Metformin (Neoform) 500mg tab; Female = BW x 0.

5 IVF TO HOOK: (Glucophage) 500, Mild = 125-135 = nausea, malaise CHF/MI = D5W250 800mg tab 500 TID, 850mg forte BID Mod = 110 120 = lethargic, headache Renal, ESRD, Inc Na = D50.3NaCl500 with food max Severe= <110 = seizure CVA = any IVF Except pure D5W 1st line 3g/day Coma PLR ALPHA GLUCONIDASE: HONK = >330 mosm/kg Dec K = D5NM (PNSS + KCl, NO D5 Acarbose (Glucobay) 50,100mg tabTID DKA <300mosm/kg containing with 1st Na Deficit: DM = PLR/PNSS Except hypoglycemia mouthful of food; max 300mg/day (D-A) x 0.6 X BW LBM = PLR, D5LR, D5NR, D5NM Voglibose (Basen) 200, 300mcg NaCl tab = 17 DHF = D5NSS, PNSS TID max 600mcg/day Corrected Na VOL = PNSS 0.016 (glucose mg% - 100) + Na ARTERIAL BLOOD GAS: Potassium deficit: ph = 7.35-7.45 (D-A) x 100 HCO3 = 22-26 THIAZOLIDINIDIONES: Corrected Calcium: pCO2 = 35-45 Rosiglitazone (Avandia) 4-8mg tab [ 4 albumin (g/dl)] x 0.8 + Ca FIO2 Requirement: OD; max 8mg/day Calcium gluconate = 90mg A = 103.5 (0.42 x-age) INSULIN SECRETAGOGUES: CaCo3 tab = 500mg B = pCO2 / 0.8 Repaglinide (Novonorm) 0.5 2mg/tab C = 713 (FIO2) B b4 meals D = pO2 / C Max 6mg/day DRIPS C=dose/rate E = (A / D + B) / 713 UNSTABLE ANGINA AMINOPHYLLINE DRIP: FIO2 = 4 x LPM + 20 I = new onset; pain in last 2 mos D5W250cc + 1 amp amino (250mg/amp) x 15cc/h pF = pO2 / pCO2 (NV = 400 500) II = angina at rest preceeding mos; to 40 cc/hr MV = TV x RR (NV = 6-10L) not within 48hrs RSBI = RR / TV x 1000 (NV 60 100) III = acute, during preceeding 48hrs NV: 0.2 0.3 mg/dl (narrow therapeutic index) Rate / wt = 15cc / 60 = 0.2 OR 250 / 250 x 15 / 7 TV = 6- 8 cc/hr A = non cardiac = 0.2 B = cardiac BURINEX DRIP: Metabolic Acidosis: C = post infarction D5W80cc + 5 amps burinex (10mg) x 10cc/hr Dec pCO2 = (1.5 x HCO3) + 8 2 1 = no or minimal treatment (1mg/hr) mmHg 2 = standard tx Metabolic Alkalosis: 3 = occur despite max dose (PO/IV) CATAPRESS DRIP: D5W250cc + 2 amps (20mg/amp) x 15-30 cc/hr Inc pCO2 = (0.9 x HCO3) + 9 2 mmHg KILLIPS CORDARONE DRIP: Respiratory Acidosis: (ACUTE) I = no signs of congestion D5W250cc + 3 amps cordarone (150mg/amp) x HCO3 = pCO2 x (1/10) 3 meqs/LII = mod HF / bibasal crackles, JVP KVO Respiratory Acidosis: (CHRONIC) congestion HCO3 = pCO2 x (3/10) 4 meqs/LIII = severe heart failure, rales >50%, Tablet: 200mg TID x 14days then 200 OD DIAZEPAM DRIP: Respiratory Alkalosis: (ACUTE) pulm edema D5W100cc + 2 amps (5mg/ml = 1 amp) q 6hrs HCO3 = pCO2 x (2/10) but not IV = shock (60mg/day) <18meqs/L CREATININE CLEARANCE: DOBUTAMINE DRIP: Respiratory Alkalosis: (CHRONIC) (140 age) wt in kilograms D5W250cc + 1 amp (250mg in 20ml) x 10cc/hr HCO3 = pCO2 x (4/10) but not 72 x Crea (mg/dl) 16.66 x 10 / 60kg = 2.7ukm OR 250 / 250 X 10 <14meqs/L x 0.85 (female) 60kg ACUTE RESPIRATORY FAILURE NV: male: 100-125 ml/min = 0.16mg/kg/hr x 1000 / 1kg x 1hr/60min = 2.7 I = hypoxemia ( V / Q mismatch) Female: 85-105 ml/min ukm Pneum/ PE / ARDS 80-120 = normal DOPAMINE DRIP: II = hypercapnia >50 = renal impairment D5W250cc + 1 amp dopa x 10cc/hr COPD / Asthma / stroke 20-50 = renal insufficiency 13.33 x 10 x 1 / 60kg = 2.2 ukm III = Post- op 5-20 = renal failure DORMICUM DRIP: Atelectasis < 5 = uremia PNSS98cc + 2 amps (5mg/ml/amp) x 10cc/hr IV = Extrapulmonary Stages: EPINEPHRINE DRIP: Sepsis, SCD I = >90 D5W250cc + 5 amps (1mg/ml/amp) x 10-30cc/hr II = 60-90 HEPARIN DRIP: DECADRON in DENGUE III = 30-59 D5W99cc + 1 amp heparin (1:5000 IU/ml) x 0.5cc q 30 min x 4 doses IV = 15-39 20cc/hr (1000 u/hr) 0.25cc q 2 hrs x 4 doses V = <15 0r dialysis 5000 u / 100ml x 20cc = 1000 u/hr 0.25 q 6 hrs x 4 doses BUN/CREA RATIO: APTT (1.5 2.5x) = q 6 APTT <19 = renal Bolus = 60-80mg/kg IV push (bolus) INSULIN >20 = pre renal HYDRALAZINE DRIP: Short Acting - HR, Actrapid HM, Humalog D5W250cc + 2 amps (20mg/amp) x 5-60ugtts/min Intermediate HN, Monotard HM, ANION GAP: (NV 10-11mmol/L) HYDERGINE DRIP: Protaphane HM Na (Cl + HCO3) D5NM1L + 6amps (300mcg/ml) x 16-24hrs x dos Long Acting ultralente, ultrapid HM INSULIN DRIP: GFR = 125 (Age x 0.96) PNSS99cc +1cc insilun (100ml) x 10cc/hr (10u/hr ONSET PEAK DURATION 100ml/100 x 10cc/hr = 10 u/hr SERUM EFFECTIVE OSMOLALITY: SHORT A 15MIN 2-4 HRS 6-12 HRS ISOKET DRIP=proload unloader = congestion 2Na = (RSB / 18) INTER A 2-4 HRS 8-12 HRS 18-24 HRS D5W90cc + 1amp (10mg/10ml) x 10cc/hr (1mg/hr LONG A 4-6 HRS 24-36 HRS PLASMA OSMOLALITY (NV 280 300 CP = Isordil 5mg SL x 3 doses (5min apart) SE: dec BP (inf wall infarct) mosm/L) Start: Sulfonylureas Persistent CP = morphine Older px : Glipizide (Minidiab) CLOSE: 2(Na + K) + BUN + RBS (mmol/L) Younger px: Glibenclamide 1. hypotension ` 2.818 Add Biguanides in unresp to sulfonylureas 2. no chest pain Metformin 500 TID 3. headache BODY MASS INDEX: Add Alpha glucosidase if with post pran ASA = only given Wt in kg /(Ht in meters)2 hypergly NO NSAIDS NV: underwt = <18.5 Acarbose (Glucobay) 50 -100mg TID with LEVOPHED DRIP: Normal = 18.5 24.9 1st mouthful D5W250cc + 8mg Levo x 10cc/hr Overt = 25 -29.9 Add Thiazolidinedione 8000ug/250 cc = 32ug/cc Obese = > 30 Rosiglitazone (Avandia) 4-8mg OD [(cc/hr)/wt (kg)] x [(ug/cc)/60min/hr]= ukm SULFONYLUREAS: LIDOCAINE DRIP: Bicarbonate Deficits: Glipizide (Minidiab) 2.5 / 5mg tab D5W250cc + 1 grm lidocaine x 15cc/hr (1mg/min) (D-A) x BW x 0.4 BID / TID 30mins AC; max 40mg/day 1000mg / 250ml x 15cc/hr x 1hr/60min = 1 2 Gliclazide 80mg/tab MANNITOL DRIP: given thru SIM/IV BID-TID with food; max 320mg/dl Mannitol250cc + Furo 100mg x 10ugtts/min O given thru drip Glibenclamide (Hovid, Euglocon) 2.55mg Mannitol36cc + furo 250mg x 6hrs 1amp = 50meqs NaHCO3 OD- BID with food max 20mg/day MORPHINE SO4 DRIP: Push Bicarb ph < 7.2 Glimepiride (Solosa) 1,2,3mg tab PNSS1L +1amp x 6ugtts/min (2mg/hr) HCO3 = <15 OD with food max 8mg NICARDIPINE DRIP: Water Deficit: Chlorpropamide (Diabinese) 250mg tab D5W90cc + 1amp (10mg/10ml) x 10cc/hr (1mg/hr OD in AM with food max 500mg/day TBW x{ (A-140) /140 } - 1 15mg/hr) TBW: male = BW x 0.6 BIGUANIDES: 10 / 100 x 10 = 1mg/hr

NIMODIPINE DRIP: Conc 10mg/50ml vial Drip: 5-10ugtts/min (1-2mg/hr) PHENYTOIN LOADING 300mg/IVT q4 x 2 doses then 100mg/IVT q6 POTASSIUM DRIP: PNSS80cc + 40meqs KCl x 20cc/hr (8meq/hr) 40/100 x 20 = 8meqs/hr D5NM1L X 8hrs = 13/8 = 1.6meqs/hr SANDOSTATIN DRIP: D5W99cc + 1amp (0.1mg/ml or 0.5mg/ml) x 10cc/hr SODIUM HCO3: D5W50cc + 1 amp (50mg) x 20cc/hr (10meqs/hr) 50/100 x 20 = 10mg/KCl SOMATOSTATIN DRIP: Give 250mg SIVT then D5W500cc + 3 mg x 42cc/hr (250mcg/hr) OR D5W250cc + 3mg x 21cc/hr x 2-5days STREPTOKINASE DRIP: D5W90cc + 1.5Million x 1 hr TERBUTALINE DRIP: D5W250cc + 5amps x 10-30cc/hr

Nexium Drip:

PNSS 80cc + 2 amps nexium x 10cc/hr

Pantoloc Drip:
PNSS 90cc + 2amps Pantoloc x 10cc/hr

FBS BUN CREA URIC ACID CHOLESTEROL TRIGYLCERIDES HDL LDL VLDL HDL RATIO TOTAL PROTEIN ALBUMIN GLOBULIN A/G TOTAL BILIRUBIN DIRECT BILIRUBIN INDIRECT BILIRUBIN SGOT SGPT ALKALINE PHOS ACID PHOSPHATASE AMYLASE

70.7 116.0 7.79 21.40 0.50 1.20 0.0 - 7.11 0.0 200.0 0.0 201.75 35.0 65.0 60.0 159.0 0.0 - 40.0 Less than 4.0 6.4 - 8.3 3.2 - 5.0 1.2 - 3.2 0.0 - 1.0 0.0 - 0.20 0.0 - 0.80 0.0 - 37.0 0.0 - 41.0 35.0 129.0 0.0 - 7.3

28.0 100.0 LIPASE 13.0 60.0 CREATINE 0.0 IV Soln GLU Na Cl K C KINASE 170.0 CKMB 0.0 - 24.0 D 5W 50 CKMM 9.0 D10W 100 - 160.0 MAGNESIUM 1.58 0.9NSS/P 15 15 2.56 2.69 D5PHOSPHORUS 13 LR 10 4 3 4.48 POTASSIUM 3.8 - 5.5 1 NM 40 40 SODIUM 135.0 145.0 NR 14 98 5 CHLORIDE 96.0 108.0 D30.9NaC 50 15 15 CALCIUM 8.4 - 11.0 135.0 - 1 D5LDH NM1L 50 40 40 225.0 ASO ETIOLOGY ANATO Less than PHYSIOLOGY 200.0 MY RA Less than HCVD FACTOR LVH CHF 14 IU Ess. HPN LAE NSR COMPLEMNT 0.90 - 1.8Stable IHD 2 vessel Chronic CAD C3 etc angina ACS LAD Ant. Wall MR/MS TR/TS Unstable angina MI CHF AF CHF AF CHF AF

HCO 28 FUNC CLASS NYHC Canadian Class Braunwald Killips NYHC

RHD RF Valvular HD Congenita l HD Valvular HD Infectious HD Endocardi tis Myocarditi s

VSD ASD etc

NYHC

NYHC