‘Going to Extremes’ Hall of Fame

LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog

In 2012, Greg Kelly suggested that LITFL collate the most extreme ‘medical extremes’.

This is how things currently stand:

Parameter Level Diagnosis Submitted by
Ammonia 514 umol/L Torsten Behrens
Bilirubin 728 umol/L ?
CD4 count (lowest) 2 cells/uL AIDS Anne
Creatinine 1920 umol/L Diarrhoea and vomiting, chronic alcohol abuse, Acute kidney injury David Mackintosh
Creatinine Kinase (CK) 130,000 U/L Rhabdomyolysis Robbie Ley Greaves
CRP 970.8 mg/L Matthieu Komorowski
Ethanol level (in conscious patient) 0.76 g/dL Alcohol intoxication Neil Hughes
Fastest door to operation time 25 minutes from triage to appendix out Appendicitis Casey Parker
Fluid gain between hemodialysis sessions 21 L Renal failure KT
Frusemide dose 1 g q8h IV for 3 days, with 11-12 L fluid loss Atheer
Haemoglobin 263 g/L Clarkson disease Pieter Roel Tuinman
Haemoglobin in chronic anemia 13 g/L Menorrhagia Hammer Doc
Highest glucose 121 mmol/L HHS/ HONK Guru
Hypertension >300 mmHg (non-invasive) Post-op hypertension Tony Lourensen
Ketamine infusion 500mg/h for 3 hrs sedated unintubated psychotic patient Minh Le Cong
Lactate, hyperlactemia unrecordable, repeated with patient improvement as 30 mmol/L Shaun
longest time from cardiac arrest to ROSC 6 h 52 min Environmental hypothermia treated with cardiac bypass Mads Gilbert
pH (lowest in any diagnosis, and survived) 6.27 DKA, cardiac arrest Jonathan Ilicki, Zaiti Kamarzaman
pH (lowest in DKA, and survived) 6.27 DKA, cardiac arrest Jonathan Ilicki, Zaiti Kamarzaman
Potassium 1.9 mmol/L Hypokalaemia and VT Bojan Hartmann
Sedation with no effect (1) 80mg IV midazolam, 80 mg IV haloperidol
(2) 120 mg diazepam, 100 mg haloperidol
(1) Agitated patient
(2) IVDU
(1) Duncan
(2) Toby
Sodium, hypernatremia 212 mmol/L Gastroenteritis James Fordyce
Sodium, hyponatremia 98 mmol/L Beer drinker’s potomania Matthieu G
Temperature, lowest (in survivor) 13.7 C Hypothermia Mads Gilbert
Triglycerides 3,586mg/dl Pancreatitis and hyperlipidaemia Chandra Roy
Troponin I 443.50 ng/mL STEMI Vince Di Guilio
Urea 135 mmol/L Diarrhoea and vomiting, chronic alcohol abuse, Acute kidney injury David Mackintosh
Door-to-needle time for coronary catherisation 6 minutes STEMI Tracy Morton
Diuresis over 24 hours 24 L (peak rate 1525 mL/h) Caffeine overdose (500 mg) Ian Humble

If you think you have something worthy of addition to this league table, send evidence of the pathophysiological phenomenon to chris @ lifeinthefastlane.com (nothing patient identifiable!), and we will amend the list.

‘Going to Extremes’ Hall of Fame Chris Nickson

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Author: Chris Nickson

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