Anticoagulant Overdose

Unfractionated Heparin Overdose:

1. Discontinue heparin infusion.

2. Protamine sulfate, 1 mg IV for every 100 units of heparin infused in preceding hour, dilute in 25 mL fluid IV over 10 min (max 50 mg in 10 min period). Watch for signs of anaphylaxis, especially if patient has been on NPH insulin therapy.

Low Molecular Weight Heparin (Enoxaparin) Overdose:

-Protamine sulfate 1 mg IV for each 1 mg of enoxaparin given. Repeat protamine 0.5 mg IV for each 1 mg of enoxaparin, if bleeding continues after 2-4 hours. Measure factor Xa. Warfarin (Coumadin) Overdose:

-Gastric lavage and activated charcoal if recent oral ingestion. Discontinue Coumadin and heparin, and monitor hematocrit q2h.

Partial Reversal:

-Vitamin K (Phytonadione), 0.5-1.0 mg IV/SQ. Check INR in 24 hours, and repeat vitamin K dose if INR remains elevated. Minor Bleeds:

-Vitamin K (Phytonadione), 5-10 mg IV/SQ q12h, titrated to desired INR. Serious Bleeds:

-Vitamin K (Phytonadione), 10-20 mg in 50-100 mL fluid IV over 30-60 min

(check INR q6h until corrected) AND -Fresh frozen plasma 2-4 units x 1.

-Type and cross match for 2 units of PRBC, and transfuse wide open. -Cryoprecipitate 10 U x 1 if fibrinogen is less than100 mg/dL. Labs: CBC, platelets, PTT, INR.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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