Anticoagulation, endocrine and GI
Insulin (regular) (Humulin R) drip
Humulin R, Novolin R
Dosing
| Start | DKA: 0.1 units/kg/h once K is above 3.5 (2024 consensus; older sources 3.3, or 0.14 with no bolus); bolus 0.1 units/kg only if IV access is delayed. ICU hyperglycemia: per protocol, target 140–180 |
|---|---|
| Titrate | Per protocol with hourly glucose |
| Maximum | Per protocol |
| Common bags | 100 units in 100 mL (1 units/mL) |
| Dose units | units/h, units/kg/h |
Line and administration
- Prime and flush the tubing: insulin binds to plastic
Watch for
Insulin (regular): full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- DKA and HHSDiagnosis (2024 consensus): 2024 changes: DKA glucose 250 → 200 or known diabetes; blood BOHB preferred; HHS effective osmolality 320 → 300; hold insulin if K⁺ <3.5 (was 3.3); dextrose at 250 (was 200). Older books use 2009 numbers.
- Electrolyte ImbalancesHyperkalemia: stabilize, shift, remove: Shift: regular insulin 10 units IV with dextrose 25–50 g. K falls within 15 min, lowest at 30–60 min.
- ICU Nutrition and RefeedingGlucose and daily nursing checks: Insulin for persistent glucose ≥180 mg/dL; do not target 80–139 (SCCM 2024)
- Toxidromes and AntidotesCardiotoxic drugs: Beta-blockers, CCBs: High-dose insulin 1 unit/kg, then 1–10 units/kg/h: Give dextrose; check glucose, K
- After Cardiac SurgeryFirst hours and bleeding: Labs: ABG, Hgb, K, Mg, ionized Ca, coags; glucose 180 mg/dL or less (insulin drip)
- BurnsBurn shock and the systemic response: From about day 3 the flow phase takes over: catecholamines rise up to 50-fold, with cortisol and glucagon (Williams 2009), driving tachycardia, fever, high cardiac output, low SVR, insulin resistance and muscle wasting, so fever and tachycardia no longer prove infection. In children with burns over 30% TBSA the response was still measurable 3 years later (Jesc
Practice DKA and HHS questions free44 exam-style questions with rationales on the topic where insulin (regular) comes up most. No account or download needed.
Other anticoagulation, endocrine and gi
- Heparin
- Amiodarone
- Diltiazem
- Octreotide
- Pantoprazole
- Furosemide
- Argatroban
- Bivalirudin
- Procainamide
- Lidocaine
- Magnesium sulfate
- Naloxone
- Eptifibatide
- Bumetanide
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.