Sliding Scales

HEPARIN

An initial heparin bolus of 60 U/kg, followed by a maintenance infusion of 12 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.

PTT (sec)	Change	IV infusion
< 35	70 U/kg bolus	Increase by 3 U/kg/hr
35 – 49	35 U/kg bolus	Increase by 2 U/kg/hr
50 – 70	no change	no change
71 – 90	no change	Decrease by 2 U/kg/hr
> 90	Hold infusion for 30 minutes	Decrease by 3 U/kg/hr

Becker BC, et al. A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease. Am Heart J. 1999;137:59-71.

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:

FBS	Action
< 50	1 amp D₅₀ IV and call MD
51 – 80	Give juice and repeat in ½ hour
81 – 200	No coverage
201 – 250	3 U regular insulin SQ
251 – 300	6 U regular insulin SQ
301 – 350	8 U regular insulin SQ
351 – 400	10 U regular insulin SQ
> 400	12 U regular insulin SQ, call MD

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.

SBP	Action
< 100	wipe off
100–120	1"
121–140	2"
>140	3"

POTASSIUM

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

Serum K⁺	KCl (mEq) to give IV or PO
3.7 – 3.8	20
3.5 – 3.6	40
3.3 – 3.4	60
3.1 – 3.2	80
£ 3.0	100

MAGNESIUM

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

Serum Mg²⁺	MgSO₄ (g) to give IV
1.8 – 1.9	1
1.6 – 1.7	2
1.4 – 1.5	3
1.2 – 1.3	4
< 1.2	5