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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-101160-en.cckm

201705146

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UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Emergency Medicine

ED - Diabetic Ketoacidosis - Pediatric [3464]

ED - Diabetic Ketoacidosis - Pediatric [3464] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Diabetic Ketoacidosis - Pediatric [3464]
Pediatric ED DKA Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/guidelines/diabetes-and-
endocrinology/resources/name-99554-en.file
Initial Orders - First Hour
Suspected DKA Initial Orders [205181]
Suspected DKA Initial Orders [205182]
Vital Signs [NURMON0013] EVERY 1 HOUR, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Measure Weight [NURMON0015] ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Measure Intake And Output [NURMON0005] EVERY 1 HOUR, Routine
Diet - NPO [NURDIE0012] CONTINUOUS, Routine
Diet: NPO
Assess Neurologic Status [NURMON0006] EVERY 1 HOUR, Routine
Cardio-Respiratory Monitor - Pediatric - With
Rhythm [NURMON0014]
CONTINUOUS, Routine, Most pediatric patients do
NOT require rhythm analysis. Please complete the
Notify Provider order below, including specification
for apnea > *** seconds. If indicated, order pulse
oximetry separately.
Notify Provider:
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
Notify based on:
For apnea > 20 seconds
Turn Patient's Insulin Pump Off [NURCOM0022] ONCE
GLUCOSE, POC [HCMGLUC] ONCE For 1 Occurrences, Routine
If Conditional, What Condition?
POTASSIUM, WHOLE BLOOD [HCWBK] STAT - RN COLLECT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
SODIUM, WHOLE BLOOD [HCWBNA] STAT - RN COLLECT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
BASIC METABOLIC PANEL [BMET] STAT - RN COLLECT For 1 Occurrences, Routine,
Test includes Sodium; Potassium; Chloride; Carbon
Dioxide, Total; Anion Gap; Glucose; BUN;
Creatinine; and Calcium.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
MAGNESIUM [MAG] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Page 1 of 8
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:09:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

PHOSPHATE [PHOS] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
PH [HCPH] STAT - RN COLLECT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY [UA] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
IV Fluids [205190]
weight rate = 1.5 x [((100mL x first 10 kg) + (50mL x second 10 kg) + (20mL x Maintenance
>20kg)) / 24]
sodium chloride 0.9 % infusion - NOTE: Order
for MILD dehydration (<5%) [64367]
Intravenous, CONTINUOUS
sodium chloride 0.9% BOLUS - NOTE: Order for
MODERATE dehydration (5-10%) [730003]
10 mL/kg, Intravenous, ONCE For 1 Doses
sodium chloride 0.9% BOLUS - NOTE: Order for
SEVERE dehydration (>10%) [730003]
20 mL/kg, Intravenous, ONCE For 1 Doses
Obtain if Not Done Within Last 90 Days [19217]
HEMOGLOBIN A1C [HA1C] NEXT DRAW, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Not DKA - Second Hour
Nutrition [205183]
Diet - NPO Except Meds [NURDIE0012] CONTINUOUS, Routine
Diet: Other (Comment) (NPO Except Meds)
Clear liquid, Advance as tolerated [NURDIE0012] CONTINUOUS, Routine
Diet: Other (Comment) (Clear Liquid, Advance as
tolerated)
Insulin [205187]
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection [53264]
Subcutaneous, ONCE For 1 Doses
insulin glargine (LANTUS) 100 UNIT/ML injection
[64829]
Subcutaneous, ONCE For 1 Doses
Hypoglycemia Management (Pediatrics) [203310]
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until
specified, Routine, Glucose, POC should always be
ordered in conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today For Until specified,
Routine, Glucose, POC should always be ordered
in conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Page 2 of 8
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:09:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 70
Other: Nutritional status changes,Mental status
changes
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose
less than 40mg/dL and patient able to eat/swallow
safely.
Give 30 grams of carbohydrate (6-8 oz. of fruit
juice). Repeat treatment every 15 minutes until
glucose is 70 mg/dL or greater. Give 15 gram
carbohydrate and protein snack if meal or snack is
not scheduled within 1 hour of hypoglycemic
episode.
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (3-4 oz. of fruit
juice). Repeat treatment every 15 minutes until
glucose is 70 mg/dL or greater. Give 15 gram
carbohydrate and protein snack if meal or snack is
not scheduled within 1 hour of hypoglycemic
episode.
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
40-69 mg/dL
Use in patients able to safely eat/swallow but
unable to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
less than 40 mg/dL
Use in patients able to safely eat/swallow but
unable to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucagon injection kit - Maximum Dose = 1 mg
[107799]
0.03 mg/kg, Subcutaneous, PRN, For blood
glucose less than or equal to 69 mg/dL AND patient
is unable to eat/swallow safely, NPO, or
unconscious AND has NO IV access.
Reconstituted concentration equals 1 mg/mL. If no
weight entered and patient 3 years or younger, give
0.5 mg. If no weight entered and patient older than
3 years, give 1 mg.
dextrose injection - Maximum Dose = 25 grams
[800233]
0.5-1 g/kg, Intravenous, PRN, For blood glucose
less than or equal to 69 mg/dL AND patient is
unable to eat/swallow safely, NPO, or unconscious
AND has IV access.
Repeat every 15 minutes until blood glucose
greater than 70 mg/dL
Page 3 of 8
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:09:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting today For
7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting 6/3/17 For
7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
IV Fluids [205188]
sodium chloride 0.9% BOLUS [730003] Intravenous, ONCE For 1 Doses
dextrose 5%-NaCl 0.9% infusion [51641] Intravenous, CONTINUOUS
Laboratory [205184]
GLUCOSE, POC [HCMGLUC] ONCE, Routine
If Conditional, What Condition?
DKA - Second Hour
Insulin Infusion [205177]
insulin regular (HUMAN) infusion PEDS PANEL
[191555]
Pediatric Hypoglycemia Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97515-en.cckm
insulin regular (human) infusion PEDS [800147] 0.1 Units/kg/hr, Intravenous, CONTINUOUS
Do NOT titrate
Glucose, POC [IPGLUCOSE] ONCE, Starting today, Routine, Glucose, POC
should always be ordered in conjunction with
orders for hypoglycemia management and
monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today, Routine,
Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today, Routine, Glucose,
POC should always be ordered in conjunction with
orders for hypoglycemia management and
monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
glucagon injection kit - Maximum Dose = 1 mg
[107799]
0.03 mg/kg, Subcutaneous, PRN, For blood
glucose less than or equal to 60 mg/dL AND patient
is unable to eat/swallow safely, NPO, or
unconscious AND has NO IV access.
Reconstituted concentration equals 1 mg/mL. If no
weight entered and patient 3 years or younger, give
0.5 mg. If older than 3 years, give 1 mg.
Page 4 of 8
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:09:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

dextrose injection - Maximum Dose = 25 grams
[800233]
0.5-1 g/kg, Intravenous, PRN, For blood glucose
less than or equal to 60 mg/dL AND patient is
unable to eat/swallow safely, NPO or unconscious
AND has IV access.
Repeat every 15 minutes until blood glucose
greater than 70 mg/dL.
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today
If Conditional, What Condition? For blood glucose
less than 40 mg/dL and patient able to eat/swallow
safely
Give 30 grams of carbohydrate (6-8 oz. of fruit
juice). Repeat treatment every 15 minutes until
glucose is 70 mg/dL or greater. Give 15 gram
carbohydrate and protein snack if meal or snack is
not scheduled within 1 hour of hypoglycemic
episode.
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting today
If Conditional, What Condition? For blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely
Give 15 grams of carbohydrate (3-4 oz. of fruit
juice). Repeat treatment every 15 minutes until
glucose is 70 mg/dL or greater. Give 15 gram
carbohydrate and protein snack if meal or snack is
not scheduled within 1 hour of hypoglycemic
episode.
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
40-69 mg/dL
Use in patients able to safely eat/swallow but
unable to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
less than 40 mg/dL
Use in patients able to safely eat/swallow but
unable to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
IV Fluids (Single Response) [205178]
Pediatric - DKA - Potassium Less than 5.5
[205179]
Page 5 of 8
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:09:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

Note: IV Fluid Rate [950006] 4 X DAILY (NOTE ACKNOWLEDGE)
Total IV fluids at *** mL/hr (suggested 1.5x
maintenance)
Fluid Titration Guideline for "2 Bag" IVF System in
Pediatric DKA
Total fluid rate for Saline Bag A and Dextrose Bag
B combined= ***ml/hr
Run each individual bag (Saline Bag A and
Dextrose Bag B) based on Pediatric's blood
glucose level as described below:
Blood Glucose (> 350) Rate of Saline Bag A
(100%) Rate of Dextrose Bag B (0%)
Blood Glucose (301-350) Rate of Saline Bag A
(75%) Rate of Dextrose Bag B (25%)
Blood Glucose (251-300) Rate of Saline Bag A
(50%) Rate of Dextrose Bag B (50%)
Blood Glucose (201-250) Rate of Saline Bag A
(25%) Rate of Dextrose Bag B (75%)
Blood Glucose (101-200) Rate of Saline Bag A
(0%) Rate of Dextrose Bag B (100%)
Blood Glucose (<100) Rate of Saline Bag A (0%)
Rate of Dextrose Bag B (125% and call physician)
Each single bag rate = Total fluid rate x Percent
indicated.
*Please call physician if blood glucose falling more
than 100mg/dl per hour.
*Please call physician if blood glucose less than
100mg/dl.
Example:
Consider a sample patient with a total fluid rate of
100ml/hr currently has a blood glucose of 225.
Per the table above:
The Saline Bag A should run at 25%, so 100ml x
25%= 25ml/hr.
The Dextrose Bag B should run at 75%, so 100ml x
75%= 75ml/hr.
The patient is still getting 100ml/hr total fluids.
sodium chloride 0.9% with KCl 20 mEq/L infusion
- NOTE: Bag A [46261]
at 0-125, Intravenous, CONTINUOUS
Refer to IV Fluid Rate Order to determine
appropriate dose rate for Saline Bag A
administration. Page Emergency Department
Pharmacist to expedite bag preparation.
dextrose 10% 1000 mL with sodium chloride
0.9%, potassium chloride 20 mEq, potassium
phosphate 13.6 mmol infusion - NOTE: Bag B
[710000]
at 0-125, Intravenous, CONTINUOUS
Refer to IV Fluid Rate Order to determine
appropriate dose rate for Saline Bag B
administration. Page Emergency Department
Pharmacist to expedite bag preparation.
Pediatric - DKA - Potassium Greater Than 5.5
[205180]
Page 6 of 8
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:09:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

Note: IV Fluid Rate [950006] 4 X DAILY (NOTE ACKNOWLEDGE)
Total IV fluids at *** mL/hr (suggested 1.5x
maintenance)
Fluid Titration Guideline for "2 Bag" IVF System in
Pediatric DKA
Total fluid rate for Saline Bag A and Dextrose Bag
B combined= ***ml/hr
Run each individual bag (Saline Bag A and
Dextrose Bag B) based on Pediatric's blood
glucose level as described below:
Blood Glucose (> 350) Rate of Saline Bag A
(100%) Rate of Dextrose Bag B (0%)
Blood Glucose (301-350) Rate of Saline Bag A
(75%) Rate of Dextrose Bag B (25%)
Blood Glucose (251-300) Rate of Saline Bag A
(50%) Rate of Dextrose Bag B (50%)
Blood Glucose (201-250) Rate of Saline Bag A
(25%) Rate of Dextrose Bag B (75%)
Blood Glucose (101-200) Rate of Saline Bag A
(0%) Rate of Dextrose Bag B (100%)
Blood Glucose (<100) Rate of Saline Bag A (0%)
Rate of Dextrose Bag B (125% and call physician)
Each single bag rate = Total fluid rate x Percent
indicated.
*Please call physician if blood glucose falling more
than 100mg/dl per hour.
*Please call physician if blood glucose less than
100mg/dl.
Example:
Consider a sample patient with a total fluid rate of
100ml/hr currently has a blood glucose of 225.
Per the table above:
The Saline Bag A should run at 25%, so 100ml x
25%= 25ml/hr.
The Dextrose Bag B should run at 75%, so 100ml x
75%= 75ml/hr.
The patient is still getting 100ml/hr total fluids.
sodium chloride 0.9 % infusion - NOTE: Bag A
[64367]
at 0-125, Intravenous, CONTINUOUS
Refer to IV Fluid Rate Order to determine
appropriate dose rate for Saline Bag A
administration. Page Emergency Department
Pharmacist to expedite bag preparation.
dextrose 10%-NaCl 0.9% infusion - NOTE: Bag B
[700590]
at 0-125, Intravenous, CONTINUOUS
Refer to IV Fluid Rate Order to determine
appropriate dose rate for Saline Bag B
administration. Page Emergency Department
Pharmacist to expedite bag preparation.
Laboratory - Hourly [205185]
Glucose, POC [IPGLUCOSE] EVERY 1 HOUR For 12 Hours, Routine, Glucose,
POC should always be ordered in conjunction with
orders for hypoglycemia management and monitoring
as indicated in the Hypoglycemia Management
(Adult) panel.
If Conditional, What Condition?
Page 7 of 8
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:09:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

ELECTROLYTES, WHOLE BLOOD
[HCWBLYTS]
EVERY 1 HOUR For 12 Hours, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PH, Venous [HCPH] EVERY 1 HOUR For 12 Hours, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 8 of 8
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:09:25 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org