DOSAGE CALCULATIONS (ADULT AND PEDIATRICS)

Introduction

 Three systems of measurement- metric, apothecary, and household-are used to

measure drugs and solutions.

 Metric system
 Is a decimal system based on the power of 10.
 Basic units of measure are GRAM (g, gm, G, GM) for weight; LITER (L) for volume;
and METER (m, M) for linear measurement or length.
 KILO is the prefix used for larger units (e.g., kilometer) and milli, centi, micro, and
nano are the prefixes used in smaller units (e.g., millimeter)

 Apothecary system
 Was the common system used by the most practitioners before the universal
acceptance of the international metric system.
 Uses roman numerals instead of Arabic numbers to express the quantity.
 The unit of weight is the grain (gr), and the units of fluid volume is ounce (oz)

 Household system
 Not as accurate as the metric system because lack of standardization of spoons,
cups, and glasses.
 A teaspoon is considered to be equivalent to 5ml according to the official United
States pharmacopeia.

Calculations of Oral Dosage

Introduction

 80% of all drugs consumed are given orally.

 Oral drugs are available in tablet, capsule, powder, and liquid form.
 Written abbreviation for the drug given orally is PO or P.O. (per mouth)

Calculation for Tablet, Capsule, and Liquid doses

Examples:
1. Order: diltiazem (cardizem) 60 mg PO b.i.d.
Available: diltiazem (cardizem) 30 mg

Solution:
Formula = D/S x Q or D
-----x Q where: D= doctor’s order (DOSE DESIRED)
S S= (DOSE ON HAND) stock dose
Q= quantity
60mg
------- x 1 = 2 tablets
30mg

2. Order: clarithromycin (Biaxin) 100mg PO q6

Available: 125mg per 5ml

D 100mg
-----x Q = ----------- x 5ml = 4ml
S 12mg
Body Weight and Body Surface Area

 Calculating the drug dosage for adults by body weight (BW) and body surface area
used mostly when administering drugs to treat cancer (antineoplastic drugs)
 These two individualized methods are used frequently to calculate dosages for
children.

 To use the body weight method, convert the person’s weight in pounds to kilograms
(kg).
 To convert, divide pounds by 2.2 to equal kilograms.
 To use the body surface area (BSA) method, the person’s weight and height and a
nomogram is needed.

Example:
Order: cyclophosphamide (cytoxan) 2mg/kg PO daily. Client weighs 143 lb.
How much the client weights in kilograms? How many mg should the client receive?

Solution:
143/ 2.2= 65 kg
2mg x 65kg= 130 mg of cyclophosphamide (cytoxan)

Calculations of Injectible Dosages

Introduction

 When medication cannot be taken by mouth because:

 An inability to swallow
 A decreased level of LOC
 An inactivation of the drug by gastric juices
 A desire to increase the effectiveness of the drug

 Parenteral route may be the route of choice.

 Parenteral medications are administered INTRADERMALLY (ID under the skin),
SUBCUTANEOUSLY (SQ into the fatty tissue), INTRAMUSCULARLY (IM within the
muscle) and INTRAVENOUSLY (IV in the vein)
 Injectible preparations are in appropriate container (vial or ampule)

Interpreting Injectible Drug Labels

Intradermal injections
Usually used for skin testing to diagnose the cause of an allergy or to determine the
presence of a microorganism

Subcutaneous injections
Drugs injected to the subcutaneous or fatty tissues are absorbed slowly because there are
fewer blood vessels in the fatty tissue.

Calculation
Order: heparin 2500 units’ subQ
Available: heparin 10,000 units/ml in multiple dose vial (10ml)

Solution:
D 2500 units
-----x Q = ------------ x 1 ml = 0.25ml
S 10,000 units

Intramuscular injections

Muscles have more blood vessels than fatty tissues and are absorbed more rapidly than
those given by SQ injection.
Example:

Drug order: gentamycin (garamycin) 50mg IM

Available: gentamycin 80mg/2 ml in a vial

D 50mg
-----x Q = ----------- x 2ml = 1.25ml
S 80mg

Certain drugs lose their potency in liquid form; therefore manufacturers package these drugs
in powdered form.
They are reconstituted using diluents (bacteriostatic water or saline) before administration.

Example:
Order: cefotetan disodium (Cefotan) 0.5g IM, q12
Available: 1g of cefotetan disodium (Cefotan) add 3ml of diluents

D 0.5g
-----x Q = ----------- x 3ml = 1.5ml
S 1g

Pediatric Drug Calculations

Introduction

 Pediatric dosages differ greatly from those for adults because of the physiologic
differences between the two.
 Neonates and infants have immature kidney and liver function, which delays
metabolism and elimination of many drugs.
 The purpose of learning how to calculate pediatric drug dosages is to ensure that
children receive the correct dose within the approved therapeutic range.

Oral

 Oral pediatric drug delivery usually occurs the use of a calibrated measuring device
because most drugs for small children are in liquid form.
 The measuring device can be a small plastic, an oral dropper, a measuring spoon, or
an oral syringe.

Intramuscular

 Intramuscular sites for drug administration are chosen on the basis of age and muscle
development of the child.

Pediatric dosage per body weight

Example:
Order: cefaclor (Ceclor) 50mg q.i.d. child weighs 15lb or 6.8 kg (15lb/2.2=6.8)
Child’s drug dosage: 20-40 mg/kg/day in three different doses

Available:
cefaclor (Ceclor) 125mg/5ml

drug parameters: 20mg x 6.8kg= 136mg/day

40mg x 6.8kg= 272mg/day
50mg x 4 times= 200mg/day
 D 50mg
-----x Q = ----------- x 5ml = 2ml, give 2ml four times a day.
S 125mg

Pediatric Dosage per Body Surface Area

Directions:
1. Find height
2. Find weight
3. Draw a straight line that connects height and weight
4. Where the line intersects on the BSA column is the body surface area.

Example:
Order: methotrexate (mexate) 50mg weekly. Child’s height is 54 inch and weighs is 90lb
(41kg)
Child’s drug dosage: 25-75mg/m2/week
Child’s height and weight intersect at 1.3m2 (BSA)
 Is the prescribed dose safe?
Answer:
Multiply the BSA, 1.3 m2, by the maximum and minimum doses.

25mg x 1.3m2 = 32.5 mg

75mg x 1.3m2 = 97.5 mg

pediatric dosage from adult dosage

to calculate pediatric dosage from the adult dosage, determine the child’s height and weight.
Where they intersect on the nomogram is the BSA in square meters.

Formula:

Surface area (m2)

------------------------- x adult dose = Pediatric dose
1.73m2

Example:
Order: erythromycin (E-Mycin) 125 mg PO qid. Child’s height is 42 inches and weight is 60lb.
Child’s height and weight intersect at 0.9 m2.
The adult dose is 1000mg/day

0.9m2
--------- x 1000mg/day = 520mg/day
1.73m2

Drug dosage: 520mg/ 4 times a day = 130mg/dose.

Calculations of Intravenous Fluids

Intravenous (IV) fluid is used to administer fluids that contain water, dextrose, vitamins,
electrolytes, and drugs.

Continuous Intravenous Administration

The nurses calculate the IV flow rate according to the drop factor, the amount of fluids to be
administered and time of period.

Intravenous Sets

Various IV sets are marked by Abbott, Cutter, McGaw, and Travenol. The drop
factor, the number of drops per milliliter, is normally printed on the packaging cover of
the IV set. A set that delivers large drops per milliliter (10 to 20 gtts/min) is called
macrodrip set, and one with small drops per milliliter (60gtts/min) is called microdrip set.

Calculating Intravenous Flow Rate

AMOUNT OF FLUID DROP PER MILLILITER (IV SET)

---------------------------- X --------------------------------------------- =DROPS/ MINUTE (GTTS/MIN)
HOURS TO MINUTES PER HOUR (60)
ADMINISTER
DOSAGE CALCULATIONS
ADULT AND PEDIATRIC

IV CALCULATION

ENDORSEMENT

CATALA, KRISTAL
MANLAPAZ, MAYNARD
BSN IV-E
 Exercises:

1. Order: doxepin HCL (sinequan) 30mg PO @bedtime

Available: doxepin HCL (sinequan) 10mg/ capsule

How many capsules should the client receive?

2. Order: digoxin (lanoxin) 0.5mg PO, daily

Available: 250mcg (0.25mg) per tab

How many tablets should the nurse administer?

3. Order: cefadroxil (Duricef) 500mg PO bid

Available: 250mg/5ml

4. Order: heparin 7,500 units subQ

Available: heparin 10,000 units/ml

How many milliliters should the client receive?

5. Order; cefazolin 500mg IV, q6

Available: 1g (diluted 3ml)

How many milliliters should the client receive in one day?

6. Ceftazidine 1.5g IV q6
Available: 2g (diluted @ 10ml of sterile water)

7. Ampicillin 500mg IV q6
Available: 2mg/5ml

8. IV volume is 750ml and should be infused at how many hours if the flow rate is
32gtts/min?

9. Order: 1L of D5 0.5 NSS to infuse over 12h

Available macroset with 10gtts/ml
Calculate for the flow rate.

10. Order: 1000ml of D5 0.5 NSS and 10 mEq of KCL in 10hr

How many milliliters of KCL should be injected into the bag
How many drops per minute using the macroset?