Alternate Name(s):
Humulin-R, Novolin GE Toronto
Classification:
Hormone
Original Date:
June 1996
Revised Date:
May 2022
Indications:
- To maintain normoglycemia
- Adjuvant therapy for hyperkalemia
Administration:
- IV continuous infusion
- SC
Dosage:
- Use only Regular insulin for IV administration
- IV continuous infusion: 0.01 - 0.1 units/kg/hour. Titrate infusion based on blood glucose
- SC: 0.1 - 0.25 units/kg/dose Q4-12h
Management of Non- Oliguric Hyperkalemia in the Newborn Infant:
- Commence insulin continuous infusion (at 0.05-0.1 units/kg/hour) along with IV dextrose (to increase GIR to at least 8.3 mg/kg/min)
- After stabilizing, must gradually reduce insulin and glucose over hours to prevent rebound hypoglycemia and hyperkalemia.
Side Effects:
- CVS: tachycardia
- Endocrine and metabolic: hypoglycemia, hypokalemia
Parameters to Monitor:
- Blood glucose one hour after starting infusion and after any change; Q4h once blood glucose stable
- Electrolytes, urine glucose
- For treatment of hyperkalemia: monitor blood glucose q30- 60 min after commencing therapy, and 2 to 4 hrs after stabilizing blood glucose.
Reconstitution and Stability:
** Prior to connecting IV line to the patient, fill the IV line with the insulin infusion and let it stand 15 to 30 minutes. After 15 - 30 minutes, open the IV and rapidly flush through the line with the insulin infusion to prime it.
CHEO:
- Insulin Reg. 100 units/mL (fridge)
- Add 0.02 mL (2 units) to 20 mL D5W
- Final concentration: 0.1 unit/mL
- Insulin Reg. 100 units/mL (fridge)
- Add 0.1 mL (10 units) to 19.9 mL D5W
- Final concentration: 0.5 unit/mL
TOH:
- Insulin Reg. 100 units/mL
- Take 0.1 mL (10 units) add to 9.9 mL D5W
- Take 1 mL of above solution and add to 19 mL of D5W
- Final concentration: 0.05 unit/mL
- Insulin Reg. 100 units/mL (fridge)
- Take 0.1 mL (10 units) add to 9.9 mL D5W
- Take 2 mL of above solution and add to 18 mL D5W
- Final concentration: 0.1 unit/mL
- Insulin Reg. 100 units/mL (fridge)
- Take 0.1 mL (10 units) add to 9.9 mL D5W
- Take 4 mL of above solution and add to 16 mL D5W
- Final concentration: 0.2 unit/mL
- Insulin Reg. 100 units/mL (fridge)
- Take 0.1 mL (10 units) add to 9.9 mL D5W
- Take 10 mL of above solution and add to 10 mL D5W
- Final concentration: 0.5 unit/mL
Compatibility:
- Solutions Compatible: D5W, D10W, TPN, heparin, KCl
References:
- Vemgal P, Ohlsson. Interventions for non-oliguric hyperkalaemia in preterm
neonates. Cochrane Database Syst Rev. 2012 May 16;5:CD005257. - Lexi-Comp Database