Pediatric and Critical-Care Dosing: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

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1Formulas and methods

Pediatric & critical-care dosing

Daily dose
mg/day = mg/kg/day × weight (kg)
Doses per day
number = 24 h / dosing interval (h)
Pounds to kilograms
kg = lb / 2.2
Infusion concentration
units/mL = units in bag / bag volume
Pump rate
mL/h = dose per hour / concentration
Titrated drip
mL/h = mcg/kg/min × kg × 60 / (mcg/mL)
Dose from pump rate
mcg/kg/min = mL/h × (mcg/mL) / (60 × kg)
Units
1 mg = 1000 mcg

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

2Practice problems

1.Pediatric & critical-care dosingMedium
100 units50 mLregular insulin? mL/h7 units/h

Practice exercise (made-up values, not clinical guidance). An infusion contains 100 units of regular insulin in 50 mL. The order is 7 units/h. Find the pump rate R in mL/h. Round to one decimal place.

100 units/50 mL7 units/h
R = mL/h
2.Pediatric & critical-care dosingHard
250 mg250 mLdobutamine14 mL/h58 kg? mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 250 mg in 250 mL runs at 14 mL/h. The patient weighs 58 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.

250 mg/250 mL14 mL/h58 kg
D = mcg/kg/min
3.Dosage calculationsMedium
25 kg30 mg/kgD = ? mg

A patient weighs 25 kg and is prescribed 30 mg/kg as a single dose. Find the dose D in mg.

25 kg30 mg/kg
D = mg
4.Dosage calculationsHard
40k units1000 mL? mL/h1500 units/h

An infusion contains 40000 units of a drug in 1000 mL. The prescription is 1500 units per hour. At what rate R do you set the pump, in mL/h?

40000 units/1000 mL1500 units/h
R = mL/h
5.IV infusion ratesMedium
V = ?60 gtt/mL75 gtt/min12 h

A drip runs at 75 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 12 hours?

75 gtt/min60 gtt/mL12 h
V = mL
6.IV infusion ratesHard
1 g500 mL? mL/h1.5 mg/min

A bag contains 1 g of a drug in 500 mL. The order is 1.5 mg per minute. At what rate R do you set the pump, in mL/h?

1 g/500 mL1.5 mg/min
R = mL/h

3Solutions

1.Pediatric & critical-care dosing

Answer: R = 3.5 mL/h

Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Concentration

100/50 = 2 units/mL

Pump rate

R = 7/2 = 3.5 mL/h

Answer

R = 3.5 mL/h
2.Pediatric & critical-care dosing

Answer: D = 4 mcg/kg/min

Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Concentration

250 000/250 = 1000 mcg/mL

Micrograms per minute

14·1000 = 14000 mcg/h
14000/60 = 233.3 mcg/min

Per kilogram

D = 233.3/58 = 4.023 ≈ 4 mcg/kg/min

Answer

D = 4 mcg/kg/min
3.Dosage calculations

Answer: D = 750 mg

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Dose

30·25 = 750 mg

Answer

D = 750 mg
4.Dosage calculations

Answer: R = 37.5 mL/h

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Concentration

40000/1000 = 40 units/mL

Pump rate

R = 1500/40 = 37.5 mL/h

Answer

R = 37.5 mL/h
5.IV infusion rates

Answer: V = 900 mL

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Rate in mL/h

75·60/60 = 75 mL/h

Volume

V = 75·12 = 900 mL

Answer

V = 900 mL
6.IV infusion rates

Answer: R = 45 mL/h

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

1000 mg/500 mL = 2 mg/mL

Dose per hour

1.5·60 = 90 mg/h

Pump rate

R = 90/2 = 45 mL/h

Answer

R = 45 mL/h

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