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
heparin 5 000 units/mL60 units/kg · 50 kg → V = ? mL

Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 60 units/kg for a patient who weighs 50 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to two decimal places.

60 units/kg50 kg5 000 units/mL
V = mL
2.Pediatric & critical-care dosingHard
800 mg500 mLdopamine? mL/h106 kg10 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 800 mg in 500 mL. The order is 10 mcg/kg/min for a patient who weighs 106 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

800 mg/500 mL10 mcg/kg/min106 kg
R = mL/h
3.Dosage calculationsMedium
1 g+ 4.2 mLV = ? mL

A vial contains 1 g of powder. The label says: add 4.2 mL of water for injection to give a total volume of 5 mL. The prescription is 120 mg. What volume V of the reconstituted solution do you give?

1 g+ 4.2 mL → 5 mL120 mg
V = mL
4.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 320 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

320 units1000 units/mL
V = mL
5.IV infusion ratesMedium
V = ?20 gtt/mL25 gtt/min2 h

A drip runs at 25 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 2 hours?

25 gtt/min20 gtt/mL2 h
V = mL
6.IV infusion ratesHard
300 mL60 gtt/mL28 gtt/mint = ? h

A drip runs at 28 gtt/min through a set of 60 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

28 gtt/min60 gtt/mL300 mL
t = h

3Solutions

1.Pediatric & critical-care dosing

Answer: V = 0.6 mL

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.

Units needed

60·50 = 3 000 units

Volume

V = 3000/5000 = 0.6 mL

Answer

V = 0.6 mL
2.Pediatric & critical-care dosing

Answer: R = 39.8 mL/h

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

800 mg = 800 000 mcg
800 000/500 = 1600 mcg/mL

Dose per minute and per hour

10·106 = 1060 mcg/min
1060·60 = 63600 mcg/h

Pump rate

R = 63600/1600 = 39.75 ≈ 39.8 mL/h

Answer

R = 39.8 mL/h
3.Dosage calculations

Answer: V = 0.6 mL

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 after mixing

1000 mg/5 mL = 200 mg/mL

Volume

V = 120/200 = 0.6 mL

Answer

V = 0.6 mL
4.Dosage calculations

Answer: V = 0.32 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Volume

V = 320/1000 = 0.32 mL

On the syringe

On this 1 mL syringe every small line is 0.01 mL.

Answer

V = 0.32 mL
5.IV infusion rates

Answer: V = 150 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

25·60/20 = 75 mL/h

Volume

V = 75·2 = 150 mL

Answer

V = 150 mL
6.IV infusion rates

Answer: t = 10.7 h

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

28·60/60 = 28 mL/h

Time left

t = 300/28 = 10.71 ≈ 10.7 h

Answer

t = 10.7 h

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