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” Notify MD if VS, HR: Notify MD if VS, BP: Notify MD if Glucose: Call MD for blood glucose < 100 or > 300 or if more than 100 mg/dl decrease inblood glucose over one hour while on insulin drip. Notify MD if Miscellaneous: Notify MD if patient is ready to transition from IV to SC insulin. Criteriainclude Bicarb > 15mmol/L, pH >7.3, anion gap > 12 mmol/L, patient wants to eat,Labs – Today Priority Source or Otherþ BMPQ4H X 48hrþ PhosphorusQ4H X 48hrþ Bedside Blood Gas Q12h X 48hr Venousþ Bedside Glucose (NUR) Q1Hþ If Then, Medication: If insulin drip is stopped then contact attending on day shift to consider stoppingthe q4h BMP, q4h Phosphorous, q12h blood gas and hourly blood glucose.Education Education: DKA per protocol. Print “Guidelines for Management of Diabetic Ketoacidosis” and give topatient. RN Communication, DC Plan: Plan on patient being discharged one day after teaching started bydiabetic nurse educator. The diabetic nurse educator will start education once the patient has beentransitioned to subcutaneous insulin (so if transition is at lunch, education should start that afternoon). RN Communication Miscellaneous: Assist patient and their family in keeping a “Diabetes Diary” atpatient’s bedside. Use only after patient is on subcutaneous insulin. RN Communication, Medication: Parent to draw up and administer all subcutaneous insulin injectionswith nursing supervision Dietary referral. Reason: DKA Social services referral. Reason: DKA. RN Communication, Miscellaneous: Please call Diabetic nurse educator to ensure they are aware ofthis patient’s educational needs. Plan to have parents available continuously once diabetic teachinghas been started by the diabetic nurse educator.Physician’s Signature/ID number : ______________________________________ Date: ____/____/____ Time: _________DKA page 3 of 3 Patient Label0032*0032*pathway 3/2012Physician’s Order Sheet