Critical and Urgent Values & Results
Updated August 3, 2021
Values listed are for outpatient/reference laboratory clients only.
Cleveland Clinic Providers: Inpatient values are listed on the RT-PLMI Intranet.
Laboratory Resources
Critical Results & Values
These test results are defined as those that indicate the patient is in danger of death unless treatment is initiated immediately.
Critical results require immediate interruptive notification of the responsible licensed caregiver who can initiate the appropriate clinical action for the patient.
Client Services or laboratory personnel are responsible for reporting critical results within 30 minutes of the result being known.
Cleveland Clinic Laboratories will immediately notify the individual who requested a test when any result indicates an imminent, life-threatening condition. This policy is compliant with CLIA regulation 493.1109 (f).
Test
Low Value
High Value
Glucose
Less than 40 mg/dL
None
Test
Low Value
High Value
Hematocrit
Less than 15.0%
None
Test
Low Value
High Value
Hemoglobin
Less than 6 g/dL
None
Test
Low Value
High Value
Platelets*
Less than 10 K/μL
None
*Note: If the lab has documented communication of a preliminary critical platelet count, there will not be an additional call with the final result under the following circumstances:
• the final value does not change at all.
• the final value changes, but is still critical.
• the final value becomes non-critical.
Test
Low Value
High Value
Potassium
Less than 2.5 mmol/L
None
Test
Low Value
High Value
Activated Partial Thromboplastin Time (PTT)
Activated Partial Thromboplastin Time, Anticoagulant Therapy (PTTAC)
Performing Laboratory Location: Akron, Avon, Euclid, Fairview, Hillcrest, Lakewood, Lutheran, Main Campus, Marymount, Medina, South Pointe
None
EXTREMELY ABNORMAL RESULT.
No clot detected at 320 seconds.
Refer to Heparin Nomogram for further actions.
Test
Low Value
High Value
Activated Partial Thromboplastin Time (PTT)
Activated Partial Thromboplastin Time, Anticoagulant Therapy (PTTAC)
Performing Laboratory Location: Amherst, Brunswick, Sheffield, Twinsburg
None
EXTREMELY ABNORMAL RESULT.
No clot detected at 300 seconds.
Refer to Heparin Nomogram for further actions.
Urgent Results & Values
These values are test results that fall outside of a normal range and represent a significant finding for the patient or indicate a need for infection control precautions to be initiated.
Urgent results and values require prompt communication to, and attention from, the patient’s caregiver.
Results are provided by Client Services immediately after any pending critical values are called. While there is no national standard for calling urgent values, every effort is made to call urgent values within approximately two hours from result availability.
Urgent values are reported to a responsible licensed caregiver, and an accurate read back of the communication is requested. All actions are documented.
Chemistry
Test
Low Value
High Value
Patient Info
Bilirubin, total
None
> 15.0 mg/dL or QNS
Non-neonates (≥ 31 days old)
Calcium
< 7.0 mg/dL
> 14.0 mg/dL
Neonates (< 30 days old)
< 6.0 mg/dL
> 14.0 mg/dL
Non-neonates (≥ 31 days old)
Calcium, ionized
< 0.9 mmol/L
> 1.5 mmol/L
Carboxyhemoglobin
None
> 20%
Glucose
None
> 500 mg/dL
Lactic Acid (Lactate)
None
> 4.0 mmol/L
Magnesium
< 1.0 mg/dL
> 6.0 mg/dL
Phosphorus
< 1.1 mg/dL
None
Sepsis Lactate
None
> 2.0 mmol/L
Sodium
< 120 mmol/L
> 160 mmol/L
%CKMB
None
> 4%
Called once every 24 hours
Troponin T
None
≥ 0.03 ng/mL
Called once every 24 hours
High-Sensitivity Troponin T
None
≥ 52 ng/L
Called once every 24 hours
Hematology/Coagulation
Test
Low Value
High Value
Patient Info
Activated Partial Thromboplastin Time (aPTT)
None
> 100 sec
ADAMTS13
< 10%
None
Anti PF4 Elisa Assay (Heparin Antibody)
None
> 0.400 OD reading with more than 50% inhibition with excess heparin
Factor Assay
< 5%
None
Fibrinogen
< 100 mg/dL
None
Hematocrit
< 26%
> 65%
Neonates (< 30 days old)
International Normalised Ratio (INR)
None
> 5.0
Prothrombin Time (PT/INR)
None
No clot detected at 320 seconds.
This could be due to an extreme hemostasis abnormality or a contaminated or clotted specimen.
Suggest redraw.
Performing Laboratory Location:
Avon, Euclid, Fairview, Hillcrest, Lakewood, Lutheran, Main Campus, Marymount, Medina, South Pointe
Prothrombin Time (PT/INR)
None
No clot detected at 300 seconds.
This could be due to an extreme hemostasis abnormality or a contaminated or clotted specimen.
Suggest redraw.
Performing Laboratory Location:
Amherst, Brunswick, Sheffield, Twinsburg
Platelets
< 20 K/μL
(call once every 72 hours)
White Blood Count
< 1.01 K/μL
> 74.99 K/μL
Non-neonates (≥ 31 days old)
< 4.0 K/μL
> 30.0 K/μL
Neonates (< 30 days old)
Microbiology
*Note: Outpatient positive results are called between 8 a.m. and 8 p.m. Results that become available after 8 p.m. are called the next day after 8 a.m.
Primary Test
Result
Primary Test
Result
Acid-Fast Bacteria (AFB), Culture & Stain*
Positive (initial “AFB” result) & ID of M. tuberculosis
Eye Culture
Positive (initial detection of organism)
Will not call organisms listed as probable contaminant.
AFB, Culture Only*
Positive (initial “AFB” result) & ID of M. tuberculosis
Eye Culture & Gram Stain
Positive (initial detection of organism)
Will not call organisms listed as probable contaminant.
AFB, Stain Only*
Positive (initial “AFB” result) & ID of M. tuberculosis
Gram Stain
from a normally sterile site (e.g. CSF, body fluid, eye, tissue)
Positive
Blood Culture
Positive (initial Gram stain)
Herpes Simplex Virus (HSV) by PCR, CSF
Positive
Blood Culture, Special
Positive (initial Gram stain)
Mycobacterium tuberculosis (MTB) Complex, PCR
on Smear-Positive Specimens
Positive for Mycobacterium tuberculosis
Blood Parasites
Positive
MTB Complex, PCR
on Smear-Positive FFPE Tissue
Positive for Mycobacterium tuberculosis
Body Fluid, Culture & Stain
Positive (initial detection of organism)
Organism Identification
Mycobacterium tuberculosis
Cerebrospinal Fluid (CSF), Culture & Stain
Positive (initial detection of organism)
Tissue Culture & Stain
from a normally sterile site
Positive (initial detection of organsim)
Enterovirus PCR
Positive
Toxic Drug Levels
There are no urgent low values for toxic drugs, except for Methotrexate, for which all values are called.
Test
High Value
Test
High Value
Acetaminophen
> 150.0 μg/mL
(>4hr post-ingestion)
Mexiletine
> 3.0 ng/mL
Amikacin, Random
> 40.0 μg/mL
Nordoxepin
> 500 ng/mL
Amikacin, Pre
> 8.0 μg/mL
Nortriptyline
> 500 ng/mL
Amikacin, Post
> 40.0 μg/mL
Oxcarbazepine
> 40 μg/mL
Amiodarone/DEA
> 40.0 μg/mL
Pentobarbital
> 40 μg/mL
Amitriptyline
> 500 ng/mL
Phenobarbital
> 60.0 μg/mL
Caffeine
> 30 μg/mL
Phenobarbital, Free
> 25.0 μg/mL
Carbamazepine (Tegretol)
> 15.0 μg/mL
Phenytoin (Dilantin)
> 40.0 μg/mL
Carbamazepine-10, 11-Epoxide
> 15.0 μg/mL
Phenytoin, Free
> 4.0 μg/mL
Carbamazepine, Free
> 5.0 μg/mL
Primadone
> 18.0 μg/mL
Cyclosporine
> 2000 ng/mL
Procainamide
> 15.0 μg/mL
Desipramine
> 500 ng/mL
Quinidine
> 7.0 μg/mL
Digoxin
> 3.0 ng/mL
Rapamycin
> 30 ng/mL
Disopyramide
> 7.0 μg/mL
Salicylate
> 40.0 mg/dL
Doxepine
> 500 ng/mL
Tacrolimus
> 30.0 ng/mL
Everolimus
> 30 ng/mL
Theophylline
> 30.0 μg/mL
Gentamicin, Random
> 20.0 μg/mL
Thiocyanate
> 5.0 mg/dL
Gentamicin, Pre (Trough)
> 2.0 μg/mL
Tobramycin, Random
> 20.0 μg/mL
Gentamicin, Post (Peak)
> 20.0 μg/mL
Tobramycin, Pre (Trough)
> 2.0 μg/mL
Imipramine
> 500 ng/mL
Tobramycin, Post (Peak)
> 20.0 μg/mL
Lead, Blood
> 44.9 μg/mL
Valproic Acid
> 150.0 μg/mL
Lidocaine
> 8.0 μg/mL
Valproic Acid, Free
> 75.0 μg/mL
Lithium
> 2.0 mmol/L
Vancomycin
> 50.0 μg/mL
Methotrexate
All values
Zinc Protoporphyrins
(0–13 years)
> 35 μg/mL
Methylmalonic Acid
> 50,000 nmol/L
Zinc Protoporphyrins
(> 13 years)
> 100 μg/mL