Hospital website: http://www.mednet.ucla.edu Links to email, electronic records
How to cover the Ob pager: 231 (or 800-BEEP-231) *95946#1,1 ----- (your 5 digit pager ID)
Electrolytes
Potassium Desired K minus actual K/creatinine x 100 E.g. 4 – 3.2/1 x 100 = 80meq, or 4-3.2/2 x 100 = 40meq **Be very careful in renal failure and don’t replete unless really low if pt’s on HD KCl is in MEQ (not MG) IV K really burns, you can write it as a peripheral IV mix or give it orally liquid or tablets The 20 meq tabs are huge, you can write for 10meq tabs which are smaller
Magnesium Desired magnesium – actual magnesium x 10 - E.g. 2 – 1.4 = 0.6 x 10 = 6 gms magnesium - Cut this in half if renal failure - You can and should still replete magnesium in patients on HD
Phosphorus - Can do neutraphos 2 packets po tid if >2 - IV soln comes in 3 mmol increments - Units are MMOL not mg - If Ph<2, give 9mmol IV Kphos or Naphos - If Ph<1.5, give 15mmol IV Kphos or Naphos - Don’t need to replete in HD, but should replete when on CVVHD
Symptom Management
Bowel movements Colace 100mg po bid – stool softener only – won’t work for real constipation Senna 2tabs po bid – should be standing order for anyone on narcotics
Milk of magnesia 30cc po q6 prn constipation (do not give if renal failure) Miralax 17gm (one packet) po daily prn constipation Dulcolax 5-10mg po or PR bid prn constipation Lactulose 15-30cc po q 6 prn constipation Tap water enema PR x 1 Fleets enema PR x 1 (avoid in renal failure)
Sleep Elderly: Ambien 2.5-5mg po qhs prn insomnia Trazadone 25mg po qhs prn insomnia
Younger (< 50): Restoril 15mg po qhs prn insomnia Ambien 5mg po qhs prn insomnia
Pain Tylenol 650mg po q6 prn pain Vicodin 500/5 mg po q6 prn pain (no more than 4gm tylenol a day, no more than 2gm a day in liver patients) Morphine – good starting dose is 0.05mg/kg IV(or around 4mg in a 70kg adult) – cut everything in half for old or opioid naïve patients Dilaudid – 4 times as potent as morphine
Nausea Compazine 10mg po or IV q6 hours prn nausea Zofran 4mg po or IV q6 hours prn Reglan 10mg po or IV q6 prn (can exacerbate diarrhea) Dronabinol 10mg po q6 for CA pts Ativan 1mg IV (avoid in elderly) *change to around the clock for nausea
Cough Robitussin 10 cc po q4 prn Benzonatate (Tessalon) 100-200mg po tid prn cough Tylenol with codeine 1-2 tabs po q6 hours prn cough Albuterol 2.5mg NEB inh q6 prn cough (if any reactive airways disease)
GI cocktail (for dyspepsia) 30 cc Maalox 10 cc viscous Lidocaine 10 cc Donnatol (optional)
Mucositis cocktail 10 cc viscous Lidocaine 10 cc Maalox 10 cc Benadryl
Itching Benadryl 25mg po q6 prn itching – not for elderly Hydroxyzine (atarax) – 25 mg po q6 prn, can do 10mg po q6 prn for elderly Benadryl cream AAA bid prn itching
