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Panel

Therapeutic Drug Levels

Digoxin, lithium, phenytoin, vancomycin, and other drugs with narrow therapeutic windows. 9 tests, 9 with a critical value.

TestConventionalSICritical
Acetaminophen Level10–30 (therapeutic) µg/mL66–199 µmol/L> 150 µg/mL at 4 h post-ingestion risks hepatotoxicity
Carbamazepine Level4–12 µg/mL17–51 µmol/L> 12–15 µg/mL (ataxia, diplopia, drowsiness)
Digoxin Level0.8–2 ng/mL1–2.6 nmol/L> 2.0 ng/mL is toxic (many target 0.5–0.9 in heart failure)
Lithium Level0.6–1.2 mEq/L0.6–1.2 mmol/L> 1.5 mEq/L is toxic; > 2.0 is a medical emergency
Phenytoin Level10–20 µg/mL40–79 µmol/L> 20 µg/mL (nystagmus, ataxia); > 30 confusion
Salicylate Level15–30 (anti-inflammatory) mg/dL1.1–2.2 mmol/L> 40–50 mg/dL (tinnitus, tachypnea, acid–base disturbance)
Theophylline Level10–20 µg/mL56–111 µmol/L> 20 µg/mL (nausea, tachycardia, seizures)
Valproic Acid Level50–100 µg/mL347–693 µmol/L> 100–150 µg/mL (sedation, tremor)
Vancomycin Trough10–20 µg/mL7–14 µmol/L> 20 µg/mL raises nephrotoxicity risk

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