Chemistry
	Less Than	Greater Than
Amikacin		35 mcg/mL
Bilirubin, Total		10.0 mg/dL for first 24 hrs 13.0 mg/dL for 1-30 days
Calcium	6.0 mg/dL	13.0 mg/dL
Carbon Dioxide	10 mEq/L	50 mEq/l
Cortisol (*see below)	2.0 mcg/dL
Ethanol		300 mg/dL
Ethylene Glycol		10 mg/dL
Glucose       Adults                   Pediatrics	50 mg/dL 40 mg/dL	450 mg/dL 300 mg/dL
Isopropanol		10 mg/dL
Lidocaine		5 mg/mL
Lithium		1.4 mEq/l
Magnesium	1.0 mg/dL	4.7 mg/dL
Methanol		10 mg/dL
Phosphorus, Inorganic (*see below)	1.0 mg/dL
Potassium    Adults > 16 years                   Peds (0-15 years)	2.8 mEq/l 3.0 mEq/l	6.2 mEq/l 6.5 mEq/l
Propylene Glycol		100 mg/dL
Sodium	120 mEq/l	160 mEq/l
Valproic Acid		150 mcg/mL

*Cortisol serum/plasma concentrations less than 2.0 mcg/dL and phosphorus (inorganic) less than 1.0 mg/dL are treated
  as significant (not critical) values.

Results Called on these Critical Drug Levels:
Test Name	Greater Than
Acetaminophen	40 mcg/mL
Amikacin	35 mcg/mL
Carbamazepine	12 mcg/mL
Digoxin	2.1 ng/mL for adults
Ethanol/Volatiles Screen (EVS)	300 mg/dL
Gentamicin	15 mcg/mL
Lidocaine	5 mcg/mL
Lithium	1.4 mEq/l
Phenobarbital	60 ug/mL
Phenytoin	40 mcg/mL
Procainamide	16 mcg/mL
Salicylate	40 mg/dL
Theophylline	20.0 mcg/mL
Tobramycin	10 mcg/mL
Vancomycin	50 mcg/mL

Requests for assistance with interpretation should be directed to UIDL Client Services at 319-356-8588 (toll-free at 1-866-844-2522).

Hematology
	Less Than or Equal to	Greater Than or Equal to
Fibrinogen	80 mg/dL
Hematocrit	18%	55% (adult)
Hemoglobin	6 gm/dL	22 gm/dL (adult)
HIT (Heparin dependent antibody)	Results: Positive
INR (venous)		4.0
Platelet Count	10 k/mm3	1,000 k/mm3
PTT (Outpatient only)		50 seconds
White Blood Count (WBCT)	1.0 k/mm3	50.0 k/mm3

Microbiology
Critical or Significant values: patient results are called to the physician or service area as soon as results are available.

1. Critical value patient results include:

1. Positive direct examination from sterile body fluid/site
1. Cerebrospinal fluid
2. Joint fluid
3. Pericardial fluid
4. Pleural fluid
5. Peritoneal fluid
2. Positive blood culture (initial gram stain report)
3. Positive Legionella pneumophila antigen (also page on-call epidemiologist)
4. Positive Cryptococcus neoformans antigen

2. Significant patient results include:
    a. Positive STAT gram stain results
    b. Negative STAT gram stain results from the Operating Room.
    c. Positive direct examination from intraoperative specimens
    d. Positive culture of sterile body fluid (Do not call identical result within 5 days)
        1) Cerebrospinal fluid
        2) Joint fluid
        3) Pleural fluid
        4) Pericardial fluid
        5) Peritoneal fluid
        6) Intraoperative body fluids
    e. Positive malaria smears
    f. Positive direct antigen tests
        1) Pneumocystis carinii
        2) Streptococcus agalactiae
        3) Clostridium difficile
        4) Cryptosporidium spp.
        5) Giardia lamblia
        6) Herpes Simplex (HSV)
        7) Varicella-Zoster (VZV)
        8) Rotavirus
        9) Respiratory viruses - Adenovirus, Influenza A and B, Parainfluenza 1,2,3 and Respiratory syncytial virus (RSV)
    g. Significant serology results
        1) Positive Lyme Serology confirmed by Western Blot
        2) Positive Toxo IgM confirmed by reference laboratory
    h. Epidemiology considerations (call to floor)
        1) Methicillin-resistant Staphylococcus aureus
        2) Vancomycin-resistant enterococci
        3) Extended spectrum β-lactamases
    i. Epidemiology considerations (call floor and on-call epidemiologist pager)
        1) Acid-fast bacilli smear
        2) M. tuberculosis (culture or UHL PCR)
        3) Legionella pneumophila (urine antigen or growth from environmental culture)
        4) Neisseria meningitidis (CSF gram stains with gram negative diplococci or growth from normally sterile site)
        5) Category A bioterrorism agents (Bacillus anthracis, Yersinia pestis, Francisella tularensis,
            Clostridium botulinum toxin, Smallpox, Viral hemorrhagic fever)
    j. Culture or molecular detection of following organisms from any source:
       (If patient is from OB/GYN do not call results unless the organism is isolated from blood or normally sterile body fluids.)
        1) Streptococcus pyogenes
        2) Pathogenic Neisseria
        3) Virus culture
        4) Chlamydia, Herpes Simplex (HSV), or Enterovirus PCR
        5) Dimorphic fungi
    k. Positive ocular cultures (other than conjunctiva)
    l. Culture of stool pathogens
        1) Salmonella spp.
        2) Shigella spp.
        3) Campylobacter spp.
        4) Yersinia spp.
        5) Escherichia coli H7;O157
    m. Culture of potential bioterrorism agents
        1) Francisella tularensis
        2) Bacillus anthracis
        3) Brucella spp.
        4) Yersinia pestis
        5) Coccidiodes immitis

3. Calling Algorithm:
Follow Department of Pathology guidelines (500.020) entitled "Reporting Critical Tests and Critical Values." This policy defines authorized staff that may accept critical values and provides a detailed calling algorithm. The results must be "read back" by the authorized staff and the call documented in body of CERNER report using the CALL template.

For OB/GYN patients only smear or culture results from blood cultures and normally sterile body fluid specimens are phoned on a STAT basis.

Significant results called to physicians or service areas must be documented in a CALL report.