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A 14 year old boy presents to GP with 2 weeks history of lethargy - request form states 'jaundice and lethargy'. Sample for U&E's, FBC and liver profile received in lab 16:30 on a Friday in April, results electronically transmitted back to GP surgery at 19:00. Na 122 (<121) K 6.2 (>6.5) Urea 18.8 (>30) Creat 106 Bili 19 This wasn't flagged for 'phoning based on cut-offs from RCPath guidance Nov 2010 on 'Out-of-hours reporting of results requiring urgent clinical attention to primary care' (in brackets above), and the results auto-authorised. The parents of the boy contacted the OOH service 3 times over the weekend. Results above were available and reviewed, but put down to 'artefactual change' and not repeated, despite the child becoming progressively more unwell. The child then re-presented to ED on the Monday: Na 114 K 7.0 Urea 24.7 Creat 150 No prizes for guessing his cortisol at that point was 169 nmol/L with an ACTH of 2817 ng/L (0-46). He was rapidly treated for newly presenting Addison's disease and made a good recovery. My point is that we only then became aware of the new guidance from RCPath Oct 2017, updating 'phoning limits for children <16 years old in terms of Na, K, urea, creat and Glucose. We instigated the new guidance within 24 hours of becoming aware of this case; the new cut-off for 'phoning Na at 130 mmol/L (and urea > 10 mmol/L) would have almost certainly lead to a more rapid diagnosis, and so treatment. Am I missing some way of being advised of new relevant guidance from the RCPath - we have actually been awaiting this guidance for some time? I hope this case can serve to bring the new guidance to anyone else's attention who has yet to read them. Dr Niki Meston Consultant Chemical Pathologist Salisbury NHS Foundation Trust ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/