Heparin

Bolus and initial maintenance rate are determined by underlying disease state (higher initial bolus for pulmonary embolism than acute coronary syndrome). Always check with your local hospital pharmacy for correct initial bolus and maintenance rate.

• Acute coronary syndrome: initial bolus = 60 U/kg, initial maintenance rate = 12 U/kg/hr. 
• Pulmonary embolism: initial bolus = 80 U/kg, initial maintenance rate = 18 U/kg/hr

Check PTT and adjust infusion at 6, 12, and 24 hours after the initiation of heparin and QD thereafter. Check PTT 4 to 6 hours after any dose adjustment.

Insulin

For updated insulin sliding scales and regimens that take into account differences between type 1 and type 2 diabetics, see Endocrine: Insulin sliding scale. Included here is the more traditional sliding scale (most hospitals are transitioning toward pre-printed insulin sliding scale order sheets and away from arbitrary insulin sliding scales):

Nitropaste

Apply to chest wall q 6 hours according to sliding scale and after 24 hours, wipe off nightly from 12 a.m. to 6 a.m. to avoid development of tolerance.

Potassium

Caution in renal failure or ESRD. Always check the creatinine prior to replacing potassium.

Magnesium

Caution in renal failure or ESRD. Always check the creatinine prior to replacing magnesium.