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IP - Severe Hyperkalemia - Pediatric - Supplemental [4845]

IP - Severe Hyperkalemia - Pediatric - Supplemental [4845] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


SmartSet: IP - SEVERE HYPERKALEMIA - PEDIATRIC - SUPPLEMENTAL
(ID:4845)
General Information
Display name: IP - Severe Hyperkalemia - Pediatric - Supplemental
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. Hyperkalemia
2. Pediatric
3. K
4. High Potassium
5. Potassium
6. .OTHER
7. .SUPPLEMENTAL
8. .PEDS
9. .PICU
SmartSet notes:
Description: CAUTION: Before ordering sodium polyseyrene sulfonate (KAYEXALATE)
consider before ordering for patients with high risk for necrotizing enterocolitis
(NEC), extreme prematurity, or abdominal surgical issues.
High Alert: Severe Hyperkalemia is defined as potassium (K) equal to or greater
than 7 on a non-hemolyzed sample. Provider to discontinue any potassium
containing fluids or medications containing potassium. Discontinue potassium
containing feeds.
Web information: Title URL
1.
Questionnaire:
Configuration
Patient Care Orders
Vital Signs
Non-Categorized Patient Care Orders
Page 1 of 6
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

Contingency Parameters
Notify Nephrology if Serum Potassium is Greater
Than or Equal to 7.0 mmol/L
CONTINUOUS, Starting S For Until specified
Notify Provider Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
Intravenous Therapy
Premedication for Needle Insertion
Lidocaine
lidocaine (LMX) 4% topical dressing kit Topical, EVERY 1 HOUR PRN, prior to needle
sticks to reduce pain. See "LMX Use Instructions"
order in Active Orders report or the Admin
Instructions for application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply
to area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 2 sites per hour, 6
times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do
NOT apply to area greater than 200 square
centimeters. (maximum 2.5 g/site; maximum 4
sites per hour, 6 times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
LMX Use Instructions for Premedication Prior to
Needle Insertion
Details
IV Fluids
dextrose 10 % infusion Intravenous, CONTINUOUS
dextrose 10 %, amino acids (TROPHAMINE) 3.5
%, heparin 0.5 Units/mL in water (sterile)
Intravenous, CONTINUOUS
dextrose 10% 1/2 Normal Saline Intravenous, CONTINUOUS
dextrose 10% 1/4 Normal Saline Intravenous, CONTINUOUS
Page 2 of 6
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

Medications - Severe Hyperkalemia
Immediate Action Medications (Cardiac Membrane Stabilization)
Medications
calcium GLUConate intraVENOUS -
PERIPHERAL LINE ONLY - Maximum Dose = 2
grams
50 mg/kg, Intravenous, ONCE For 1 Doses
Administer over 5 minutes May repeat 1-2 times
after 5-10 minutes if ECG changes persist. Do not
administer in the same line as sodium bicarbonate
and do not give if there is the possibility of digoxin
toxicity. Administer calcium first for the treatment
of hyperkalemia.
calcium CHLOride intraVENOUS - CENTRAL
LINE ONLY - Maximum Dose = 1 gram
10 mg/kg, Intravenous, ONCE For 1 Doses
Administer in a central line only. Do not administer
in the same line as bicarbonate, and do not give if
there is the possibility of digoxin toxicity.
Administer calcium first for the treatment of
hyperkalemia.
sodium bicarbonate injection 0.5 mEq/kg, Intravenous, ONCE For 1 Doses
Fast Acting (Onset of Action: 15-30 Minutes)
Patients who are less than 25 kg - NOTE:
Dextrose and Insulin should be ordered together
insulin lispro (human) 100 UNIT/ML injection -
Suggested dose - 0.1 units/kg (Maximum Dose
= 10 units)
Subcutaneous, ONCE For 1 Doses
dextrose 10 % BOLUS 0.5 g/kg, Intravenous, ONCE For 1 Doses
albuterol neb soln (3 mL) - Maximum Dose = 20
mg
2.5 mg, Nebulization, ONCE For 1 Doses
Patient who are 25-50 kg - NOTE: Dextrose and
Insulin should be ordered together
insulin lispro (human) 100 UNIT/ML injection -
Suggested dose - 0.1 units/kg (Maximum Dose
= 10 units)
Subcutaneous, ONCE For 1 Doses
dextrose 10 % BOLUS 0.5 g/kg, Intravenous, ONCE For 1 Doses
albuterol neb soln (3 mL) - Maximum Dose = 20
mg
5 mg, Nebulization, ONCE For 1 Doses
Patients who are greater than 50 kg
insulin lispro (human) 100 UNIT/ML injection -
Suggested dose - 0.1 units/kg (Maximum Dose
= 10 units)
Subcutaneous, ONCE For 1 Doses
dextrose 10 % BOLUS 0.5 g/kg, Intravenous, ONCE For 1 Doses
albuterol neb soln (3 mL) - Maximum Dose = 20
mg
10 mg, Nebulization, ONCE For 1 Doses
Intermediate Acting (Onset of Action: 1 - 2 Hours)
Medications
furosemide (LASIX) intravenous - NOTE:
Suggested dose 1-4 mg/kg/dose
Intravenous, ONCE For 1 Doses
sodium polystyrene sulfonate (KAYEXALATE)
susp - Maximum Dose = 60 grams
1 g/kg, Oral, ONCE For 1 Doses
Do not use if the patient has an ileus, has had
recent abdominal surgery or perforation, or is
suffering from hypernatremia
Metabolic Acidosis
Page 3 of 6
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

sodium bicarbonate injection - Maximum Dose =
50 meQ
1 mEq/kg, Intravenous, ONCE For 1 Doses
Over 10-15 minutes
Medications - Moderate Hyperkalemia
Fast Acting (Onset of Action: 15-30 Minutes
Patients who are less than 25 kg - NOTE:
Dextrose and Insulin should be ordered together
insulin lispro (human) 100 UNIT/ML injection -
Suggested dose - 0.1 units/kg (Maximum Dose
= 10 units)
Subcutaneous, ONCE For 1 Doses
dextrose 10 % BOLUS 0.5 g/kg, Intravenous, ONCE For 1 Doses
albuterol neb soln (3 mL) - Maximum Dose = 20
mg
2.5 mg, Nebulization, ONCE For 1 Doses
Patient who are 25-50 kg - NOTE: Dextrose and
Insulin should be ordered together
insulin lispro (human) 100 UNIT/ML injection -
Suggested dose - 0.1 units/kg (Maximum Dose
= 10 units)
Subcutaneous, ONCE For 1 Doses
dextrose 10 % BOLUS 0.5 g/kg, Intravenous, ONCE For 1 Doses
albuterol neb soln (3 mL) - Maximum Dose = 20
mg
5 mg, Nebulization, ONCE For 1 Doses
Patients who are greater than 50 kg
insulin lispro (human) 100 UNIT/ML injection -
Suggested dose - 0.1 units/kg (Maximum Dose
= 10 units)
Subcutaneous, ONCE For 1 Doses
dextrose 10 % BOLUS 0.5 g/kg, Intravenous, ONCE For 1 Doses
albuterol neb soln (3 mL) - Maximum Dose = 20
mg
5 mg, Nebulization, ONCE For 1 Doses
Immediate Acting (Onset of Action: 1-2 Hours)
Medications
furosemide (LASIX) intravenous - NOTE:
Suggested dose 1-4 mg/kg/dose
Intravenous, ONCE For 1 Doses
sodium polystyrene sulfonate (KAYEXALATE)
susp - Maximum Dose = 60 grams
1 g/kg, Oral, ONCE For 1 Doses
Do not use if the patient has an ileus, has had
recent abdominal surgery or perforation, or is
suffering from hypernatremia
Medications - Mild Hyperkalemia
Immediate Acting (Onset of Action 1-2 Hours)
Medications
furosemide (LASIX) intravenous - NOTE:
Suggested dose 1-4 mg/kg/dose
Intravenous, ONCE For 1 Doses
sodium polystyrene sulfonate (KAYEXALATE)
susp - Maximum Dose = 60 grams
1 g/kg, Oral, ONCE For 1 Doses
Do not use if the patient has an ileus, has had
recent abdominal surgery or perforation, or is
suffering from hypernatremia
Page 4 of 6
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

Laboratory
Laboratory
POTASSIUM 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?
Draw every *** hours until potassium within normal
limits.
BUN 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?
CALCIUM 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?
CALCIUM, IONIZED 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?
CREATININE 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?
ELECTROLYTES 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?
GLUCOSE 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?
Conditional Labs
POTASSIUM - STAT CONDITIONAL - RN COLLECT, Starting S For 7
Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? STAT for any
potassium greater than or equal to 6.5 mmol/L
GLUCOSE CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Stat every time blood
glucose monitoring (bedside) less than 40 or greater
than 400 mg/dL
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging
Page 5 of 6
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

ECG - 12 Lead (PEDS) ONCE, Starting S For 1 Occurrences, Routine
Reason for exam:
Consults
Consults
Consult Pediatric Renal - Nephrology (Inpatient) ONCE
Intent:
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Call back number:
Criteria
Suggestions: UWIP C LOGIN DEPT IP PEDIATRICS[3001746]
Filter: UWIP ORDER SET RESTRICTOR - IP AND PEDS - NOT IP DC[3000404]
Restrict SmartSet:
Settings
Discontinue action:
Deselect sections for
Pended/Held orders:
Pended/Held orders
display:
Release date: Use System Definitions Setting
Disallow user override:
Page 6 of 6
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org