Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


D-Dimer, PE, and Lactate

Daren Beam, M.D.

  • A D-dimer of <500 is considered negative when evaluating for Pulmonary Embolism in the non pregnant adult. During pregnancy the level is adjusted by trimester as follows: 1st:<750, 2nd:<1000, 3rd:<1250. Below these levels testing is considered complete and no further workup is indicated.
    • Point-of-care d-dimer used at CMC uses reduced cutoff values for each number.  Adjust down by 100 per trimester( 650/900/1150) if using POC values - the level is still 500 for non-pregnant patients though!
  • If a patient has PE and is normotensive, check a BNP and Troponin to look for evidence of right heart strain. Patients with elevated levels (BNP>90, Pro-BNP>900, or any positive troponin) have ~7 fold increase in mortality.
  • Elevated lactate:
    • May cause a false elevation of EtOH levels.
    • Is expected in liver failure - but may also be elevated for other reasons.
    • DOES NOT define sepsis.  However, lactate clearance is one of your best guides for adequate resuscitation, so use it often.
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  1. I thought the D-dimer cutoffs in pregnancy were 750, 1000, 1250?

  2. What does lactate elevates your EtOH assay mean?

    Hyperlactatemia is well recognized in acute liver failure. Chronic liver disease patients also often exhibit abnormal lactate clearance but elevated lactate in this population is still a helpful marker of illness severity and should not be ascribed to ESLD in the absence of another significant issue.

  3. Edited for clarification. Thanks, Dr. Koehler and Heffner!

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