{
  "id": "medical/insulin-dilution-error",
  "signature": "AI instructs a nurse to dilute insulin for IV infusion using normal saline instead of the manufacturer-recommended diluent, causing insulin precipitation",
  "signature_zh": "AI指示护士用生理盐水而非制造商推荐的稀释剂稀释胰岛素用于静脉输注，导致胰岛素沉淀",
  "regex": "(dilute|dilution).*(insulin).*(normal saline|0.9% NaCl|saline).*(IV infusion|intravenous)",
  "domain": "medical",
  "category": "config_error",
  "subcategory": null,
  "root_cause": "Regular insulin (e.g., Humulin R) is compatible with 0.9% NaCl for IV infusion only at specific concentrations; using NS at high concentrations or with certain insulin analogs can cause precipitation and dosing errors.",
  "root_cause_type": "generic",
  "root_cause_zh": "常规胰岛素（如Humulin R）仅能在特定浓度下与0.9%生理盐水兼容用于静脉输注；高浓度或使用某些胰岛素类似物时会导致沉淀和剂量错误。",
  "versions": [
    {
      "version": "Humulin R U-100 (Eli Lilly) prescribing info 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Novolin R (Novo Nordisk) prescribing info 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "ISMP Guidelines for IV Insulin Infusions 2022",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "Use 0.45% NaCl (half-normal saline) as a safer alternative for all insulin dilutions",
      "why_fails": "Half-normal saline is not recommended for insulin dilution; it can cause hemolysis in IV lines and is not tested for insulin stability.",
      "fail_rate": 0.85,
      "condition": "",
      "sources": []
    },
    {
      "action": "Add albumin to the insulin infusion to prevent adsorption to the IV tubing",
      "why_fails": "Albumin is not recommended for routine insulin infusions; it may cause foaming and inaccurate dosing, and is not approved for this use.",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    },
    {
      "action": "Mix insulin directly into the IV bag without dilution",
      "why_fails": "Direct addition without proper dilution can cause insulin aggregation and unpredictable dosing; manufacturer guidelines require specific dilution protocols.",
      "fail_rate": 0.95,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "For Humulin R U-100 IV infusion, dilute 100 units (1 mL) in 100 mL of 0.9% NaCl (final concentration 1 unit/mL). Use a dedicated IV line with a 0.22-micron in-line filter. Do not use D5W or lactated Ringer's without checking compatibility. Example: 'Add 1 mL Humulin R U-100 to 100 mL 0.9% NaCl in a PVC bag.'",
      "success_rate": 0.88,
      "how": "For Humulin R U-100 IV infusion, dilute 100 units (1 mL) in 100 mL of 0.9% NaCl (final concentration 1 unit/mL). Use a dedicated IV line with a 0.22-micron in-line filter. Do not use D5W or lactated Ringer's without checking compatibility. Example: 'Add 1 mL Humulin R U-100 to 100 mL 0.9% NaCl in a PVC bag.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "For Novolin R, use only 0.9% NaCl for dilution at 1 unit/mL concentration. If D5W is required for other medications, use a Y-site connector with a separate insulin line. Always inspect the solution for turbidity before administration.",
      "success_rate": 0.82,
      "how": "For Novolin R, use only 0.9% NaCl for dilution at 1 unit/mL concentration. If D5W is required for other medications, use a Y-site connector with a separate insulin line. Always inspect the solution for turbidity before administration.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "For Humulin R U-100 IV infusion, dilute 100 units (1 mL) in 100 mL of 0.9% NaCl (final concentration 1 unit/mL). Use a dedicated IV line with a 0.22-micron in-line filter. Do not use D5W or lactated Ringer's without checking compatibility. Example: 'Add 1 mL Humulin R U-100 to 100 mL 0.9% NaCl in a PVC bag.'",
    "For Novolin R, use only 0.9% NaCl for dilution at 1 unit/mL concentration. If D5W is required for other medications, use a Y-site connector with a separate insulin line. Always inspect the solution for turbidity before administration."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://pi.lilly.com/us/humulin-r-usp.pdf",
  "official_doc_section": null,
  "error_code": "INSULIN-PRECIP-003",
  "verification_tier": "ai_generated",
  "confidence": 0.85,
  "fix_success_rate": 0.8,
  "resolvable": "true",
  "first_seen": "2024-03-22",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}