A patient that was admitted to me through the ER for exacerbation of heart failure, had an ammonia level ordered by the ER physician. I was done talking to my patient and was looking through his lab results and orders, and I found an ammonia level ordered.
I turned to the ER doc, "Hey John, what's the ammonia level for? Was he unconscious or something?"
"No, I'm not sure why I ordered that. I think I had a brain fart."
"Oh. Really?" Then we both started cracking up.
"It's good that it was normal."
"Yeah."
We both laughed. But sometimes you see unnecessary testing and there is no reason for it. Or worse yet, the reasoning is idiotic. Why do they order acetone levels for patients in DKA? Don't they know the patient is in DKA? Why do they order a BNP on heart failure patients? Isn't it obvious?
