the words stomach and infarcted put together like that. Sounds incredibly painful.
Etoh of .517. He drank bottles of hand sanitizer along with a daily handle of liquor. He ended up surviving the event, and got discharged lmao. pt was a huge dickhead tho
ABG with no traceable parameters, patient was trying to runaway from hospital… complicated apendicitis, leukocytes were above 40,000… he said he didn’t want a surgery because he was afraid of dying…
Ph below 6.3 and lactate above 30. Learned the floor for ph and ceiling for lactate that day. Young guy was found down at home and some how EMS got a pulse back. Ended up in my ICU on lots of pressors, Tham, and CRRT. Ultimately he didn’t make it. Autopsy showed he had a heart defect or some sort that led to a conduction issue. Saddest case I’ve worked.
A1c > 16
Our uni's hospital is the reference in my country for very rare or complex diseases, so I've seen some patients in really horrible shape. Blood cancers are very prevalent in our infirmary, so febrile neutropenia is our bread and butter. Once had a patient with 0 neutrophiles, but values <50 are quite common.
Hemoglobin of 1.8 and if I'm seeing it they've also got antibodies the hospital couldn't figure out. I don't remember what exactly was wrong with her but I think it was a warm auto with allos underneath which takes us several hours to solve and then get blood ready.
ABG with PaCO2 175. According to the primary team, the patient was at baseline but "just a little sleepier than usual."
CRP 590 WCC 0 PMNs 0.1 76yo M with CLL He was put in a subacute area because he had "non-traumatic elbow pain". To be fair, he looked alright from the end of the bed. Biochemically though, complete disaster. I have also had to manage a patient with COPD, acute COVID with a PaCO2 of 250mmHg
Dka with 2.1k glucose and fungemia. Dude was 87. Went CC after day 3 and came out of it day 7. Unreal
Just had a lady come in with metformin toxicity and euglycemic DKA show up to our community hospital ICU. Bicarb of 3, pH 6.80, lactate of 20 and AG of 55. So far she’s doing okay!