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Neonatal Intensive Care Drug Manual
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| bet | 317/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
FURTHER DILUTE: 2.5 mL/kg (5 units/kg) of the above solution and dilute with glucose 5%, glucose 10% or sodium chloride 0.9% to a final volume of 50 mL with a concentration of 0.1 unit/kg in each mL
Infusion at 1 mL/h = 0.1 unit/kg/hour
DOUBLE STRENGTH INFUSION
Infusion strength
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Prescribed amount
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1 mL/hour = 0.2 unit/kg/hour
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10 unit/kg insulin and make up to 50 mL
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Draw up 0.6 mL (60 units of insulin) and add 29.4 mL glucose 5%, glucose 10% or sodium
chloride 0.9% to make a final volume of 30 mL with a concentration of 2 unit/mL.
FURTHER DILUTE: 5 mL/kg (10 unit/kg) of the above solution and dilute with glucose 5%, glucose
10% or sodium chloride 0.9% to a final volume of 50 mL with a concentration of 0.2 unit/kg in
each mL.
Infusion at 1mL/h = 0.2 unit/kg/hour
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Administration
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Intravenous: Insulin binds to the plastic of giving sets. Flush the plastic tubing with 20 mL of prepared insulin solution into a receptacle prior to connecting to the infant. This is to saturate the binding.
Do not filter infusion. Insulin also binds to the filter.
Can be infused with maintenance fluids. Recommend attaching insulin infusion after the filter.
Do not bolus other drugs through this line.
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Monitoring
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Blood glucose concentration
Initiation: Every 30 minutes until stabilised.
Stabilisation: 4–6 hourly
After cessation of infusion: At 30 minutes and at 1 hour
Alteration of infusion: Within 1 hour
Serum potassium concentration.
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Contraindications
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Hypersensitivity to regular insulin or any of its components.
During episodes of hypoglycaemia.
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Precautions
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Hypoglycaemia is a common adverse effect. Blood glucose must be monitored closely to detect hypoglycaemia. Consider commencing lower dose of insulin in acute hyperglycemic conditions like sepsis.
Do not adjust the rate of the maintenance solution or other infusions when insulin is commenced or the insulin infusion rate is altered. For example, if insulin is commenced or the rate of the insulin infusion is increased, do not turn down the maintenance solution to compensate for the total volume delivered. The amount of glucose being delivered to the infant will then be reduced as the insulin is commenced or dose is increased, possibly causing hypoglycaemia in an already unstable infant.
If ceasing insulin or changing the strength, be careful to remove and replace the previous line and T-piece to avoid flushing through insulin remaining in the tubing.
Administer IV bolus medication via separate IV access to avoid insulin bolus administration.
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Drug Interactions
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The following may reduce insulin requirements: Octreotide, beta-adrenergic blocking agents, angiotensin converting enzyme inhibitors, salicylates, anabolic steroids, alpha-adrenergic blocking agents, quinine, quinidine and sulfonamides.
The following may increase insulin requirements: Thiazides, furosemide, ethacrynic acid, glucocorticoids, thyroid hormones, sympathomimetics, growth hormone, diazoxide.
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Adverse Reactions
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Hypoglycaemia; hypokalaemia; and hyponatraemia.
Urticaria and anaphylaxis (extremely rare)
Insulin resistance may develop resulting in a larger dose requirement.
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Compatibility
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Fluids: Amino acid solution, glucose 5%, glucose 10%, glucose 50%, lipid emulsion, sodium chloride 0.9%.
Y-site administration: Amiodarone, azathioprine sodium; aztreonam; bretylium tosylate; bumetanide; buprenorphine hydrochloride; calcium chloride dihydrate; calcium gluconate monohydrate; caspofungin acetate;; cefazolin sodium; cefepime hydrochloride; cefotaxime; ceftazidime; ceftizoxime; ceftriaxone sodium; cefuroxime; chloramphenicol sodium succinate; clindamycin phosphate; cyanocobalamin; dexamethasone sodium phosphate;; enalaprilat; epirubicin hydrochloride; epoetin alfa; erythromycin lactobionate; fentanyl citrate; fluconazole; folic acid (as sodium salt); foscarnet sodium; fosphenytoin sodium; ganciclovir sodium; hydrocortisone sodium succinate; ibuprofen lysine; imipenem-cilastatin sodium; indometacin sodium trihydrate; lactated ringer's injection; lidocaine hydrochloride; magnesium sulfate; mannitol; meropenem; methadone hydrochloride; methylprednisolone sodium succinate; metoclopramide hydrochloride; metoprolol tartrate; metronidazole; milrinone lactate; naloxone hydrochloride; nitroglycerin; nitroprusside sodium; octreotide acetate; pancuronium bromide; penicillin g potassium; penicillin g sodium; phenobarbital sodium; phytonadione; piperacillin sodium; potassium acetate; potassium chloride; procainamide hydrochloride; promethazine hydrochloride; propofol; pyridoxine hydrochloride; remifentanil hydrochloride; sodium bicarbonate; streptokinase; sufentanil citrate; tacrolimus; terbutaline sulfate; thiamine hydrochloride; ticarcillin disodium; ticarcillin disodium-clavulanate potassium; urokinase; vancomycin hydrochloride; vecuronium bromide; verapamil hydrochloride; voriconazole
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