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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98238-en.cckm

20180110

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100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP/ED - Severe Hyperkalemia - Adult - Supplemental [3515]

IP/ED - Severe Hyperkalemia - Adult - Supplemental [3515] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP/ED - Severe Hyperkalemia - Adult - Supplemental [3515]
for Adult Use Only Intended
CAUTION: Before ordering sodium polyseyrene sulfonate (KAYEXALATE)
consider before ordering for patients with high risk for necrotizing
enterocolitis (NEC), or abdominal surgical issues.
High Alert: Severe Hyperkalemia is defined as potassium (K) equal to or
hemolyzed sample. Provider to discontinue any -greater than 6.5 on a non
potassium containing fluids or medications containing potassium.
Discontinue potassium containing feeds.
Patient Care Orders
Vital Signs [103390]
Vital Signs [NURMON0013] EVERY 1 HOUR, Starting today For Until specified,
Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Until potassium less than 6.0 mmol/L
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication: Other (Comment Required)
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
PCO-IP-SEVERE HYPERKALEMIA - ADULT IP ED-SUPPLEMENTAL-CONPAR-UWIP [240384]
REMINDER: Provider to discontinue any potassium containing fluids or medications containing
potassium. Discontinue potassium containing feeds.
Notify Provider [NURCOM0001] 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: If serum potassium is greater than or equal to
6.0 mmol/L
Medications - Severe Hyperkalemia
Immediate Acting Medications (Cardiac Membrane Stabilization) Administer with EKG changes (Single
Response) [103738]
Note: Calcium gluconate is usually selected unless the patient has a central line
Page 1 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/10/2018 2:44:13 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

calcium GLUConate STOCK vial [35492] 2 g, Intravenous, ONCE For 1 Doses, for 5 Minutes
calcium CHLOride STOCK vial [35486] 1 g, Intravenous, ONCE For 1 Doses, for 10 Minutes
Fast Acting Medications (Onset of Action 15-30 Minutes) [236130]
Severe Hyperkalemia - Fast Acting - Adult
[236133]
insulin lispro (human) 100 UNIT/ML injection
[53264]
5 units, Intravenous, ONCE For 1 Doses
Draw up using insulin syringe. Dilute using 10 mL
saline flush. Administer immediately prior to dextrose
administration.
sodium chloride 0.9% vial [42188] 10 mL, Intravenous, ONCE For 1 Doses
dextrose injection [800233] 25 g, Intravenous, ONCE For 1 Doses
Hold if blood glucose is greater than 250 mg/dL
albuterol 2.5 mg/0.5 mL neb soln [34315] 10 mg, Nebulization, ONCE For 1 Doses
Administer over 10 minutes. Use albuterol cautiously
in patient with active coronary disease. Administer if
patient not responsive to insulin and dextrose within
30 minutes and serum potassium remains greater
than or equal to 6 mmol/L. Dilute to 4 mL with
normal saline before administering.
Intermediate Acting Medications (Onset of Action 1-2 Hours) [222595]
sodium polystyrene sulfonate (KAYEXALATE)
susp [64534]
30 g, Oral, ONCE For 1 Doses
Avoid use if post-operative, bowel obstruction, and/or
ileus present.
sodium polystyrene sulfonate (KAYEXALATE)
susp - NOTE: Rectal administration of sodium
polystyrene sulfonate is less effective than oral
administration for hyperkalemia and should be
reserved for NPO patients. [64534]
30 g, Rectal, ONCE For 1 Doses
Avoid use if post-operative, bowel obstruction, and/or
ileus present. Administer cleaning enema first. Instill
suspension in rectum along with 100 mL of fluid.
Have patient retain for 60 minutes. At completion of
therapy, rinse with copious amount of sodium-free
fluid to remove any residual sodium polystyrene
sulfonate.
furosemide (LASIX) intraVENOUS [800046] 40 mg, Intravenous, ONCE For 1 Doses
Medications - Hypoglycemia Management
Hypoglycemia Management [239976]
Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97511-en.cckm
Hypoglycemia Management (Adult) [239978]
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?
Page 2 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/10/2018 2:44:13 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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?
Per hypoglycemia treatment algorithm Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less than
40 mg/dL), recheck glucose after 1 hour to ensure
glucose remains greater than or equal to 70mg/dL.
After resolution of mild hypoglycemia (i.e., glucose
40-69 mg/dL), consider rechecking after 1 hour if
patient has signs/symptoms of hypoglycemia or is at
risk for a subsequent hypoglycemic event (e.g.,
previously administered insulin still active, altered
renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that
increases hypoglycemia risk)
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional 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 (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
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 (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
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 [107799] 1 mg, Subcutaneous, PRN, For blood glucose less
than 69 mg/dL and patient unable to eat/swallow
safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
Page 3 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/10/2018 2:44:13 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69
mg/dL and patient unable to eat/swallow safely AND
has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than
40 mg/dL and patient unable to eat/swallow safely
AND has IV access.
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, 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, Starting 1/18/18 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.
Laboratory
Laboratory [213186]
POTASSIUM [K] STAT 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 2 hours after
treatment.
Draw every *** hours until potassium is less than 5.5
mmol/L.
BUN [BUN] STAT 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 [CA] STAT 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 [XICAL] STAT 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 [CRET] STAT 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 [LYTE] STAT 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 4 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/10/2018 2:44:13 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] STAT For 1 Occurrences, 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?
Check glucose prior to insulin administration.
Conditional Labs [213185]
Adult Hypoglycemia Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97511-en.cckm
POTASSIUM - STAT [K] CONDITIONAL, Starting today For 2 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw 2 hours after
treatment
Notify Provider if potassium is greater than 6mmol/L
Glucose, POC [IPGLUCOSE] CONDITIONAL, 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? Check glucose every 1
hour for 3 hours after insulin administration.
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [103411]
ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, STAT
Reason for exam: Other (enter comments)
Comment: Hyperkalemia
Disclaimer for University Hospital Only: A Stat status
for an ECG is in reference to the timing of the ECG.
The goal is to perform a STAT ECG within 10 minutes
of the order being placed. It is the responsibility of the
ordering provider to review the STAT ECGs. All ECGs
(stat or routine) will be formally reviewed within one
business day.
Page 5 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/10/2018 2:44:13 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org