Klinisk Biokemi i Norden · 4 2013
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might be varying, however, the simple administra-
tion of glucose iv would help to successfully treat
and thus diagnose hypoglycemia. On the other hand,
hyperglycemia will present a picture of diabetic ketoa-
cidosis in many cases, which could be confounded
with alcoholic ketoacidosis, acute renal failure or
sepsis. Whilst the admission of glucose might be
relatively safe in most circumstances without blood
analysis (if combined with substitution of thiamine
in case of suspected alcoholism or malnutrition),
most clinicians would not treat a patient with insulin
on empirical grounds, as this might result in direct
massive harm to the patient. Even if considering that
fluid-resuscitation with 2-3 L cristalloids would result
in clinical improvement of both the patient with DKA
and sepsis, the patient with acute renal failure would
most probably suffer severe respiratory distress and
pulmonary oedema on such a treatment without prior
analysis of blood samples.
So which tests to choose?
From the clinical point of view, which is the most
important investigation a laboratory could offer to
the emergency department? This question can be
answered simply by “The one I need to adopt my
therapy to the patient’s benefit.”
In a broader view, no single analysis can be defined
to be the most important one. However, as shown
above, with the limited set of glucose, arterial blood
gas analysis, lactate, hemoglobin, thrombocyte count,
sodium, potassium, ionized calcium and creatinine,
INR, aPTT, liver enzymes including amylase or lipase,
a limited toxicology screening (alcohols, lithium, and
the most common local intoxications), and a white
blood count and blood sedimentation rate the expe-
rienced physician will be able to manage the emer-
gency presentation of the vast majority of common
emergent and life-threatening disease. (might require
more extensive testing to be available at all times.)
However, complementary samples as urinary dip-
stick, malaria testing, HIV- or hepatitis rapid tests can
be necessary to improve overall care of the patient and
to allow the adoption of standardized guidelines at
the ED as for examples the guidelines of the societies
of infectious disease.
Hematology
Electrolytes
Liver and proteins Coagulation Infection
Further
Hb
Hc
MCH
MCHC
EVF
Leukocytes
5-Differential
Thrombocytes
Erythrocytes
Reticulocytes
BSR
Blood-group
Coombs/auto-
antibodies
Na
K
ionCa
(Mg)
Creatinine
BUN
Chloride
Lithium
ABG
Venous blood
gases (VBG)
lactate
Glucose
Osmolality
ASAT
ALAT
ALP
y-GT
LDH
Bilirubin
Conj. bilirubin
Amylase/lipase
Albumin
INR
aPTT
D-Dimer
(Fibrinogen)
Thrombocytes
Hb
Urinary dipstick
CRP
PCT
(IL 6)
Malaria
HIV
(Strep A)
(Mono-nucleosis)
HCG
Troponins
Myoglobin
TSH, T3, T4
TOX:
Paracetamol
Alcohols
Local panel
Valproic acid
Carbamazepine
LIQUOR:
Erythrocytes
Total Leukocytes
Differential
Xanthochromia
Glucose
Lactate
JOINTS:
Leukocytes
Crystals
Lactate
Table 5.
The generic emergency laboratory
