Hello, My health system sees limited pediatric patients. We are developing an insulin drip orderable for kids in DKA to be used while awaiting transfer to a nearby children's hospital. We use Baxter Sigma pumps; hence at the lowest rate (0.5 mL/hr), they may be off as much as 20%.

Key players are debating risks and benefits of using a non-standard insulin drip concentration (0.2 or 0.5 units/mL) in these patients given variability of pump accuracy at low doses using the standard 1 unit/mL concentration.

What have other hospitals done in this situation? Any insight or lessons learned would be appreciated.

Megan Fragale, PharmD, MS, BCPS
Medication Safety Officer
Skagit Regional Health
Mount Vernon, Washington