Unique Plan Description: NICU Hyperkalemia Protocol
Plan Selection Display: NICU Hyperkalemia Protocol
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2015-09-21 15:37:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 11:14:42
Available at all facilities: No

NICU Hyperkalemia Protocol
IV Solutions
	Dextrose 10% intravenous soln (Bolus)
		2 mL/kg, Syringe, IV Push, Once, STAT
			Comment: Give immediately following insulin bolus. Do not give if glucose >250mg/dL
	Insulin regular 5 units/Dextrose 10% 50 mL (NICU)
		50 mL, IV
			Comment: Give to promote intracellular movement of K+
		5 units, EVERY BAG, 0.1 unit/kg/hr
	Dextrose 10% in Water
		250 mL, IV, 1 ml/hr
			Comment: 50-120ml/kg/day.Start at same time as insulin regular continuous drip
Medications
		Discontinue or modify any oral potassium and/or potassium IV additives already ordered (ie: TPN, fortifiers)(NOTE)*
		Discontinue nephrotoxic medications pending follow up (ie: gentamicin)(NOTE)*
	calcium gluconate IVPB (NICU)
		100 mg/kg, Solution-Injection, IVPB, Once, STAT
			Comment: Give over 10-30 minutes to reverse effect of potassium on cell membrane. Central access preferred-do not give intra arterially. Do not give if HR <100bpm.
	Insulin regular/NS 1unit/mL (NICU)
		0.05 units/kg, Solution, IV Push, Once, STAT
			Comment: Give before Dextrose to promote intracellular movement of K+
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		1.5 mL, Solution-Nebulization, NEBULIZED, Q4H-Sch, PRN, wheezing
			Comment: 0.4mg/kg rounded to nearest 1.25mg/1.5ml. Give until K+ <5 or maximum of 12 doses to promote intracellular movement K+.Consider alternative product if K+>7.5. Do not give if HR >210 bpm
	sodium bicarbonate 4.2% (NICU)
		1 mEq/kg, Injection, IVPB, Once, STAT, infuse over 1 hr
			Comment: Give over 30-60 minutes to promote intracellular movement of K+
	Lasix Injection
		1 mg/kg, IV Push, Once, PRN, see comment
			Comment: give to promote excretion of K+ from the body
	sodium polystyrene sulfonate
		1 gm/kg, RECTALLY, Q6H
			Comment: Use in neonates should be reserved for refractory cases; oral administration in neonates contraindicated. Give to promote excretion of K+ from the body. Note 1mEq K+ exchanged for 2-3mEq Na+
Patient Care
	Intake and Output
		
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: Electrolyte disorder
			Comment: Verify rhythm on initiation
	Order Lab
		T;N, K+ level 1 and 4 hrs after treatment complete
	Glucose POC - NICU
		T;N
			Comment: Prior to insulin administration and 15 min after insulin administration
		T;N+15
			Comment: 15 minutes after insulin administration
		If patient has arterial line, order POC WB Glucose Nurse Collect - NICU(NOTE)*
	POC WB Glucose Nurse Collect - NICU
		T;N
			Comment: Prior to insulin administration and 15 min after insulin administration
		T;N+15
			Comment: 15 minutes after insulin administration

*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