Nephrolithiasis, Suspected — MD Orders — Clinical Pathway: Emergency

Nephrolithiasis Clinical Pathway — Emergency Department

MD Orders

Laboratory

  • Send BMP, phosphate, CBC if:
    • Concern for electrolyte abnormality
    • Renal insufficiency
    • Fever or concern for infection
  • Consider need for urine culture, HCG

Intravenous Fluids

For clinical dehydration, ongoing losses
Normal saline bolus 20 ml/kg

Analgesia

Assess and treat pain (use appropriate pain scores). Before treating stone pain with NSAIDs, consider checking BMP first in children with extended period of poor PO intake before presentation or AKI.

Oral

Acetaminophen 15 mg/kg PO Max 650 mg
Ibuprofen 10 mg/kg PO Max 600 mg
Oxycodone 0.1-0.15 mg/kg PO Max 10 mg

Intravenous

Ketorolac 0.5 mg/kg IV Max 30 mg
Morphine 0.05-0.1 mg/kg IV

Radiology

Use ED order set for suspected nephrolithiasis.