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 · 62 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 62 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to two decimal places.

60 units/kg62 kg5 000 units/mL
V = mL
2.Pediatric & critical-care dosingHard
400 mg250 mLdopamine? mL/h61 kg15 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 400 mg in 250 mL. The order is 15 mcg/kg/min for a patient who weighs 61 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

400 mg/250 mL15 mcg/kg/min61 kg
R = mL/h
3.Dosage calculationsMedium
15 kg30 mg/kg/day4× per dayD = ? mg

A patient weighs 15 kg. The prescribed dose is 30 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?

15 kg30 mg/kg/day4× per day
D = mg
4.Dosage calculationsHard
250 mg/5 mLV = ? mL

A child weighing 12 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 250 mg in 5 mL. What volume V do you give?

12 kg10 mg/kg250 mg/5 mL
V = mL
5.IV infusion ratesMedium
1000 mL15 gtt/mL10 h? gtt/min

Infuse 1000 mL over 10 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute.

1000 mL10 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
1000 mg100 mL12 mL/h? mg/h

A bag contains 1000 mg of a drug in 100 mL and runs at 12 mL/h. How many milligrams per hour D does the patient receive?

1000 mg/100 mL12 mL/h
D = mg/h

3Solutions

1.Pediatric & critical-care dosing

Answer: V = 0.74 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

60·62 = 3 720 units

Volume

V = 3720/5000 = 0.744 ≈ 0.74 mL

Answer

V = 0.74 mL
2.Pediatric & critical-care dosing

Answer: R = 34.3 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

400 mg = 400 000 mcg
400 000/250 = 1600 mcg/mL

Dose per minute and per hour

15·61 = 915 mcg/min
915·60 = 54900 mcg/h

Pump rate

R = 54900/1600 = 34.31 ≈ 34.3 mL/h

Answer

R = 34.3 mL/h
3.Dosage calculations

Answer: D = 112.5 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

30·15 = 450 mg

Per dose

D = 450/4 = 112.5 mg

Answer

D = 112.5 mg
4.Dosage calculations

Answer: V = 2.4 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.

Dose from weight

10·12 = 120 mg

Volume

V = (120/250)·5 = 2.4 mL

Answer

V = 2.4 mL
5.IV infusion rates

Answer: R = 25 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.

Time in minutes

10·60 = 600 min

Drip rate

R = 1000·15/600 = 25 gtt/min

Answer

R = 25 gtt/min
6.IV infusion rates

Answer: D = 120 mg/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.

Concentration

1000/100 = 10 mg/mL

Dose rate

D = 10·12 = 120 mg/h

Answer

D = 120 mg/h

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