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/mL80 units/kg · 85 kg → V = ? mL

Practice exercise (made-up values, not clinical guidance). A practice protocol calls for a heparin bolus of 80 units/kg for a patient who weighs 85 kg. The vial contains 5 000 units/mL. What volume V do you draw up? Round to one decimal place.

80 units/kg85 kg5 000 units/mL
V = mL
2.Pediatric & critical-care dosingHard
400 mg250 mLdopamine? mL/h71 kg3 mcg/kg/min

Practice exercise (made-up values, not clinical guidance). A bag contains dopamine 400 mg in 250 mL. The order is 3 mcg/kg/min for a patient who weighs 71 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.

400 mg/250 mL3 mcg/kg/min71 kg
R = mL/h
3.Dosage calculationsMedium
71 kgBSA = 1.58 m²375 mg/m²D = ? mg

A patient weighing 71 kg has a body surface area of 1.58 m². The prescription is 375 mg/m². Find the dose D in mg.

71 kgBSA = 1.58 m²375 mg/m²
D = mg
4.Dosage calculationsHard
84 kg181 cmBSA = √(h·w/3600)25 mg/m²D = ? mg

A patient is 181 cm tall and weighs 84 kg. The prescription is 25 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

181 cm84 kg25 mg/m²
D = mg
5.IV infusion ratesMedium
250 mL10 gtt/mL4 h? gtt/min

Infuse 250 mL over 4 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL4 h10 gtt/mL
R = gtt/min
6.IV infusion ratesHard
300 mL15 gtt/mL20 gtt/mint = ? h

A drip runs at 20 gtt/min through a set of 15 gtt/mL. There are 300 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

20 gtt/min15 gtt/mL300 mL
t = h

3Solutions

1.Pediatric & critical-care dosing

Answer: V = 1.4 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

80·85 = 6 800 units

Volume

V = 6800/5000 = 1.36 ≈ 1.4 mL

Answer

V = 1.4 mL
2.Pediatric & critical-care dosing

Answer: R = 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

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

Dose per minute and per hour

3·71 = 213 mcg/min
213·60 = 12780 mcg/h

Pump rate

R = 12780/1600 = 7.987 ≈ 8 mL/h

Answer

R = 8 mL/h
3.Dosage calculations

Answer: D = 592.5 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Dose

D = 375·1.58 = 592.5 mg

Answer

D = 592.5 mg
4.Dosage calculations

Answer: D = 51.38 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Body surface area

BSA = √(181·84/3600) = √4.223 = 2.055 m²

Dose

D = 25·2.055 = 51.38 mg

Answer

D = 51.38 mg
5.IV infusion rates

Answer: R = 10 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

4·60 = 240 min

Drip rate

R = 250·10/240 = 10.42 ≈ 10 gtt/min

Answer

R = 10 gtt/min

At the bedside you round to the nearest whole drop: 10 gtt/min.

6.IV infusion rates

Answer: t = 3.8 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

20·60/15 = 80 mL/h

Time left

t = 300/80 = 3.75 ≈ 3.8 h

Answer

t = 3.8 h

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