D50 amps

Accolay · Dec 19, 2017

Did that nurse follow your hospital policy?

Our policy only allows for Dextrose to be given if the patient is NPO or not alert. We should continue to give dextrose until the blood glucose is >100 with q15min glucose checks. It does not state how many instances this can occur.

However, if a blood glucose is

Always be vigilant about necrosis, but should be fine as long as your IVs are good i.e. not infiltrated.

rkitty198, BSN, RN · Dec 19, 2017

I have never seen a patient require more than one. If it still continues to drop there must have been an overdose of some fast acting insulin given. Sugars don't just continue to drop on their own unless a fast acting insulin was given. Or these amps were given over a period of a long term and sugars were checked over a long period as well.

Insulin given exongenous can result in this rapid drops of sugars and will need treatment like this.

rkitty198, BSN, RN · Dec 19, 2017

Probably should have been on some sort of a dextrose drip after one amp.

I would have called the doctor if the one didnt work since I have never had to give more than one in 11 years as an RN.

fjluce · Dec 19, 2017

I am unsure what our policy states as far as going beyond 1 amp. I didn't have time to look and it was not my patient. I have never needed to go beyond 1 amp. What was documented in the MAR was one unit of regular insulin and 12 units of lantus. I told the nurse she needed to ask for fluids to be started her response was the dr was worried about FVE. i said page him and put my name down and I'll talk to him. After that crazy enough she got fluids. This lasted awhile. Apparently it started at shift change with a blood sugar of 69, she gave juice the 15 minute recheck showed it had dropped, she gave an amp, recheck had dropped this lasted from about 2300-0500.

fjluce · Dec 19, 2017

The blood sugars were checked per policy (15 min after each intervention) but each time it had to wait for the dr to call back before another amp could be given.

rkitty198, BSN, RN · Dec 19, 2017

I am unsure what our policy states as far as going beyond 1 amp. I didn't have time to look and it was not my patient. I have never needed to go beyond 1 amp. What was documented in the MAR was one unit of regular insulin and 12 units of lantus. I told the nurse she needed to ask for fluids to be started her response was the dr was worried about FVE. i said page him and put my name down and I'll talk to him. After that crazy enough she got fluids. This lasted awhile. Apparently it started at shift change with a blood sugar of 69, she gave juice the 15 minute recheck showed it had dropped, she gave an amp, recheck had dropped this lasted from about 2300-0500.

I do know d50 is not long acting, an hour at most. Regular peaks at 1.5 to 2 hrs.

Did the patient eat? Could they eat?

I think the langue dose needed to be looked at as well as omitting the regular insulin dose.

I wonder if she gave the insulin before/after the sugar check?

fjluce · Dec 19, 2017

The patient had eaten, but not enough to be considered a full meal so per hospital policy the pt was given the coverage dose of regular insulin and not coverage plus base dose. The insulin was given on the shift before us and the pt had the same dose the night before with the exception of the regular insulin which he got 11 units (base plus coverage)

jodispamodi · Dec 19, 2017

In our unit, right in the mar parameters were made for giving D50, usually, but it was specific to where the fsbs was so give 1 for 60-50 2 for 30-40 etc (I'm making up the dosages and bs because I'm not looking at the mar right now) and we were to give it on symptomatic patients, asymptomatic got juice and cookies, also it required checking bs at specific times prior to giving next dose. so ours is pretty specific.

rkitty198, BSN, RN · Dec 19, 2017

The patient had eaten, but not enough to be considered a full meal so per hospital policy the pt was given the coverage dose of regular insulin and not coverage plus base dose. The insulin was given on the shift before us and the pt had the same dose the night before with the exception of the regular insulin which he got 11 units (base plus coverage)

Must be a case of patients metabolic needs outweighing the food/insulin ratio.

rkitty198, BSN, RN · Dec 19, 2017

In our unit, right in the mar parameters were made for giving D50, usually, but it was specific to where the fsbs was so give 1 for 60-50 2 for 30-40 etc (I'm making up the dosages and bs because I'm not looking at the mar right now) asymptomatic got juice and cookies, also it required checking bs at specific times prior to giving next dose. so ours is pretty specific.

I love the specifics of the policy that helps, except the juice and cookies! Geeze. No complex carbs or protein in that. Peanut butter or protein powder added to the juice? That sounds like a quick way to up the glucose but a quick way to drop shortly after.

amoLucia · Dec 19, 2017

Your facility pharmacy might be able to give you some information. Even in LTC on my NOC shifts, our on-call consultant would call me back for my questions. And I did call them many times. I could always pick their brains or ask for a second opinion.

Now this comment may be really off the wall, but any chance that the D50 amps may have expired? I don't know if expired dextrose DE-ACTIVATES (maybe consultant could tell me?) Bad batch? So, I'm just thinking out loud and just fishin!

I've since retired some years ago, and then in my LTCs/NHs, we didn't do IV dextrose. Like I said, here, I'm just thinking out loud ...