ICU said he will write me up
I am an ED nurse , received pt with DKA WITH BS greater than 449. Administered 10 units of insulin IV PUSH , followed by 10 quits of sub Q insulin Lispro, after on hour pt blood glucose is 352. Now pharamaxh calls me with K 6.0 and I inform the doctor. Hyperkalemic protocol is ordered for the pt. Pt is AKI as well along with being in DKA. She is complaint with dialysis and yesterday was her dialysis. Now there is no calcium glucose ordered. I give the D50, 5 units of insulin and bicarbonate 50 mEQ. Then pt is transferred to ICU. ICU CHARGE NURSE shows up and point out my mistake Pt BS GLUCOSE after 2 hours is at 350 in ICU. My mistake was I didn’t read the whole order. Whole order said give D50 and in cases where BS IS greater than 250, do not give D50. That means I was just supposed to give insulin and bicarbonate and not D50. I have given hyperkinetic protocol earlier, this is the first time I see that comment in the prescription order written by MD TO HOLD Off D50 for BS > 250 well I didn’t read. I was not rushing I was just following the protocol that was in my mind . Opinions fellow nurse pls. I checked patient’s chart later out of curiosity and found that pt was put on insulin drip and dialysis was down and pt was subsequently hypoglycemic with blood sugar 51. The insulin drop was stopped then I got busy in ED, so I didn’t snoop around patient’s chart anymore.