Unique Plan Description: Hyponatremia
Plan Selection Display: Hyponatremia
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-14 23:17:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-08-09 08:41:02
Available at all facilities: No

Hyponatremia
Admit/Discharge/Transfer
	Transfer to Critical Care (WH JE)
		T;N
			Comment: if patient has seizures and notify MD.
Diet
	Sodium Restricted Diet
		T;N
	Fluid Restriction
		T;N
Laboratory
	Osmolality
		Stat, spec type = Blood
	Osmolality Urine Random
		Stat, Stat, Urine, spec type = Urine
	Sodium Urine Random
		Stat, Stat, Urine, spec type = Urine
	Basic Metabolic Panel
		T;N+180, Routine, Q6H, 4 Dose(s)/Time(s), spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
		Timed, Q6H 4 Dose(s)/Time(s), spec type = Blood
		If patient is hypovolemic or euvolemic order cortisol level now and in am.(NOTE)*
	Cortisol Level
		Routine, spec type = Blood
		T+1;0400, Routine, spec type = Blood
		If patient is euvolemic consider the following in addtion to cortisol levels:(NOTE)*
	TSH
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
Diagnostic Tests
		If patient is euvolemic consider the following:(NOTE)*
	Chest 1 View
		r/o mass, T;N, Routine, Findings/Abnormal
	CT Head w & w/o Contrast
		r/o mass, edema, T;N, Routine, Findings/Abnormal
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
	Sodium Chloride 0.9% with KCl 20mEq
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
Medications
	Ativan Injectable
		1 mg, Injection, IV Push, Q15MIN, PRN, seizure activity
			Comment: Maximum ativan dose: 10 mg/day
		2 mg, Injection, IV Push, Q15MIN, PRN, seizure activity
			Comment: Maximum ativan dose: 10 mg/day
		3 mg, Injection, IV Push, Q15MIN, PRN, seizure activity
			Comment: Maximum ativan dose: 10 mg/day
		4 mg, Injection, IV Push, Q15MIN, PRN, seizure activity
			Comment: Maximum ativan dose: 10 mg/day
	potassium chloride IVPB - Peripheral line
		40 mEq, Injection-Premix, IVPB, Once, infuse over 4 hr
	potassium chloride IVPB (FH)
		40 mEq, Injection-Premix, IVPB, Once, infuse over 4 hr, T;N+15
		If patient is hypervolemic consider the following:(NOTE)*
	Lasix Injection
		20 mg, IV PUSH, Once, NOW
		40 mg, IV PUSH, Once, NOW
		80 mg, IV PUSH, Once, NOW
		100 mg, IV PUSH, Once, NOW
Patient Care
	Neurological Assessment-Focused
		Q2H-Sch
	Notify MD
		If patient has neurological changes, worsening nausea/vomiting seizures
	Notify MD of Lab results
		
	Notify MD
		T;N, Radiologist to insert PICC line.
Consults/Follow-up
	Pharmacy Consult
		Identify and document medications (ie:diuretics, SSRIs, and tricyclics) which could cause hyponatremia.
		Change all infusions and carrier solutions to Normal Saline.
	Consult Neurologist
		Reason for Referral: Hyponatremia
	Consult Tele Neurology (JEFH)
		Reason for Referral: Hyponatremia
	Consult Nephrologist
		Reason for Referral: Hyponatremia

Hypertonic Sodium Chloride (3%)
Laboratory
	Sodium
		T;N, Routine, Q6H, spec type = Blood
			Comment: while sodium chloride 3% infusing.
IV Solutions
	Sodium Chloride 3%
		500 mL, IV, Routine, 1 Dose(s)/Time(s), 20 ml/hr, Total Volume = 500
			Comment: Max rate 100mL/hr. Orders will automatically stop after 500mL is administered if greater than 500mL is ordered. A sodium level and new physician order must be obtained prior to dispensing subsequent doses. Administration via central line is preferred.
	zzSodium Chloride 3% 250mL
		212 mL, IV, Routine, 1 Dose(s)/Time(s), 50 ml/hr, Total Volume = 250
			Comment: Max rate 50mL/hr.  A sodium level and new physician order must be obtained prior to dispensing subsequent doses. Administration via central line is preferred
		38 mL, EVERY BAG

PICC line Access
Diagnostic Tests
	IV Team US Guidance
		T;N, PICC Line Insertion
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV Push, BID
		10 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
		20 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
		30 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
	lidocaine 1% injectable solution (MH/WH/FH)
		5 mL, SUBCUTANEOUS, Q1H, PRN, see comment
			Comment: For PICC line insert
	sodium chloride bacteriostatic 0.9% injectable soln
		5 mL, Injection, SUBCUTANEOUS, Q1H, PRN, see comment
			Comment: For PICC line insert, use if patient has lidocaine allergy.
Patient Care
	PICC Line Insert (MH/WH)
		T;N
	PICC Line Insert (JE)
		T;N
	PICC line insert (FH)
		T;N

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase