| MEDICATION | DOSAGES & INTERVALS OF ADMINISTRATION | ROUTE & FINAL DILUTION | DILUTION INSTRUCTIONS | STABILITY | RATE OF INFUSION & COMMENTS |
|---|---|---|---|---|---|
| INSULIN Regular (Neo) (Humulin-R) Mechanism of action: Enhances uptake of glucose into cells and enhances intracellular potassium uptake by direct stimulation of membrane bound Na-K ATPase. 100 units/mL Ref: 21 Last update: 2023-08-02 |
Hyperglycemia: Initial Dose: 0.05 Units/kg/hour Titrate infusion by 0.01 to 0.02 units/kg/hour to maintain target blood glucose concentrations (typically 7 - 10 mmol/L) Usual dosing range: 0.05 to 0.2 units/kg/h Hyperkalemia: Initial bolus: 0.05 units/kg/dose IV x 1 over 30 minutes. Give with 2 mL/kg (200 mg/kg) of D10W IV x 1 over 30 minutes Subsequent continuous infusion: 0.1 units/kg/h plus D10W 2 - 4 mL/kg/h (200 - 400 mg/kg/h) Titrate insulin and dextrose infusions based on target serum glucose and potassium concentrations |
IV Standard Concentrations: 3 mL and 25 mL syringes 0.5 units/mL in D5W 25 mL syringes |
Note: DO NOT SHAKE. Roll to mix 0.1 units/mL 3 mL syringe: 1. Prepare 1 unit/mL solution: Mix 0.1 mL of insulin REGULAR 100 unit/mL with 9.9 mL of D5W (use 2 syringes: 9 mL in a 10 mL syringe and 0.9 mL in a 1 mL syringe) into an empty sterile vial. Discard remainder after step 2. 2. Mix 0.3 mL of 1 unit/mL insulin solution with 2.7 mL of D5W in a 3 mL syringe 0.1 units/ mL 25 mL syringe: 1. Prepare 1 unit/mL solution: Mix 0.1 mL of insulin REGULAR 100 unit/mL with 9.9 mL of D5W (use 2 syringes: 9 mL in a 10 mL syringe and 0.9 mL in a 1 mL syringe) into an empty sterile vial. Discard remainder after step 2. 2. Mix 2.5 mL of 1 unit/mL insulin solution with 22.5 mL of D5W in a 30 mL syringe 0.5 units/mL 25 mL syringe: Mix 0.13 mL of insulin REGULAR 100 units/mL with 24.87 mL of D5W in a 30 mL syringe |
24 hours room Temperature Change solution and tubing Q24H. |
Administration: **Continuous Critical Infusion** 1. Do not interrupt. 2. Never bolus solutions/medications into same lumen. 3. Use low sorbing pressure sensing disc tubing. Infuse using syringe pump pressure sensing "low-sorbing" microbore tubing to reduce adsorption of insulin to tubing. If low-sorbing pressure sensing tubing is not available, use regular pressure sensing tubing and prime with double the volume of the tubing dead space. For hyperkalemia:Start insulin WITH concomitant dextrose infusion to maintain euglycemia. Usual ratio is 1 unit of insulin: 2 - 4 g of dextrose Run separate D10W and insulin infusions to simplify the adjustment of the infusion rate of either D10W or insulin in response to hyperglycemia or hypoglycaemia Monitor blood glucose and potassium levels 30 to 60 minutes after start of infusion and after a change in insulin dose. COMMENTS: **Continuous Critical Infusion** 1. Do not interrupt. 2. Never bolus solutions/medications into same lumen. 3. Use low sorbing pressure sensing disc tubing. Infuse using syringe pump pressure sensing "low-sorbing" microbore tubing to reduce adsorption of insulin to tubing. If low-sorbing pressure sensing tubing is not available, use regular pressure sensing tubing and prime with double the volume of the tubing dead space. Change solution and tubing Q24H Do not include in Total Fluids. Start insulin WITH concomitant dextrose infusion to maintain euglycemia. Usual ratio is 1 unit of insulin: 2 - 4 g of dextrose Run separate D10W and insulin infusions to simplify the adjustment of the infusion rate of either D10W or insulin in response to hyperglycemia or hypoglycaemia Monitor blood glucose and potassium levels 30 to 60 minutes after start of infusion and after a change in insulin dose. Standard Prescription: Hyperglycemia: Regular insulin __units/kg/hour IV infusion, titrate to maintain blood glucose between __ mmol/L. Monitor blood glucose concentration Q__H and inform MD if blood glucose__. Hyperkalaemia: Regular insulin __units/kg/hour IV infusion PLUS Dextrose 10% __mg/kg/hour IV infusion. Monitor blood glucose and potassium concentrations Q__H and inform MD if blood glucose__. |