REMINDER: For patients with uncomplicated DKA, regular insulin should be given as an initial dose of 0.4 to 0.6 units/kilogram (half as IV bolus and half given intramuscularly or subcutaneously), followed by 0.1

2006年3月8日 · If patient is receiving insulin for the first time, see guidelines accompanying the Insulin Order Form for dose recommendations. Stop Intravenous insulin 60 minutes after injection of subcutaneous short or rapid-acting insulin.

Begin SubQ insulin, but do not stop insulin drip yet, as follows. In Insulin naïve patient, give Lantus 0.35 unit/kg SubQ Daily, first dose NOW. Begin Moderate dose Sliding Scale Insulin Order Set–Adult. 14.

Serum electrolytes should be ordered every 2 to 4 hours during initial resuscitation in order to adjust treatment appropriately. If glucose level too high for Point of Care testing (POCT), serum glucose levels should be ordered every 1 to 2 hours until readable on bedside glucose monitors to adjust treatment appropriately.

Titrate insulin to a minimum 0.1 Units/kg/hr and glucose goal between 150 – 200 mg/dL until ketosis and anion gap resolves. Start D10W or D10NS @ 150 - 250 mL/h and/or consider reducing insulin rate by 1⁄2. D50 IVP. 70 – 150 mg/dL (minimum 0.5 Units/hr) re-instatement .

Orders for Adults with DKA and Hyperglycemic Hyperosmolar State (HHS) These orders may be initiated in the Emergency Department dKA: Moderate ketonemia, arterial pH <7.3, serum glucose >250 mg/d l, serum bicarbonate <18 meq/l HHs: serum glucose >600 mg/dl, minimal ketonemia or ketonuria, serum bicarbonate >15 m eq/l, pH ≥7.3

Emergency Department (ED) ADULT Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS) Initial Management Order Set M K O Orders Processed IV Fluids and Electrolytes Continued… Date (dd/mm/yyyy) sodium chloride 0.9% at 500 mL/h for 4 hours, sodium chloride 0.9% at Time (hhmm) By Once there is urine output, if serum potassium

DKA Treatment Phase ONE: Place lab order for BMP, Magnesium and Phosphorous 2 hours after insulin drip started and call MD with results. Nursing Communication

at _____ mL/hour IV (rate determined from DKA protocol, line 7, where 1 mL/kg/hour = 0.1 units/kg/hour). Saturate insulin binding sites by priming and flushing with 50 mL of prepared

Diabetic Ketoacidosis (DKA) Order Set Patient Information stamp will appear here Sodium Bicarbonate If pH less than 7 one hour after start of hydration, give Sodium Bicarbonate 50 mmol (1 vial) in 250 mL D5W IV over 1 hour and repeat q2 hours until pH 7 or greater