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.