Uncontrolled Type 2 Diabetes with Insulin Drip Admission Orders
Date and time:
Name:
Age:
DOB:
Allergies:
1. Admit to: [ X ] Acute Care
Telemetry
2. Attending Dr: Younger
3. Admitting Dx:
4. Contributing Dx:
5. Condition:
6. VS:
7. Activity:
8. Nursing:
[ ] Day Bed
[ X ] SCUnit
[X]
[ ] Stable
[ X ] Fair
[ ] Serious
[ ] Critical
Orthostatic BP, pulse and RESP Q 2 hr x 4, then qid
Weight on admission and each AM.
Bed rest with bathroom privileges, ad lib beginning tomorrow.
I/O Q 2 hr x 4, then q shift.
Dipstick urine, chart glucose and acetone Q shift.
Call physician if urine output < 15 mL/hr.
For action on the q 2 hour glucocheck values, please do the
following:
9. Diet:
As long as the glucose is decreasing by at least 100 to 200
mg/dL every 2 hours, the rate of the insulin drip can be left
alone.
If the glucose does not decrease by 100 mg/dL every 2 hours or
if it is decreasing by > 200 mg/dL every 2 hours, then call the
physician.
When the blood glucose level falls below 300 mg/dL, then
switch the IV fluid to D5/NS to prevent the glucose from falling
below 200 acutely, which might precipitate cerebral edema,
especially with his hyponatremia.
If the glucose falls below 200 on the insulin drip, then call the
physician.
NPO, then clear liquids as tolerated post-upper abdominal
ultrasound as tolerated.
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10. IV:
11. Meds:
12. X-rays:
13. Labs:
14. Consultants:
15. Other:
IV of NS at 180 ml per hour.
Regular insulin 6 units IV bolus, and then regular insulin
infusion 6 units/kg/hr.
Protonix 40 mg IV every 24 hours.
Zofran 4 mg IV every 6 hours as needed for nausea.
PCA MSO4 with basal rate of 1 mg/hour with a 6-minute lock
out and maximum of 20 mg over 2 hours.
Tylenol 500 mg, one tablet by mouth every 4 hours as needed
for mild pain or fever > 100 degrees.
Milk of Magnesia, 30 ml by mouth at bedtime as needed for
constipation.
Ambien 5 mg, one tablet by mouth at bedtime and may repeat
X 1 if needed for sleep.
Zosyn 3.375 grams IV every 6 hours.
Lovenox 60 mg sc every 12 hours for DVT prophylaxis.
Upper abdominal ultrasound in the AM and a renal stone
protocol CT scan of the kidneys in the AM and have the
radiologist notify Dr. Daise of the results.
SMA-7 at midnight and 4 AM and daily and do a phosphorous,
calcium, and magnesium level each time as well.
Serum ketones now and in the AM;
2 blood cultures, EKG, cardiac enzymes, U/A, ABG, and urine
culture now.
Daily CBC.
Fasting lipid panel and TSH in the AM with a repeat EKG and
cardiac enzymes.
A1C test in the AM.
Start a 24 hour urine for creatinine clearance and protein
excretion tomorrow AM.
Glucochecks q 2 hours.
Dr. Davis-Please notify of the patient’s admission in the AM.
Call MD if: BP < 90/60 or > 170/110, P 130 or T > 39C.
If magnesium is 1.4-1.8 mg/dL, supplement 1g MgSO4 IVPB
over 30 min; if magnesium is less than 1.4 mg/dL, supplement
2g MgSO4 IV piggyback over 30 to 60 min.
If both magnesium and PO4 are low, supplement magnesium
first.
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16. H&P:
17. Respiratory
Therapy:
If PO4 is 1.0-1.8 mg/dL, supplement orally if possible with
skim milk or Neutra-Phos; if PO4 is 0.5-1.0 mg/dL, supplement
IV with 0.08 mM/Kg KPO4 in 250cc NS over 4 hr.; if PO4 is <
0.5 mg/dL, supplement IV with 0.16 mM/Kg KPO4 in 250cc
NS over 4 hr.
If calcium supplementation is necessary (after repeating a
serum albumen level call the physician if the serum calcium is
less than 7.0), do not give in same IV line as PO4.
If pH < 7.1, add 1 amp (44meq) of Na Bicarbonate to bag. NS
Q 2 hr until pH > 7.1. ABG Q 4 hr (if treating with
bicarbonate).
If the serum potassium drops below 3.5 then add 20 mEq of
KCl in the IV fluid.
If the serum potassium drops to below 3.0 when on liter #5 or
greater, then in addition to doubling the amount of potassium
added to the IV fluids to 40 mEq/liter, also start having the
patient take 20 mEq of oral potassium every 2 hours until the
potassium is above 3.5. Then, stop the oral potassium and
continue the IV potassium at 20 mEq/liter.
Please type up the H&P.
Please put him on 2 liters of oxygen by nasal cannula per
minute overnight and then in the AM recheck his SpO2 level on
room air at rest and me know the result.
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