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”Basal Subcutaneous Insulin Insulin Glargine (Lantus) 0.4 units/kg subcutaneously every 24 hours. Orders received between 1700-0300 to start at ordered time. Orders received between 0301-1659 will start at 1700. (Pharmacy toedit start time)Monitoring & Vitals VS Q2H. Neuro checks Q4H If Then, VS HR: Change VS and Neuro checks to Q4h if stable for 12 hours. Monitoring: Place on bedside CR monitor while on insulin drip.MedicationsInsulin and Medications (Insulin Drip)Insulin rate should be 0.1 unit/kg/hr or whatever is currently being infused in the ED. Regular insulino Prepopulate 0.1 unit/kg/hro 1 unit/ml NS Send 2 (50 ml) syringes initially and upon RN request.o Flush new IV tubing with 50 ml of insulin drip solution prior to connecting to patient and startinginsulin infusion. Mannitol 20% 500mL bag: 0.25 g/kg IV line with in-line filter (< 5 micron) PRN symptoms of cerebraledema. Give by slow IV push - see Management of Suspected Cerebral Edema; call physician beforemannitol is given. Always keep mannitol 25% vial in or at nursing stationNursing Care Activity: No restrictions. If Then, Glu 81-100: Decrease rate of insulin drip to 0.05 unit/kg/hr and increase IV fluid rate to 2times maintenance. Page physician on-call. Recheck blood glucose in 30 minutes. If Then, Glu < 81: Decrease insulin drip to 0.05 unit/kg/hr and give a bolus of D10W 2 ml/kg IV.Increase IV fluid rate to 2 times maintenance. Page physician on-call. Re-check blood sugar in 15 minutes.If blood glucose still < 80 mg/dl give another bolus of D10W 2 ml/kg IV and recheck blood glucosein 15 minutes. Notify MD if, AMS: Page physician on-call and notify PICU attending STAT for any of the following:a. Headacheb. Deterioration in consciousness level/responsec. Unequal dilated pupilsd. Deliriume. Incontinencef. Vomitingg. Bradycardiah. Hypertension Notify MD if, UO: Notify MD for urine output > 4 ml/kg/hr or < 1 ml/kg/hr (MD may order fluid replacementof NS or NS for abnormal urinary losses). Notify MD if Lab Result: Notify MD on call immediately with results of BMP tests.DKA page 2 of 3 Patient Label0032*0032*pathway 3/2012Physician’s Order Sheet