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 units100 mLregular insulin8 mL/h? units/h

Practice exercise (made-up values, not clinical guidance). An infusion of 100 units of regular insulin in 100 mL runs at 8 mL/h. How many units per hour D does the patient receive?

100 units/100 mL8 mL/h
D = units/h
2.Pediatric & critical-care dosingHard
800 mg500 mLdopamine25 mL/h65 kg? mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A dopamine infusion of 800 mg in 500 mL runs at 25 mL/h. The patient weighs 65 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.

800 mg/500 mL25 mL/h65 kg
D = mcg/kg/min
3.Dosage calculationsMedium
60 kg7.5 mg/kg/day3× per dayD = ? mg

A patient weighs 60 kg. The prescribed dose is 7.5 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?

60 kg7.5 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
40 mg/1 mLV = ? mL

A patient weighs 149.6 lb. The prescription is 0.5 mg/kg as a single dose, and the stock contains 40 mg in 1 mL. Using 1 kg = 2.2 lb, what volume V do you give?

149.6 lb0.5 mg/kg40 mg/1 mL1 kg = 2.2 lb
V = mL
5.IV infusion ratesMedium
20 gtt/mL120 mL/h? gtt/min

An infusion is ordered at 120 mL/h, but no pump is available. It runs by gravity through a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.

120 mL/h20 gtt/mL
R = gtt/min
6.IV infusion ratesHard
200 mg100 mL15 gtt/mL120 mg/h? gtt/min

200 mg of a drug is diluted in 100 mL and given by gravity through a set of 15 gtt/mL. The order is 120 mg per hour. Find the drip rate R in drops per minute.

200 mg/100 mL120 mg/h15 gtt/mL
R = gtt/min

3Solutions

1.Pediatric & critical-care dosing

Answer: D = 8 units/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

100/100 = 1 units/mL

Units per hour

D = 8·1 = 8 units/h

Answer

D = 8 units/h
2.Pediatric & critical-care dosing

Answer: D = 10.3 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

800 000/500 = 1600 mcg/mL

Micrograms per minute

25·1600 = 40000 mcg/h
40000/60 = 666.7 mcg/min

Per kilogram

D = 666.7/65 = 10.26 ≈ 10.3 mcg/kg/min

Answer

D = 10.3 mcg/kg/min
3.Dosage calculations

Answer: D = 150 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.

Total per day

7.5·60 = 450 mg

Per dose

D = 450/3 = 150 mg

Answer

D = 150 mg
4.Dosage calculations

Answer: V = 0.85 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.

Weight in kg

149.6/2.2 = 68 kg

Dose

0.5·68 = 34 mg

Volume

V = (34/40)·1 = 0.85 mL

Answer

V = 0.85 mL
5.IV infusion rates

Answer: R = 40 gtt/min

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.

Millilitres per minute

120/60 = 2 mL/min

Drip rate

R = 2·20 = 40 gtt/min

Answer

R = 40 gtt/min
6.IV infusion rates

Answer: R = 15 gtt/min

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

200/100 = 2 mg/mL

Volume per hour

120/2 = 60 mL/h

Drip rate

R = 60·15/60 = 15 gtt/min

Answer

R = 15 gtt/min

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