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”DKA page 1 of 2 Patient Label0032*0032*pathway 3/2012Physician’s Order SheetDiabetic Ketoacidosis (DKA) PathwayPhase III: Subcutaneous InsulinThis orderset is intended for the patient on DKA pathway who is ready to transition from insulin drip to subcutaneousinsulin. All Phase II orders should be stopped when Phase III order set is initiated.Diet RN Communication, Feedings: Make sure patient wants to eat. Start sugar-free oral fluids and orderage appropriate meal according to the carb-counting meal plan recommended by the R.D. (if RD hadnot seen patient, use the following guide: < 2 years = 2 carbs, 3-5 years = 3 carbs, 5-12 years = 4carbs, >12 years = 5 carbs. 1 carb = 15 grams of carbohydrates, so 2 carbs = 30 grams, 3 carbs = 45grams, 4 carbs = 60 grams, and 5 carbs = 75 grams. Snacks are not recommended)IVFEither continue current IVF or create new orders below if IVF’s are still necessary. Saline lock IV if tolerating PO’s. D10-NS with 40 mEq KCl per liter NS with 40 mEq KCL per literMedications Glargine insulin (Lantus®) 0.4 units/Kg. Rx to dispense Lantus® SoloStar® pen for initial dose ~ 10units or a multiple dose vial for dose < 10 units. Glargine (Lantus®) insulin cannot be mixed in thesame syringe with any other insulin. It is a long-acting insulin given once or twice daily. Aspart insulin (Novolog®) subcutaneously before meals. Dose will be determined by nurse using theInsulin Dose Calculation assessment. Round dose down to nearest 0.5 Insulin Aspart (Novolog) is arapid-acting insulin given before meals. Do not give insulin unless food tray is at the bedside RN Communication, Medication: After meal tray is at bedside, check patient's blood glucose and DCBOTH IV insulin infusion and IV fluids. Let the patient eat the meal, then give the aspart insulin(Novolog®) dose subcutaneously based on the Insulin Dose Calculation assessment.Lab Bedside Glucose check: Check finger stick blood sugars using patient’s own blood glucose meterbefore breakfast, lunch, dinner, 2100 and 0300.Nursing RN Communication, Miscellaneous: Before transitioning from IV to SC insulin, check to make sureHCO3 > 15 mmol/L or pH > 7.3; anion gap < 12 mmol/L. Notify MD if, Feeding: Page physician on-call if patient does not eat all carbohydrates on meal tray orif vomits Notify MD if, Miscellaneous: Make sure endocrinologist has been by to consult on the patient. If theyhave not yet been by please contact Endocrinology clinic to determine when that will occur. RN Communication, Miscellaneous:o The 0300 blood sugar is to detect hypoglycemia. No action is needed if blood sugar is greaterthan 80 mg/dl.