Diabetic Ketoacidosis Pathway - Children's Hospital Central California

1.0 .1 cc U IU µg MS TIW QD QID QOD MSO 4 MGSO 4DRUG SENSITIVITY: WT: kgORDERS: GENERIC EQUIVELANT WILL BE DISPENSED UNLESS ORDER SPECIFIES “DO NOT SUBSTITUTE”Diabetic Ketoacidosis (DKA) PathwayPhase II: Inpatient & Insulin DripGeneralAdmitting physician: ___________________________Attending physician: ___________________________Primary service: ¨ ______________Patient Status: x Admit ¨ ObservationAdmission Diagnosis:Condition:Code status:Isolation:DKAStable¨ Full Code or ¨ __________________________Isolation for diagnosis of __________based on isolation guideline(document number 2.3562).”This orderset is intended for the patient on DKA pathway who is ready to be admitted from the ED ortransferred from the PICU.IVF and Insulin orders from the ED need to be discontinued and new orders entered.Diet NPO except medications: NPO except for ice chips and medications while on insulin dripIVF If Then, Result: Fluid rate determined based on glucose level using 4:2:1 calculation. Goal is to maintainBLOOD GLUCOSE 200-300 mg/dl during the first 24 hours of DKA treatment.o The following fluid rates assume that the patient is no more than 10% dehydrated and hasreceived adequate fluid resuscitation prior to being placed on pathway.a. Blood glucose > 300 mg/dl: NS with 40 mEq KCl/liter at 1.5 times maintenance.b. Blood glucose 201 - 300 mg/dl: NS with 40 mEq KCl/liter at 0.75 times maintenanceplus D10 NS with 40 mEq KCl/liter at 0.75 times maintenancec. Blood glucose < 200mg/dl: D10 NS with 40 mEq KCl/liter at 1.5 times maintenance RN Communication, IVF:1. Make sure that patient has voided and that K+ is < 5.5 before hanging any potassium-containingfluid.2. If patient has not voided or if K+ > 5.5 page MD on-call for alternate fluid orders.3. Fluids and insulin should be “Y’d” together and should run through a single IVIf new IVF’s are ordered, the rate should be based upon the most recent glucose result as noted above inthe “If Then, Glu” order. D10-NS with 40 mEq KCl per liter NS with 40 mEq KCL per literDKA0032*0032*pathway 3/2012Physician’s Order Sheetpage 1 of 3Patient Label