We recently had a medication incident due to a confusing regular insulin drip titration unit of measures in peds vs. adults patients with DKA - MD meant to order initial regular insulin drip (for ped patient) at 5.4 units/hr, however 5.4 units/kg/hr was entered.

Our peds initial insulin drip order has “units/kg/hr” as a default whereas our adults initial and maintenance insulin drip order has “units/hr” as a default. Note - We do not titrate insulin drip in peds but titrate IV fluid instead.

We are considering changing our protocol by using “units/kg/hr” as a default across the board from initial to titration and in both peds and adults. However, there’s a concern since this major change in practice requires education and monitoring.

What is the current practice at your institution regarding ordering and titration of insulin drip for peds and adult patients?
• What is your initial unit of measure for insulin drip in peds vs adults?
• What is your maintenance unit of measure for insulin drip in peds vs adults?
• Has your site adopted the new ADA DKA guideline (no longer titrate insulin but instead adjusting IV fluid)?

Any additional comments or insights are greatly appreciated!