Full Clinical Guidelines - Community First Health Plans.

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Orders for Adults with DKA and Hyperglycemic Hyperosmolar State (HHS) These orders may be initiated in the Emergency Department Potassium replacement Phosphorus replacement Sodium bicarbonate (DKA) Alert parameters for notifying physician Call physician if K is 6 mEq/L (Note: Urine output should be >30 mL/hour before starting K + replacement) Add KCl to IV fluids: ♦ If K is 5.2 mEq/L, hold KCl ♦ Consider KPO 4 instead of KCl if serum PO 4 is low Other: Consider if evidence of alcohol abuse, malnutrition, etc. Give 10 mEq/L KPO 4 in one liter of IV fluid x 1 Other:___________________________________________________________________ Give sodium bicarbonate If pH 1 hour with no other source of insulin ♦ TPN stopped, interrupted or any change in formulation ♦ Deterioration in mental status ♦ Patient does not respond to above orders for glycemic control Other_________________________________________________________________ Transition to SQ insulin Other orders Other _________________________________________________________________ Proceed to Texas Diabetes Council Transition Algorithm From I.V. to S.Q. Insulin Other: 1. ________________________________________________________________________________ 2. ________________________________________________________________________________ 3.________________________________________________________________________________ 4. ________________________________________________________________________________ References: 1. American Diabetes Association. Standards of medical care in diabetes-2008. Diabetes Care. 2008;31(Suppl 1): S12-S54. 2. Kitabchi AE, Umpierrez GE, Murphy MB, et al. Hyperglycemic crises in adult patients with diabetes. A consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(12):2739-2748. 3. American Diabetes Association. Hyperglycemic crises in patients with diabetes mellitus (Position Statement). Diabetes Care. 2004;27 (Suppl 1):S94-S102. 4. Clement S, Braithwaite S, Magee M, et al. Management of diabetes and hyperglycemia in hospitals (technical review). Diabetes Care. 2004;27:533-591. 5. Lee P, Greenfield JR, Campbell LV. “Mind the gap” when managing ketoacidosis in type 1 diabetes. Diabetes Care. 2008;31(7):e58. Physician Signature__________________________________________Date_________________Time___ Approved: July 31, 2008 3 of 3 82 H EALTH PLANS www.cfhp.com
D i a b e t e s t r e a t m e n t a l g o r i t h m s Transition Algorithm from I.v. to S.Q. Insulin for Patients with Diabetes or Hyperglycemia Approved 7/31/08 GOALS: NPO or PO FpG 100-130 mg/dl 2h pp
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Community First Health Plans Qualit
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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Footnotes — Recommended Adult Imm
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CFHP has adopted the National Asthm
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Patient Name ______________________
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Managing Asthma Long Term 41 FIGURE
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FIGURE 14. CLASSIFYING ASTHMA SEVER
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FIGURE 16. STEPWISE APPROACH FOR MA
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FIGURE 20. CLASSIFYING SEVERITY OF
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II. Some hyperactive-impulsive or i
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Page 41 and 42: possible), a careful, complete, and
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Page 45 and 46: GLYCEMIC CONTROL BIBLIOGRAPHY • R
Page 47 and 48: Publication # 45-11647 Targets* A1
Page 49 and 50: WORKSHEET Revised 10-20-05 Advancin
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Page 53 and 54: Publication # 45-11266 Age 126 mg/d
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Page 73 and 74: Revised 10-25-07 IV INSULIN INFUSIO
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Page 77 and 78: Revised 2-21-08 Publication #: E45-
Page 79 and 80: Abbreviations AGI Alpha-Glucosidase
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CHILDREN’S SERVICES HANDBOOK P h
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CHILDREN’S SERVICES HANDBOOK P R
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CHILDREN’S SERVICES HANDBOOK P h
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H EALTH PLANS www.cfhp.com 139
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FIGURE 2: Recommended immunization
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Comprehensive antepartum care is vi
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The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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