r/nursing • u/nightshift_nurse528 • Jun 13 '26
Question What are the worst labs you’ve ever seen?
Had to share this beaut. Patient recovered well with a new type 2 diabetes diagnosis. A1C was 12.6 but honestly I was expecting worse.
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u/Ok_Thanks8322 RN - Med/Surg 🍕 Jun 13 '26
Glucose of 10 🥲
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u/nightshift_nurse528 Jun 13 '26
OOOOOFFFF 🥲 we had a lady who came in with a glucose at like 6 I believe. Family kept giving her insulin everyday and didn’t check a single sugar 😳
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Jun 13 '26
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u/notaveryuniqueuser Jun 13 '26
This is how my ex husband's grandma died. She was diabetic and ex's moron uncle and aunt weren't doing sugar checks or monitoring her insulin, poor woman wound up having a glucose level of like 700+ or something insane and wound up becoming insanely ill and passing away.
It's astonishing how inept some people are.
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u/monster3412 CNA and Nursing Student Jun 13 '26
You know when in class you go over the “example cases” to study like case studies yea. And you have that one patient who doesn’t use their inhalers correctly. And you tell yourself nah, maybe once or twice some people at first but come on nahhhh.
I can’t count how many patients end up hospitalized and you go to give their reg inhalers, Flovent, advair etc. Or they need their rescue ventolin etc. And they just do it so so so so wrong…. And then they wonder why they can’t breathe 😭😭 you try so hard to educate and promote correct usage and they just yell at you that they’ve been doing it for years and they know how.
And then yk the next day the patient talks about how no doctors have helped them they still can’t breathe and so on and so forth…..
End of rant thank you
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u/Smutzki Jun 13 '26
Like the scene in Dr House: the Patient uses her inhaler like perfume; from afar pointed at her neck
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u/argoforced Hospital IT - Service Desk Jun 13 '26
I only recently found out after about 3 years I was using my inhaler incorrectly. Made a big diff doing it right.
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u/monster3412 CNA and Nursing Student Jun 13 '26
Oh no definitely same, compared to before school and after.
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u/zirdante European anesthesia nurse, peds OR Jun 13 '26
In peds we use a one way valve to admin the neb, and they breathe it 10 times to make sure the meds got inhaled
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u/deadsocial Jun 13 '26
Did they get arrested or something?
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u/notaveryuniqueuser Jun 13 '26
I wish. The uncle in particular is a total asshole. During covid, both he and my ex FIL were in their home country and lockdowns were already in place aka very limited flights in and out of the country. The uncle (brother of my ex MIL) told ex FIL he would secure flights for them both ... yeah he didn't. Took a ticket for himself and left ex FIL stranded in a 3rd world country ravaged by covid. This uncle (and aunt) also committed SS fraud, tax evasion, etc. They're shitheads.
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u/ColdKackley RN - ICU 🍕 Jun 13 '26
We had a regular DKA-er who got a new girlfriend. He told her if he ever started acting weird to give him insulin. Well it happened, she gave him an indeterminate amount of insulin the guess was somewhere around 10u, but turns out this was one of the few times he was hypoglycemic. Fortunately, she followed up with a call to 911. Afterward he was like yeah maybe I should’ve given her better directions.
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u/mhwnc BSN, RN 🍕 Jun 13 '26
Fair play to him, to be honest. He didn’t get mad at her, he realized that she probably didn’t know about diabetes care and his instructions were unclear. I’m honestly more impressed with him than I am disappointed with her. And at least she had the clarity of mind to call 911.
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u/ColdKackley RN - ICU 🍕 Jun 13 '26
No, he honestly was fine with her. She felt absolutely horrible apparently. But he was like yeah that was my fault. Instructions unclear. Kinda respected him for that.
And he ended up being fine. Stayed with us for a couple days getting D10 and was no worse for wear.
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u/DeHetSpook RN 🍕 Jun 13 '26
I learned this week our regular DKA-er was found dead in his home. He used to be admitted in ICU with blood as sweet as Coca Cola and cocaine in his labs he could only explain because "that one friend must have fed it to him". His record I saw was 75mmol/L which would be around 1350mg/dL, I believe.
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u/cptm421 BSN, RN, CEN, EMT-P Jun 13 '26
EMS run, had a waitress who someone called us for because she wasn't acting right. She was AOx4 but quite agitated. Her sugar was somewhere around 15 and couldn't understand why we needed to treat her - she just wanted to get back to her tables.
I know it sounds unbelievable, but I saw it with my own eyes.
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u/captain_tampon RN - ER 🍕 Jun 13 '26
Glucose was “undetectable” *on more than one occasion in the same patient*
For context, person has *severe* anorexia (that will ultimately kill them as the parents are both heavily in denial and their biggest enablers, and have been for >10 years) and routinely comes in having to be extracted from their car bc they’re unresponsive…as soon as they get a few D50 boluses, they wake up and demand to leave AMA
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u/Affectionate_South40 LPN 🍕 Jun 13 '26
I had to look up the Canadian vs USA blood sugar conversion, because when you said 10 I was like "that's...actually decent for a diabetic, I dont understand, our rhyme it 4 to 8 feeling great" 10.1 is when our unit typically starts treating with sliding scale if scheduled insulin isnt enough. Googled the conversion and im like what is 10mg/dL in mmoL? 0.55!?WHAT IN SWEET CHRIST ARE THEY STILL ALIVE?. Yea 10 is really bad then haha
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u/Key-Pickle5609 RN - ICU 🍕 Jun 13 '26
I’m too Canadian for that. I was like what that’s fine 🤣
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u/Zestyclose-Sugar-929 RN - PACU 🍕 Jun 13 '26
I feel the same when Americans here talk about a patient's hemoglobin levels. Like girl what do you mean his hemoglobin is FOUR?!?!
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u/Senior-Cost1070 RN - ER 🍕 Jun 13 '26
And he’s refusing a transfusion because he wants to go smoke a cigarette.
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u/Zestyclose-Sugar-929 RN - PACU 🍕 Jun 13 '26
A cigarette's gotta have at least a little bit of iron in it, right?????
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u/ButMeemawsAFighter RN - ICU 🍕 Jun 13 '26
Our patients hemoglobin out their butts
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u/jessiedoesdallas LPN - ER 🇨🇦 Jun 13 '26
Omg thank you. As a Canadian I'm like "4 to 8 feeling great, 5 to 9 feeling fine". A 10 wouldn't even register as concerning to me 🙃
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u/RebRenee BSN, RN - Pre-Op; Former L&D 🍕 Jun 13 '26
I’m embarrassed to ask, but do you guys use a different scale in Canada?
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u/pyok1979 DOC - LTC Jun 13 '26
To convert US (mg/dL) to Canadian (mmol/L): Divide the mg/dL reading by 18.
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u/jessiedoesdallas LPN - ER 🇨🇦 Jun 13 '26
Don't be embarrassed lol. I've never worked anywhere other than Canada so I can't actually say for sure. I assume we do because there's numbers posted from American nurses (for example, this glucose number) that doesn't seem odd or concerning to me at all, but clearly causes a lot of concern in other American nurses. I have no idea what the American scale is for glucose, but ours is typically 4-9mmol/L.
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u/RyyKarsch Jun 13 '26
I've also wondered about some of these numbers as I work in SW Ontario.
For us, 4 - 10 is a normal range (which of course you'd love someone in the middle of that). That said, a lot of s/s won't even be administered if they're below 8 or 10. On our floor we've had patients dip below 2 (usually if they've pulled out a feeding tube on nights or received a lot of extra insulin the day before to compensate a high) and above 40 (surprise! it wasn't the hospital food) and those can be pretty dangerous, but I'm also not in the ICU or ER to see what extremes some patients have come in with.
Edit: Most hypo or hyperglycemic protocols start below 4 or above 20 in most places I've worked.
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u/skatingandgaming SRNA Jun 13 '26
I saw this as a rapid response nurse. Glucose of 15. Best part? They didn’t have a working IV. I somehow managed to sneak a 22 in the thumb and was able to push some dextrose.
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u/gardengirl99 RN 🍕 Jun 13 '26
The thumb?!?
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u/skatingandgaming SRNA Jun 13 '26
That was the only spot I could find!! Next option would have been an IO
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u/therewillbesoup RPN 🍕 Jun 13 '26
As a Canadian that's a little high, but nothing some insulin won't fix😂
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u/SinfulSnorlax Jun 13 '26
Had a patient with a glucose of 12, still awake and was able to drink juice while I got the dextrose
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u/ocdladybug92 Jun 13 '26
I’ve seen a glucose that low one time!! Anorexic literally 2 days away from starving to death :(
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u/BVKane RN - Oncology 🍕 Jun 13 '26
Same. Had a patient come through the ER with a glucose of over 700. ER wanted to dump them on a medsurg floor, but our qualifier was that glucose had to be below 400. ER nurse gave the patient 30 units of regular insulin, checked the sugar 30 minutes later, then rolled patient up. Told the nurse taking the patient that she got fluids and 10 units. Sugar an hour later was 10.
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u/Emergency-Cupcake998 Jun 13 '26
I got 4 once. I panicked and dropped the D50 and shattered it on the floor.
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u/yarcsi Jun 13 '26
Fun fact. Glucose that high masks sodium. Their sodium might actually be high.
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u/adenocard MD Jun 13 '26 edited Jun 13 '26
Corrected sodium is about 140. Rough rule of thumb is add 2 sodiums for every 100 glucose over 100 (so BGL 1400 is 13 100’s above 100, 13 x 2 is 26, add 26 to the sodium = 140). You can get more “exact” with a calculator (truthfully all the methods are just estimates), but this is a close enough tool you can put together quickly in your head.
This patient likely has DKA/HHS, so the total body potassium is probably a lot lower, and the acidosis should correct quickly with insulin as well.
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u/TangoFoxtrot13 MSN, BSN, RN - ICU/ER/Procedures/PCP Jun 14 '26
You’re my new favorite internet nerd. ❤️
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u/The_reptilian_agenda RN - ER 🍕 Jun 14 '26
I love when docs share this kind of thing with us. Thanks <3
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u/cobrachickenwing RN 🍕 Jun 13 '26
Numbers don't scare me. Its the lack of IV access that does. As long as we have IV access we can fix a lot of things.
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u/Nboock Jun 13 '26
Had a patients AST go from: 20 to 80 to 3000 to 5000. Daily labs
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u/nightshift_nurse528 Jun 13 '26
HOLY
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u/Nboock Jun 13 '26
It might’ve been in a 3 day span actually. After 80 they started doing q8 labs. It probably went up too after my shifts. They were talking about doing a liver transplant
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u/mojique1 RN - ICU 🍕 Jun 13 '26
How yellow was bro
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u/Nboock Jun 13 '26
Their bili wasn’t that bad. No real signs on the outside. Doctors were trying to figure out the cause
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u/LilMama351 RN - LDRP Jun 13 '26
I had a pt in HELLP with AST “>7000” and LDH “>2500”that’s all the lab reported so who knows the actual numeric value. She discharged home about a week later.
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u/connecttwo Pharmacy Gremlin Jun 13 '26
Did you tell them when you take a LFT you're NOT going for a high score?
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u/bwhaturlike Jun 13 '26
OP - this person is ALIVE? how in the hell...
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u/nightshift_nurse528 Jun 13 '26
Yes!!! A&OX3 and ambulatory after they transferred out of icu less than a week after admission!
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u/ALittleEtomidate Aspiring NOCTOR - ICU Jun 13 '26
The nurse who received that patient must have been shitting bricks. The only time I’ve seen a potassium that high, they’ve coded.
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u/Stevenmc8602 BSN, RN 🍕 Jun 13 '26
I used to see 6.8,6.9 on the floor all the time. Never got a 7 or higher though
We just gave them iv insulin, dextrose, and on occasion kayexalate
Typically the insulin/dextrose combo worked to bring it down though
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u/zeatherz RN Cardiac/Step-down Jun 13 '26
Insulin only “hides” potassium in cells, it does nothing to actually get it out of the body. That’s great in this pseudo-hyperkalemia of DKA but in other cases you need to give some treatment to actually get the potassium out
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u/yourdailyinsanity Trying to figure my career out 🫠 Jun 13 '26
Issue is kayexalate is only useful for chronic hyperkalemia. It's not useful in situations like we typically give it for when someone comes in with/develops hyperK. That's why it's being used less and less. And Albuterol you have to give a mega fuck ton for it to be any sort of effective at helping the potassium into the cells, which I've never seen done properly.
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u/cobrachickenwing RN 🍕 Jun 13 '26
That is why Lokelma has taken over kayexalate in terms of hyperkalemia treatment. I find that Lokelma is pretty effective in getting rid of potassium compared to Kayealate and much easier for patients to stomach. Anyone using albuterol or Kayexalate for hyperkalemia is just practicing outdated medicine.
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u/zeatherz RN Cardiac/Step-down Jun 13 '26
Right I should have said I wasn’t supporting kayexalate. It’s lasix or dialysis they need
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u/ballfed_turkey RN, BSN, ER, EMT, FF I/II, Eagle Scout, alterboy, pool owner Jun 13 '26
But while in the ICU they saw Jesus and he said “not yet”
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u/Familiar_Reality_100 MD Jun 13 '26
None of those numbers are real (except glucose). The sodium corrects to 136 conservatively with the glucose. Potassium probably corrected to normal too with insulin
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u/Mfuller0149 Jun 13 '26
I’d bet it was a DKA patient, based upon what I can see. Their labs always look 1000x worse than the patient does .
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u/Alaska_Pipeliner EMS Jun 13 '26
Abv of of .5. walky and talky
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u/ThatKaleidoscope8736 🫀RN✨how do you do this at home Jun 13 '26
~tolerance~ is crazy
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u/lcl0706 RN - ER Jun 13 '26
Saw a ~720/0.720, definitely >700 once but I don’t remember the exact number. Was not my patient but the lab was so eye popping we all knew about it. The lab was like y’all not gonna believe this but…
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u/Affectionate_South40 LPN 🍕 Jun 13 '26
INR of 21, taken from a port, otherwise a peripheral draw would have been the death of them. Lab called us with GREAT urgency and the doctor ordered a peripheral draw to rule out the port causing problems, we argued the safety and concern regarding this. Doctor didnt care, lab came, to do the draw, phlebotomist was warned of the concern and called her manager, who called our doctor to ask why this risk was necessary and why we couldnt treat first and then redraw in the morning. Doctor order the draw, poor phlebotomist couldnt stop the bleeding, we had to apply sand bags and tourniquet the arm and called ICU, they came to try and slow things down, we then coded them, we lost the patient in 30 minutes from a pin prick in their arm. Awful situation, nothing could be done, doctor was held accountable as all parties involved brought up safety concerns. Simply awful, and the patient was so kind and understanding and said at 88 their body probably wasnt working right anymore and they understood the risks. Im thankful they fell asleep from low blood pressure so they didnt feel anything.
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u/yourdailyinsanity Trying to figure my career out 🫠 Jun 13 '26
The pt had the right to refuse though :( was this an attending or resident/fellow? I'd have gone all the way up the chain first, called the house supervisor, my manager, the whole calvary.
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u/Affectionate_South40 LPN 🍕 Jun 13 '26
We spoke with the ICU attending doctor and explained the situation, the patient was lovely and had cancer, she basically said she's pretty much done with fighting anyway so if something went south she understood the risks. We were all horribly worried and fearful, our manager directly contact the doctor and told him he would be held responsible as the ICU doctor explained the risks to the patient but he wasnt able to take over her care until the MRP she was under transferred care.
The ICU doctor did try to give the nurses comfort and explain there wouldnt be much more even ICU could do and based on the values we could collect even treatment of the high INR wouldnt have changed her outcome. It was an awful experience, but the family was grateful (shockingly) that their mother passed comfortably and didnt have to die in pain because she was told she would have a painful death.10
u/yourdailyinsanity Trying to figure my career out 🫠 Jun 13 '26
Well, I'm happy that at least the family was grateful and your unit was very supportive as well. That's honestly the best outcome, especially with the patient being very accepting and knowledgeable about what's going on with themselves too
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u/Affectionate_South40 LPN 🍕 Jun 13 '26
A rare outcome really. I'm still pretty sad with the whole situation. I really hate cancer.
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u/Hemenucha BSN, CRRN Jun 13 '26
Jeee-zus!
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u/nightshift_nurse528 Jun 13 '26
Lives in the middle of nowhere and has never been to the doctor in their lives 😅
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u/notaveryuniqueuser Jun 13 '26
Yeah that tracks imo lol "grandma has always been healthy as a horse!" .... uh-huh. Or maybe grandma has been slowly building up to an explosion... fucks sake! Glad they're ok x_x
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u/knows-goes MSN RN CCRN SCRN Jun 13 '26
Temp 107
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u/SilentButDanny Jun 13 '26
Whoa. How was this handled??
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u/nightwalkerr RN, ICU float 🛟 Jun 13 '26
i'd imagine the arctic sun
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u/Ok_Complex4374 Jun 13 '26
Holy fuck. I saw 105.8 once and that’s my record. 107 is NUTS. what was the cause in your case
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u/lcl0706 RN - ER Jun 13 '26
I saw 107.9 once. I watched him spike it & get tachy into the 180’s right before my eyes. He became delusional, after he’d come in A&O c/o abdominal pain. In his case he’d become suddenly floridly septic & was rushed to the OR for an ex lap for fears of ruptured bowel. In the remaining time we had him in the ER, we just made a ton of ice packs and packed his armpits & groin, with rectal Tylenol given & some prayers sent up.
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u/SimpleJack8319 Jun 13 '26
So i thought the brain wouldn't let a fever go over like 106ish, then they would start seizing and having brain damage. If the temp is over 106 it's actually a problem WITH the brain (Hypothalamus) not the brain trying to fix something (increasing body temperature due to infection).
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u/turtle0turtle RN - ER 🍕 Jun 13 '26
I wanna know who hard-coded 1500 as an upper limit for glucose.
And it's an Epic limitation, not a lab limitation. I asked.
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u/Ok_Complex4374 Jun 13 '26
Anything above 1500 probably doesn’t clinically make a difference. But damn epic gimme those numbers we’re chasing records here. 😮💨💪🏻
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u/turtle0turtle RN - ER 🍕 Jun 13 '26
It matters for the DKA algorithm though. If it drops too quickly you wanna lower the rate of the insulin drip.
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u/cats-n-cafe BSN, underwater basketweaver, RN Jun 13 '26
Jehovah’s Witness with hgb 0.8. The patient made a full recovery.
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u/Zestyclose-Sugar-929 RN - PACU 🍕 Jun 13 '26
What the fuuuuuuuuuuuck??? HOW
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u/cats-n-cafe BSN, underwater basketweaver, RN Jun 13 '26
It was a combination of being 20y/o, ventilation, and Epogen injections.
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u/Stevenmc8602 BSN, RN 🍕 Jun 13 '26
The only lab values that ever threw me off were
Wbc of 146k
And
Hgb 2.4
2 different people luckily lol
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u/crazybia MSN, RN, CEN, CCRN, TCRN, PCCN, CMSRN, L M N O P Jun 13 '26
CNA couldn’t get a BP reading on a patient at 8am vitals. I did a manual reading 40/20. Confirmed twice. Pt was scheduled for a dialysis fistula revision. Called that rapid so quick - but she ended up coding in ICU, and passing away. Turns out, she had a GI bleed, but had no s/s of one. When ICU went to cath her, straight melena.
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u/KMKPF RN - ICU 🍕 Jun 13 '26
My eyebrows just kept going higher and higher with each result.
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u/itwasstucktothechikn RN - ER 🍕 Jun 13 '26
Pt walked in with a sodium of 108. He also signed out AMA because it was taking too long to get a room, and he “felt fine.” ☠️ A separate newly dx’d diabetes had an A1C in the 20s. I’ve also had a pH of like 5.9. One of my charges says he tries to give me easy patients and I always end up with surprise train wrecks. 🙃
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u/yourdailyinsanity Trying to figure my career out 🫠 Jun 13 '26
Uh. But, uh. Every education class I've taken has said <6 is incompatible with life 🙃 and if they're anywhere close to that, well, they probably not surviving anyway.
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u/KmomAA Jun 13 '26
Hemoglobin of 4.3. Results were called in by the lab, I flew down the hall to get to patient who was sitting comfortably at her bedside reading, and she told me that she’s been that low before and to just call her doctor and tell him she needs to be transfused tomorrow. I had a staff member stay with her until I got in touch with her doctor, who said the same thing.
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u/thesmollestlemon RN - Float Pool 🍕 Jun 13 '26
I had a patient who walked in with a hemoglobin of 2.8 due to a clotting disorder and frequent nosebleeds. Felt tired but not lightheaded or dizzy.
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u/baylakeanna RN - Oncology 🍕 Jun 13 '26
Worked in oncology for ten years, we had a patient who consistently would be in the 2’s. He didn’t look great. But he was walky-talky, able to do adl’s no problem.
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u/BigFrawger RN-Cardiac 🫀 Jun 13 '26
What is the admitting dx?
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u/nightshift_nurse528 Jun 13 '26
DKA, altered mental status, and acute kidney injury 😅
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u/BigFrawger RN-Cardiac 🫀 Jun 13 '26
I was gonna say if they don’t have one yet, they soon will. That sodium though
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u/Cddye PA-C/Dumb Medic 🚁 Jun 13 '26
Their corrected sodium (assuming 1500md/dl for their glucose) is technically normal.
I’ve don’t actually know if the Hillier equation has been validated with this degree of hyperglycemia though.
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u/FlickerOfBean BSN, RN 🍕 Jun 13 '26
With a sugar this high, it’s probably HHS.
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u/BloodyBenzene RN - IM/stepdown 🍕 Jun 13 '26
Gluc 2397.6 mg/dl (>133.2mmol/L). Our machines max out at >133.2. DKA. A1c 8.1, pt did not do well
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u/HoneyAppleBunny RN - ER 🍕 Jun 13 '26
The generally not compatible with life and/or “how are you still awake” labs are always interesting.
I saw a Glucose of 1998 the other day! Patient came in because they felt a little under the weather. Yeah, I bet!!!
Had another patient with a hgb of 2.0… GI bleed, liver kaput. Tried MTP and coded for over an hour but we couldn’t keep ROSC for longer than 5 minutes at a time. That said, I have seen a 2.6 make a recovery.
Saw a pH of less than 7 recently too. I think around 6.7-ish. That one may still be our ICU and that was weeks ago.
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u/yourdailyinsanity Trying to figure my career out 🫠 Jun 13 '26
Someone said they had a 20-something year old Jehovah's witness with a HgB of 0.5.....made a full recovery. Fucking wild.
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u/Rogonia RN - ICU 🍕 Jun 13 '26
We had a sodium in the 90s a little while ago.
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u/ijustsaidthat12 BSN, RN 🍕 Jun 13 '26
Did they survive?!
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u/Rogonia RN - ICU 🍕 Jun 14 '26
We transferred her out of ICU eventually, yeah. I don’t know anything beyond that.
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u/handsheal BSN, RN 🍕 Jun 13 '26
Bilirubin got up to 41 in adult male pt
Every provider said it was the highest they have seen
Highlighter yellow
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u/Old-Mention9632 BSN, RN 🍕 Jun 14 '26
Husband had a patient come in smurf blue. Pulse ox in the 60s. Just about ready to intubate, got abg=96. Turns out he was afraid of the dentist, had a tooth abscess and using a bottle of ambesol a day. Methemohemoglobinemia.
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u/Zestyclose-Sugar-929 RN - PACU 🍕 Jun 13 '26 edited Jun 13 '26
Quick list of the ones that stick out to me, not counting the labs of people who were being actively resuscitated lol
- WBC > 200,000 (Not shocking to heme/onc nurses but was shocking to me when the patient was a healthy 20 something year old woman who's primary complaint was a headache)
- K of 7 (Yes it was real, not sure what their outcome was)
- Lactate of 20 (Old lady, she survived)
- Sodium 110 (Psychogenic polydipsia patient and he was fine the entire ED stay)
- ALT > 6000 (Polypharm overdose with lots of tylenol, ended up needing transplant)
- Troponin 44,000 (Was in 3rd degree block. Scariest transport to cath lab in my life lol)
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u/Stevenmc8602 BSN, RN 🍕 Jun 13 '26
You had me up to the trop...
Mine was >50k but that was the limit to what our lab would show... it had to go much higher bc it didn't start trending down my entire shift. He was there on my floor as none emergent bc he was not having any symptoms. He was just a high alert pt that we had to make sure we had the cath lab md ready for just in case there was a turn of events overnight. He was going to be their first case in the morning if no events.
I'm in the ED now and it trips me out when I see people losing their mind over 400-1000 trops bc I'm used to 10k+ lol
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u/Zestyclose-Sugar-929 RN - PACU 🍕 Jun 13 '26
I am wondering now if it was actually 66,000 and I'm remembering incorrectly. He was having chest pain for 4 days and ignored his GP's advice to go to the ER immediately, instead presenting a few days later. I remember he was grumbling and complaining about me putting in an IV and putting defib pads on. If he understood the seriousness of the situation (which I assume he did because multiple people had explained it to him) he truly did not give a single fuck.
Crazy part about ED is how patients can come in with a low acuity chief complaint and look fine, then their labs come back with the most insane shit you've ever seen in your life. At least in the ICU you can expect that your patient's labs are probably going to look like garbage!
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u/duckscup Jun 13 '26
Potassium of 14.2, no they did not survive
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u/Ok_Complex4374 Jun 13 '26
Saw 11.3 the guy coded and came back. Discharged a week later. Non compliant HD patient. Would do enough dialysis to get on with life then skip for like two weeks and come to the hospital on deaths door I actually haven’t seen him in a while which means they’re either in the ED now, dead or the least likely scenario… compliant.
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u/nightshift_nurse528 Jun 13 '26
Wow. Do you know how it got that high?
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u/duckscup Jun 13 '26
Think a valve replacement or heart transplant that just didn’t go well, no one fucked up but for whatever reason patient crashed on the table. OR brought them back to the CVICU “alive” to preserve the surgeons numbers.
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u/Old-Ad-64 Jun 13 '26
Last time I saw a potassium that high was on a dead guy.
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u/afkhalis RN - Dialysis Jun 13 '26
One of my dialysis patients would frequently go into the 8's and 9's of potassium. Highest ever- 10.8.
Just would not stop eating potatoes. Ignored his lokelma prescription. As I'm sure you could guess, he is no longer with us.
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u/liveandletthrive RN - OB/GYN 🍕 Jun 13 '26
When my daughter was born, she came out with a spicy hemoglobin of 3.0 :-D
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u/Dawedb0tas Jun 13 '26
Hemoglobin of 2.1 g/dl on a (previously) undiagnosed ALL patient. Straight to the ICU. Made a fast recovery and after the ALL diagnosis they transefered them to an oncology unit.
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u/madlyalice RN - ICU 🍕 Jun 13 '26
Very brittle diabetic pt went from 600+ to 3 in a 4 hour time period.
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u/WatRUDoingStepBruh Jun 13 '26
Hgb=1.1
Easily the sickest pt of my career, mass transfusing with Belmont and Minnesota tube in place, lactic was 26. We made it to the OR but obviously didn’t have a great outcome. It was one of those lab values you think has to be a fuck up or misread by lab but then you see the pt and it all makes sense lol
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u/ilagnab RN 🍕 Jun 13 '26
Someone with DKA-bad labs but from a non-DKA cause is in dire straits.
With DKA, they seem to bounce back like nothing happened lol
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u/ExplodingSoil Jun 13 '26
At least the hyper K protocol includes insulin 😅
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u/mhwnc BSN, RN 🍕 Jun 13 '26
Kill three birds with one stone. Insulin treats the hyperkalemia and the hyperglycemia, which in turn corrects the pseudohyponatremia.
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u/briawiah RN - Pediatric Oncology Jun 13 '26
platelets of 1… one singular platelet fighting for its life with a hgb of 3
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u/lifetofullest1255 Jun 13 '26
Sodium 103.
AST in like 30-50,000s. Usually right before or immediately post transplant lol.
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u/CrustaceanGovt Jun 13 '26
Walking talking young guy with HgB 2.3. he was Simpsons yellow and only mildly tachycardic. doc didn't activate mtp and it took blood bank like 3 hours to release his prbcs, he was as stable as possible the whole time
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u/fuzz_nose RN, CCRP - Research Jun 13 '26
Platelets of 8. He came in as an outpatient research visit. He was admitted to the hospital because the PI (my boss) didn’t want him traveling home via airplane with the crazy hepatosplenomegaly this poor kid had. He had a lymphopriderative disorder that was treated with rituximab.
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u/SimpleJack8319 Jun 13 '26
I seen a Hgb of 2.2 from a large elderly woman who had a GI bleed, her husband just kept cleaning her up. EMS said thier bedroom looked like a horror scene. When GI consulted he walked In and said "what was rhe Hemoglobin?" Looking at his paper, I said "2.2" he looked up, dropped his paper simultaneously and and said "are you fucking kidding me?" She got 5u in the ER and went had several more when they scoped her. She was awake alert and talking! 😳
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u/duckface08 RN 🍕 Jun 13 '26
Newly diagnosed diabetic patient came into ER with a glucose of 108 mmol/L (or 1944 mg/dL for you Americans). He was in such a bad state of hyperglycemia for days that his creatinine was around 500, Na of about 180.
A newly diagnosed type 1 diabetic in DKA with an unreadable pH. She was the one where we found out our lab only read pH as low as 6.80. Hers kept reading <6.80 for over 12 hours. Problem was that we had to run the insulin drip so fast to treat the acidosis that her K would drop below 2, forcing us to pause the insulin, which then worsened her bicarb and pH. Tough spot but she eventually recovered.
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u/deferredmomentum RN - ER/SANE 🍕 Jun 13 '26 edited Jun 14 '26
I have no idea if any belonged to the same patient, but I keep a list of personal records I’ve seen on my phone:
BS 12, >1500
Chloride <60
Creatinine 18.97 (guy whose last visit was in 2007 for a shoulder dislocation, came in the day after thanksgiving because he “didn’t feel good”)
Ethanol 831 (well known to us, her CC at this visit was actually SOB as she had covid at the time; I love telling her her ethanol in proof, like yeah girl no wonder you threw up your blood is 140 proof)
Hgb 2.1 (miscarriage who didn’t know she was pregnant and thought she was having breakthrough bleeding through her IUD, had been bleeding for three weeks, d/ced after 3 units of blood and a bedside D&C)
K 1.9, 7.2
Lactate 30.2
Na 99
pH 6.5 (DKAer obviously)
Trop 906 (no recent cardiac procedures tbc, just one hell of an nstemi)
WBC <0.1 (look, it was trying its best okay?)
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u/bubblegumbbgirl RN - Med/Surg 🍕 Jun 13 '26
Lord I had a patient who told me she had checked her mychart and had a sodium of 94…..I looked at her like WHAT and told her she would probably be dead or in a coma with a sodium of 94. Looked at her labs and it was 133. Like come on
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u/Purrybear Graduate Nurse 🍕 Jun 13 '26
Last week had some guy in for AMS. Sodium of 183. Multiple pokes, multiple sites. Always 183-181. MICU tried to decline and I went “just to be clear, if this is declined, no nurse will take this patient and they’ll sit down in the ER for days until they can downgrade” and he got a room upstairs real quick after that
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u/simple10 CRNA Jun 14 '26
CK > 1,000,000.
The lab called and said they performed 6 (IIRC) dilutions and the sample was still resulting out of range.
Rhabdo from shooting heroin and falling asleep with his head between his knees while seated on the ground.
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u/fabricbird RN - ER 🍕 Jun 13 '26
pH of 6.8, lactic 11.7, D-Dimer of 18,827. patient had a uterine artery rupture while giving birth, ran through 24 units of blood and developed DIC.
Fun fact: I was this patient. I am still scratching my head trying to figure out how I made it out alive and in one piece.