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1Formulas and methods
Pharmacy calculations
Percentage strength
% w/v = g per 100 mL
Amount in a solution
g = % × mL / 100
Ratio strength
1:X = 1 g in X mL; % = 100 / X
Reconstitution
final volume = diluent + powder volume
Concentration
mg/mL = drug in vial / final volume
Alligation
parts of H = T − L, parts of L = H − T
Water or base
0%
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.
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
2Practice problems
1.Pharmacy calculationsMedium
A solution has a ratio strength of 1:10 000. You need 0.28 mg. Draw up the volume in the 10 mL syringe: what volume V is that?
1:10 0000.28 mg
V = mL
2.Pharmacy calculationsHard
A vial holds 1000 mg of powder. You add 9.6 mL of diluent, and the powder adds 0.4 mL of volume. The prescription is 130 mg. Draw up the dose: what volume V do you give?
1000 mg9.6 mL + 0.4 mL130 mg
V = mL
3.Dosage calculationsMedium
A patient weighs 12 kg. The prescribed dose is 30 mg/kg per day, given in 3 equal doses. How many milligrams D are given per dose?
12 kg30 mg/kg/day3× per day
D = mg
4.Dosage calculationsHard
A child weighing 12 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?
12 kg10 mg/kg125 mg/5 mL
V = mL
5.IV infusion ratesMedium
A drip runs at 20 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 4 hours?
20 gtt/min15 gtt/mL4 h
V = mL
6.IV infusion ratesHard
500 mg of a drug is diluted in 500 mL and given by gravity through a set of 15 gtt/mL. The order is 60 mg per hour. Find the drip rate R in drops per minute.
500 mg/500 mL60 mg/h15 gtt/mL
R = gtt/min
7.Pediatric & critical-care dosingMedium
Practice exercise (made-up values, not clinical guidance). A bag contains 25 000 units of heparin in 250 mL. The order is 20 units/kg/h for a patient who weighs 79 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
25 000 units/250 mL20 units/kg/h79 kg
R = mL/h
8.Pediatric & critical-care dosingHard
Practice exercise (made-up values, not clinical guidance). A dobutamine infusion of 250 mg in 250 mL runs at 30 mL/h. The patient weighs 52 kg. What dose D in mcg/kg/min is the patient receiving? Round to one decimal place.
250 mg/250 mL30 mL/h52 kg
D = mcg/kg/min
3Solutions
1.Pharmacy calculations
Answer: V = 2.8 mL
Strength to volume: turn the strength into mg per mL first. A w/v percentage is grams per 100 mL, so x% = 10x mg/mL. A ratio strength 1:n is 1 g in n mL. After reconstitution the concentration is the powder's dose over the final volume (diluent + powder volume). Then volume = dose/concentration.
Strength in mg/mL
1000 mg/10 000 mL = 0.1 mg/mL
Volume
V = 0.28/0.1 = 2.8 mL
Answer
V = 2.8 mL
2.Pharmacy calculations
Answer: V = 1.3 mL
Strength to volume: turn the strength into mg per mL first. A w/v percentage is grams per 100 mL, so x% = 10x mg/mL. A ratio strength 1:n is 1 g in n mL. After reconstitution the concentration is the powder's dose over the final volume (diluent + powder volume). Then volume = dose/concentration.
Final volume and concentration
9.6 + 0.4 = 10 mL
C = 1000/10 = 100 mg/mL
Volume
V = 130/100 = 1.3 mL
Answer
V = 1.3 mL
3.Dosage calculations
Answer: D = 120 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
30·12 = 360 mg
Per dose
D = 360/3 = 120 mg
Answer
D = 120 mg
4.Dosage calculations
Answer: V = 4.8 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 = (120/125)·5 = 4.8 mL
Answer
V = 4.8 mL
5.IV infusion rates
Answer: V = 320 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
20·60/15 = 80 mL/h
Volume
V = 80·4 = 320 mL
Answer
V = 320 mL
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
500/500 = 1 mg/mL
Volume per hour
60/1 = 60 mL/h
Drip rate
R = 60·15/60 = 15 gtt/min
Answer
R = 15 gtt/min
7.Pediatric & critical-care dosing
Answer: R = 15.8 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
20·79 = 1 580 units/h
Concentration
25 000/250 = 100 units/mL
Pump rate
R = 1580/100 = 15.8 mL/h
Answer
R = 15.8 mL/h
8.Pediatric & critical-care dosing
Answer: D = 9.6 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
250 000/250 = 1000 mcg/mL
Micrograms per minute
30·1000 = 30000 mcg/h
30000/60 = 500 mcg/min
Per kilogram
D = 500/52 = 9.615 ≈ 9.6 mcg/kg/min
Answer
D = 9.6 mcg/kg/min
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