Severe Pediatric Traumatic Brain Injury (TBI), PICU — Lab Monitoring Parameters — Clinical Pathway: Emergency, ICU and Inpatient

Traumatic Brain Injury (TBI) Clinical Pathway — Emergency Department and ICU

Lab Monitoring Parameters

Reduce lab frequency per patient’s clinical condition.

Lab Goal Lab Frequency Comments
Super ABG with Lactate   q4 x 24 hours If the values on the ABG do not correlate with the serum Na values, send serum Na q4 hours

Recommend obtaining Na level on admission and within 48-72 hours post admission or a minimum of 12-24 hours prior to PICU discharge
Serum Na ICP < 20: 135 to < 145 mEq
ICP ≥ 20: 145-160 mEq 		q8 hours
Blood Glucose 100-180 g/dL q8 hours x 24 hours
*for the duration of time on continuous 3% saline infusion		 Serum osmolarity should be monitored if sodium level rises > 160 mg/dL with repeat 3% NaCl boluses
BMP, Mag, Phos*  
Serum Osmolarity* < 320 mOsm/L
Type & Screen   Active throughout admission  
CBC with diff Hgb ≥ 8 g/dL q8 hours x 24 hours CBC with diff x1
If within normal limits, CBC without diff
PT/INR, PTT, Fibrinogen Normal for age