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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
Convert the ordered dose and the stock strength to the same unit.
Use desired over have times quantity: (D/H) × Q.
For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
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
Pump rate in mL/h: volume divided by time in hours.
Drip rate in drops/min: volume × drop factor divided by time in minutes.
For time remaining: volume left divided by the rate.
Round as the question or the equipment requires.
2Practice problems
1.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). An infusion contains 100 units of regular insulin in 250 mL. The order is 0.1 units/kg/h for a patient who weighs 72 kg. Find the pump rate R in mL/h. Round to one decimal place.
100 units/250 mL0.1 units/kg/h72 kg
R = mL/h
2.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A dopamine infusion of 400 mg in 250 mL runs at 26 mL/h. The patient weighs 84 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.
400 mg/250 mL26 mL/h84 kg
D = mcg/kg/min
3.Dosage calculationsMedium
A patient weighs 60 kg. The prescribed dose is 5 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?
60 kg5 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
A patient weighs 132 lb. The prescription is 0.5 mg/kg as a single dose, and the stock contains 200 mg in 5 mL. Using 1 kg = 2.2 lb, what volume V do you give?
132 lb0.5 mg/kg200 mg/5 mL1 kg = 2.2 lb
V = mL
5.IV infusion ratesMedium
Infuse 250 mL over 2 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.
250 mL2 h15 gtt/mL
R = gtt/min
6.IV infusion ratesHard
250 mg of a drug is diluted in 250 mL and given by gravity through a set of 60 gtt/mL. The order is 40 mg per hour. Find the drip rate R in drops per minute.
250 mg/250 mL40 mg/h60 gtt/mL
R = gtt/min
3Solutions
1.Pediatric & critical-care dosing
Answer: R = 18 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.
Units per hour
0.1·72 = 7.2 units/h
Concentration
100/250 = 0.4 units/mL
Pump rate
R = 7.2/0.4 = 18 mL/h
Answer
R = 18 mL/h
2.Pediatric & critical-care dosing
Answer: D = 8.3 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
400 000/250 = 1600 mcg/mL
Micrograms per minute
26·1600 = 41600 mcg/h
41600/60 = 693.3 mcg/min
Per kilogram
D = 693.3/84 = 8.254 ≈ 8.3 mcg/kg/min
Answer
D = 8.3 mcg/kg/min
3.Dosage calculations
Answer: D = 100 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
5·60 = 300 mg
Per dose
D = 300/3 = 100 mg
Answer
D = 100 mg
4.Dosage calculations
Answer: V = 0.75 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
132/2.2 = 60 kg
Dose
0.5·60 = 30 mg
Volume
V = (30/200)·5 = 0.75 mL
Answer
V = 0.75 mL
5.IV infusion rates
Answer: R = 31 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
2·60 = 120 min
Drip rate
R = 250·15/120 = 31.25 ≈ 31 gtt/min
Answer
R = 31 gtt/min
At the bedside you round to the nearest whole drop: 31 gtt/min.
6.IV infusion rates
Answer: R = 40 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).