Sepsis — Red Zone — Recommended Serial Laboratory Testing for Septic Shock or Sepsis-Associated Organ Dysfunction — Clinical Pathway: Emergency Department, Inpatient and PICU

Sepsis Clinical Pathway — Emergency Department, Inpatient and PICU

Red Zone — Recommended Serial Laboratory Testing for Septic Shock or Sepsis-Associated Organ Dysfunction

Laboratory schedule should be reassessed at least daily with modifications to below schedule made based on patient’s clinical course. All initial recurring laboratory orders will “time out” at 48 hours.

Note: Refer to Initial Laboratory testing for information regarding infectious studies

Blood Suggested Ongoing Frequency Comment
CBC with Differential Q12 hr, prn When monitoring q12h, can alternate between CBC with diff and CBC without diff so that a differential is obtained at least daily
POC Glucose prn Serial testing indicated if hypoglycemia on initial evaluation, if NPO and not receiving dextrose-containing IV fluids, or if ongoing concern for severe critical illness
Super Blood Gas with Lactate Q2 hr, prn
  • Super gas provides ionized calcium and glucose in addition to regular blood gas data. Arterial specimen preferred if patient has both arterial and central venous access. May space out with improvements in acidosis and with evidence of lactate clearance. May need more frequent blood gases if there are severe derangements.
  • If patient has a central venous line in the SVC, also send a venous blood gas or co-oximetry from the central venous line to evaluate ScvO2, then follow serially if ScvO2 is not > 70%.
BMP Q12 hr, prn
Magnesium Q12 hr, prn
Phosphorus Q12 hr, prn
Hepatic function panel Q24 hr, prn
PT/INR/PTT/fibrinogen Q12 hr, prn If abnormal on initial evaluation
Type and screen Q72 hr, prn Consider serial samples q72h if the patient remains anemic, coagulopathic, or unstable after 72 hr
Amylase, lipase prn Consider trending depending on initial values and clinical course
CRP Daily as indicated Consider daily CRP if using in combination with procalcitonin for decision making regarding antibiotic discontinuation
Procalcitonin Daily, if using to determine antibiotic duration Consider daily procalcitonin if using in combination with CRP for decision making regarding antibiotic discontinuation Serial procalcitonin measurements can be helpful to inform decisions about antibiotic discontinuation. Given the kinetics of procalcitonin, measuring more than q24 hours is rarely indicated or useful unless there is a new clinical concern for an acute infection.
ADAMSTS-13 Once, As Indicated
  • Consider sending in patients with clinical and laboratory findings suggestive of thrombocytopenia associated multisystem organ failure (TAMOF). Ordered as von Willebrand Factor Protease Activity.
  • Consider immune dysregulation service consult.
Ferritin Once, As Indicated, then prn
  • Consider sending in patients with clinical or laboratory findings suggestive of hemophagocytic lymphohistiocytosis (HLH) (thrombocytopenia, hepatosplenomegaly, coagulopathy, and/or hepatic dysfunction.)
  • Consider immune dysregulation service consult if elevated.
Cystatin C Once, As indicated Cystatin C can be used for estimation of glomerular filtration rate (eGFR). Cystatin C is a protein produced by all nucleated cells (compared to serum creatinine which is made in muscle cells) and freely filtered by the glomerulus. Cystatin C production varies less than creatinine production between individuals, thus, it may be more accurate than serum creatinine in some situations for estimating renal function, determining drug dosing based on eGFR, and detecting the presence of acute kidney injury. Measuring Cystatin C may be appropriate in children with sepsis as they are at high risk for acute kidney injury, and may be particularly useful in individuals who have decreased or increased muscle mass, for example patients with chronic illness, malnutrition, neuromuscular disorders, or athletes with high muscle mass.