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Must have adequate maintenance fluids to prevent hypoglycaemia
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| bet | 324/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Must have adequate maintenance fluids to prevent hypoglycaemia.
Infusion strength
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Prescribed amount
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1 mL/kg/hour = 0.2 unit/kg/hour
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10 units insulin and make up to 50 mL
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Draw up 0.5 mL (50 units of insulin) and add 9.5 mL sodium chloride 0.9%, glucose 5% or glucose 10% to make a final volume of 10 mL with a concentration of 5 units/mL.
FURTHER DILUTE: Draw up 2 mL (10 units of insulin) of solution and dilute with glucose 5%, glucose 10% or sodium chloride 0.9% to make a final volume of 50 mL with a concentration/dose rate of 1 mL/kg/hour = 0.2 units/kg/hour.
Cardiac arrest due to hyperkalaemia
Infusion strength
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Prescribed amount
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1 mL/kg/hour = 0.2 units/kg/hour
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10 units insulin and make up to 50 mL
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Mix 25 g (50 mL of glucose 50%) glucose and 10 units regular insulin and give 1 mL/kg (0.2 units/kg of insulin) IV over 15 to 30 minutes. Glucose:insulin ratio = 2.5 g:1 unit.
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Administration
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Intravenous:
Insulin is adsorbed to the plastic of intravenous bags, syringes and tubing which reduces the delivery of insulin.[1, 2] To saturate binding to plastic, infuse 20 mL of insulin solution through plastic tubing prior to infusion. Insulin concentrations ≤ 0.05 units/mL are not reliably delivered even after preconditioning and flushing [2].
Infuse with maintenance fluids.
Do not include in maintenance fluid requirements.
Insulin binds to the filter. Do not filter infusion.
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Monitoring
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Blood glucose must be closely monitored to detect either hypo/hyperglycaemia.
Recommend blood glucose every 20 minutes for the first hour, every 30 minutes for the second hour and every 2 to 4 hours thereafter. Increase frequency of monitoring during weaning.
Recommend check potassium within 30–60 minutes of commencing glucose/insulin infusion. Serum potassium should be closely monitored to monitor response to treatment and avoid hypokalaemia.
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Contraindications
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Hypersensitivity to human insulin or any component of the formulation.
During episodes of hypoglycaemia.
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Precautions
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Possible adverse effects include hypersensitivity, hypoglycaemia, hyperglycaemia and hypokalaemia.
Use with caution in cardiac disease, hepatic impairment, renal impairment.
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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.
Sympathomimetics have a potassium lowering effect.
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Adverse Reactions
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Insulin/glucose infusion is associated with a high rate of hyperglycaemia and hypoglycaemia during infusion and hypoglycaemia during weaning (insulin has a longer half-life than glucose).
Hypokalaemia if infusion continued.
Hypertonic solution – potential for extravasation.
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Compatibility
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Glucose 5%, glucose 10%, glucose 50%, sodium chloride 0.9%, lactated Ringer's injection
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