Pharmaceutical Calculations Module:

Clinical Calculations

The Clinical Calculations section includes calculations relating to body mass index,
ideal body weight, body surface area, creatinine clearance, chemotherapy dose
calculations, parenteral nutrition formulation, and more.

There is no full Tutorial available for the Clinical Calculations section. Most of the
calculation skills required can be obtained by working through the tutorials for the
other sections of the module. Relevant formulas will be required with the quiz
questions as required. You may also refer to your undergraduate lecture notes,
relevant pharmacy practice / clinical pharmacy texts and the APF.

Below are some clinical equations from the latest APF and a worked example to get
your started.

Body Mass Index (BMI) See APF 19 p224

A 'healthy weight range' can be defined as the body weight, adjusted for height, which
is associated with longest high quality life expectancy. The most widely used weight-
to-height ratio is the ‘body mass index’ (BMI) which is defined as:

BMI (kg/m2) = Weight (kg)

Height (m)²

The BMI is highly correlated with body fat on a population basis, although it can be
misleading in certain circumstances. For example, body builders and other heavily
muscled individuals will have a high BMI but not have excess body fat and could
therefore be incorrectly classified as overweight or obese.

Body Mass Index (BMI) and risk of metabolic complications (i.e., diabetes,
stroke, cardiovascular disease):

BMI Classification Risk

<18.5 underweight low
18.5-24.9 healthy average
25-29.9 overweight increased
30-34.9 obesity (class 1) moderate
35-39.9 obesity (class 2) severe
>40 morbid obesity (class 3) very severe

Creatinine and creatinine clearance See APF 19, pp219-220

Creatinine (Females 0.05-1.00 mmol/L; Males 0.05-0.12 nmol/L) is the metabolic

product of muscle metabolism. Its level is a reflection of both muscle mass and
kidney function, as creatinine is predominantly eliminated by glomerular filtration
through the kidney. Low levels may indicate protein starvation, liver disease or
pregnancy. High levels are seen in kidney failure, muscle degeneration, and effects of
some drugs which block renal secretion (eg cimetidine, trimethoprim).

The Cockroft-Gault Equation provides one method of estimating Creatinine

clearance.

Creatinine = 140- Age (yrs) x Ideal Body Weight(Kg)

Clearance (CrCl) 815 x Serum Creatinine (mmol/L)

For females multiply by 0.85 to account for the reduced muscle to ideal body weight
ratio in comparison to males.

Ideal body weight

Ideal Body Weight for Male

= 50 kg + 0.9 kg/each cm above 152 cm

Ideal Body weight for Female

= 45.5 kg + 0.9 kg/each cm above 152 cm

The use of ideal body weight is particularly important in overweight or obese

individuals. For other patients actual body weight may be used.

Creatinine Clearance and Levels of Renal Impairment

Normal Range Males 75-190 mL/min

Females 85-160 mL/min

Mild impairment 25-50 mL/min

Moderate impairment 10-25 mL/min
Severe impairment <10 mL/min
See AMH 2004 p xix

Example:
A 79-year old, 70 Kg man who is 172 cm tall has a serum creatinine level of 0.15 mmol/L.
What is his creatinine clearance?

Creatinine = 140- Age (yrs) x IBW (Kg)

Clearance (CrCl) 815 XSerum Creatinine (mmol/L)

= 140-79 X 68*
815 x 0.15
= 34 mL/min

*Ideal Body Weight = 50 + 0.9 x (172-152)

= 68 kg

This individual would be suffering from mild renal impairment

Based on notes prepared by: Louis Roller, 2004

© Monash University, 2005