Yeah. Here’s my 15 minutes of effort version:
it is our standard reference for all neonatal dosing and how what appropriate dilutions to use. I know the MD who wrote it, he sold it to micromedex a few years ago and is probably sitting on the beach somewhere enjoying life. But it is what EPIC links to as a reference for all things NICU
in general you only want one concentration of an item - especially when it comes to the neonate population - standardization is the key to reduction of errors, this is one item I have spent the last year of my life attempting to do amoungst a hospital system. Often you have to make a larger dilution (in your case 50ml) in order to utilize full vials and come up with a reasonable concentration that is easy to measure
the reasoning would be something like this.
We dilute our insulin to 10u/mL for neonatal compounding, and further for push doses. How you gonna draw up a 0.1unit/kg dose for 500g premi with hyperK in a 30unit syringe?
A 500g neonate isn't the norm. We have a standard dilution for infants needing smaller doses or doses more accurate than 1 unit increments. However, the diluted form is only ordered by pediatric endocrinology. There is a dilution procedure for insulin/dextrose on our neonatal code carts but it is rarely used. A ridiculous amount of hyperK in neonates is due to heel stick hemolysis. We almost never need urgent correction for potassium.
the neonate population is the only place we would consider using a different concentration of insulin - we usually use 1 unit/ml for drips, but in rare circumstances we use 0.5 unit/ml for super preemies. But to do you math above. 0.1 unit/kg in a 500g baby = 0.5 units. You can draw up 0.5 ml of insulin from a 1 unit/ml bag very easy. You don't use an insulin syringe for this population, they are getting IV, use a 1 ml luer lock syringe.
0.1unit/kg x 0.5kg = 0.05 units...which is no bueno with u100 insulin. Technically doable with 1unit/ml bag, but not accurately.
that what I do while trying to do math on my phone - you don't use u100 insulin ever - that is why you do a dilution. We would break out the 0.5 units/ml dilution for this situation. this would be 0.1 ml of this solution - that is easy to do. But seriously - we are a level 4 NICU are I have never had to measure out a dose that low - how often do you get a 500g baby thou? half a lb
Why are your 500g infants getting insulin? I still haven't figured that out. We have 100 total NICU beds including the step down NICU and almost never give insulin.
Kg and lb are different things, FYI
thanks captain obvious - it was a typo- 500g - I meant about a lb
Haha this isn't a patient case, I'm responding to a comment you made. You made the comment above "Why would anyone need to dilute insulin?" I responded with what we do and why. It simply keeps you from having to do less serial dilutions when/if insulin is ordered.
I said: "We almost NEVER dilute insulin or enoxaparin. Why are you diluting them?"
