PARENTERAL DOSAGE CALCULATION 1 Gm = 1 000 mcg

Dosage Calculation 1 mg = 1 000 mcg

- figuring out the correct dose of medication 1 L = 1 000 ml
STEPS IN CALCULATING MEDICATION DOSAGES 1 gr = 60 mg
1. Be competent in basic math skills 1 tsp = 5 ml
2. Know the measurement equivalents and conversions 1 Tbsp = 15 ml
3. Use calculation formulas correctly 1 oz = 30 ml
SYSTEMS OF MEASUREMENT AND COMMON Basic Formula
EQUIVALENTS 𝐷
× 𝑉 = 𝑎𝑚𝑜𝑢𝑛𝑡 𝑡𝑜 𝑔𝑖𝑣𝑒
1. Metric System 𝐻
Grams and Liters 1. Desired Dose (D)
- basic units of measurement in this system - dose ordered
Grams 2. On-hand/Supplied Dose (H)
- measure weight - dose on label of container
- generally, it indicates solids 3. Vehicle (V)
Liters - form and amount of supplied drug
- measure volume Ex.
- generally, it indicates liquids You have an order for Demerol 35 mg IM every 4 hours
METRIC SYSTEM OF COMMON UNITS OF prn for pain. The medication is supplied as Demerol 50
MEASUREMENT mg/ml in a pre-filled cartridge. How many milliliters will
a. Grams (Gm) you give?
1 Gm = 1 000 mg = 1 000 000 mcg D = 35 mg
b. Milligrams (mg) H = 50 mg/ml
1 mg = 1 000 mcg V = 1 ml
1 mg = 1/1 000 Gm 𝐷 35 𝑚𝑔
×𝑉 = × 1 𝑚𝑙 = 0.7 𝑚𝑙
1 mg = 0.001 Gm 𝐻 50 𝑚𝑔
c. Micrograms (mcg) Order: Compazine 10 mg IM every 6 hours prn for
1 mcg = 1/1 000 mg = 1/1 000 000 Gm nausea
1 mcg = 0.001 mg = 0.000001 Gm Supply: Compazine 5 mg/ml
d. Liters D = 10 mg
e. Milliliters H = 5 mg/ml
2. Apothecary System V = 1 ml
Grain 𝐷 10 𝑚𝑔
×𝑉 = × 1 𝑚𝑙 = 2 𝑚𝑙
- most frequent unit of measurement in this 𝐻 5 𝑚𝑔
system Order: Cefazolin (Ancef) 0.4253 gm IM BID
- unit of weight Reconstitution Instructions: For IM solution add 1.25 ml
- more powerful dose than a milligram of diluent. Shake to dissolve. Provides an approximate
- because this is a powerful unit, dosages of strong volume of 1.6 ml (240 mg/ml).
medications are often written as fractions D = 0.4253 gm = 425.3 mg
1 grain = 60 mg H = 240 mg/ml
Ex. V = 1 ml
𝐷 425.3 𝑚𝑔
Morphine ¼ grain ×𝑉= × 1 𝑚𝑙 = 1.77 𝑚𝑙 ≈ 1.8 𝑚𝑙
Nitroglycerin 1/150 grain 𝐻 240 𝑚𝑔
3. Household System Order: Ceftazidime (Fortez) 250 mg IM
- least accurate form of measurement Vial contains 500 mg powder with directions to add 1.5
- generally, it has been replaced with the metric ml of sterile water for a total volume of 1.8 ml
system D = 250 mg
COMMON MEASURMENT UNITS OF HOUSEHOLD H = 500 mg/1.8 ml
SYSTEM V = 1.8 ml
𝐷 250 𝑚𝑔
a. Teaspoon ×𝑉 = × 1.8 𝑚𝑙 = 0.9 𝑚𝑙
b. Tablespoon 𝐻 500 𝑚𝑔
Order: Furosemide (Lasix) 80 mg IV every morning
c. Ounce
Supply: Lasix 20 mg in 2 ml sterile water
METRIC EQUIVALENTS FOR THE HOUSEHOLD
D = 80 mg
MEASUREMENT UNITS
H = 20 mg/2 ml
1 tsp = 5 ml
V = 2 ml
1 Tbsp = 15 ml
𝐷 80 𝑚𝑔
1 oz = 30 ml ×𝑉 = × 2 𝑚𝑙 = 8 𝑚𝑙
𝐻 20 𝑚𝑔
SUMMARY OF MEASUREMENT AND COMMON
Parenteral Medications
EQUIVALENTS
- medications given by injection
CALCULATING INJECTABLE DOSAGES Gauge
1. Injection Routes - as this increases, the number of the gauge decreases
2. Intradermal (ID) Ex.
- given just under the skin 18 Gauge Needle
- often used for skin tests such as the Mantoux - large opening
TB test 25 Gauge Needle
Short Needles - smaller opening
- used for these injections and tiny amount of Needle
fluid are injected - choice of what to use depends on the:
3. Subcutaneous (SubQ) • Type of injection given
- given into the fatty, subcutaneous layer of skin • Viscosity of the fluid
- usually given with a shorter needle such as ½ • Body size
inch • Type of medication
- small amounts of fluid are injected via this route TYPES OF NEEDLES
4. Intramuscular (IM)
- given into the muscle
- deeper injection
- requires a longer needle, usually at least 1 inch
long Injectable Dosages
- as much as 3 ml can be injected into one site - calculated using the same formulas you used with
PACKAGING OF INJECTABLE MEDICATIONS oral dosages
1. Vial Medications for Injection
2. Ampule - will be liquid so dosages will be expressed in ml
3. Pre-filled cartridges INTRAVENOUS MEDICATIONS
4. Pre-filled syringes 1. IV Push
TYPES OF SYRINGES - medications are injected with a syringe into IV
1. Tuberculin (TB) Syringe tubing or intermittent device
- calibrated in: - pain medications may be given via this route
• Tenths (0.1 ml) 2. IV Piggyback
• Hundredths (0.01 ml) - medications are added to a small volume of fluid
and run concurrently with other IV fluids over a
short period of time
- antibiotics are frequently delivered by this
Slender, 1 ml Syringe
method
- used when the amount of solution to be given is
3. Continuous Infusion
less than 1 ml
- medications are added to IV fluids and
2. Insulin Syringe
administered as a continuous infusion
- slender syringe designed to be used with insulin
Potassium
administration only
- electrolyte replacement
- calibrated in units
- frequently given via this route
- no other type of syringe should be used for
IV Administered Fluids
insulin administration
- prescribed most frequently based on milliliters per
hour
Volume per Hour Prescribed
Insulin Dosages - administered by setting the flow rate
- ordered in units Flow Rate
3. 3 ml Syringe - counted in drops per minute
- popular syringe for many types of medication Drops
administration - abbreviated as gtts
- calibrated in tenths (0.1 ml) Microdrop
- abbreviated as ugtts
Drop/Drip Factor
- total number of drops delivered per milliliters of
4. 5 ml Syringe
solution
- usually used when fluid amounts greater than 2
- usually varies by brand
½ ml are to be given
1. Macrodrops
- calibrated in 2/10 (0.2 ml)
a. 10 gtts/ml
b. 12 gtts/ml
c. 15 gtts/ml
 d. 20 gtts/ml 𝑇𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑚𝑙 )
𝑇𝑖𝑚𝑒 =
2. Microdrip 𝑚𝑙
𝑀𝑖𝑙𝑙𝑖𝑙𝑖𝑡𝑒𝑟𝑠 𝑝𝑒𝑟 ℎ𝑜𝑢𝑟 𝑏𝑒𝑖𝑛𝑔 𝑖𝑛𝑓𝑢𝑠𝑒𝑑 ( ℎ𝑟 )
- 60 ugtts/ml 1 000 𝑚𝐿
Infusion Pumps 𝑇𝑖𝑚𝑒 = = 8 ℎ𝑟
𝑚𝑙
125 ℎ𝑟
- device that controls the rate of administration to the
programmed amount Drop Factor of Tubing
- deliver solution in milliliters per hour - may vary according to the:
- calculate ml/hr in order to program the pump • Type of solution to be administered
correctly • Rate to be infused
𝐴𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 • Clinical situation
= 𝑚𝑙/ℎ𝑟 • Company which manufactures the tubing
𝐻𝑜𝑢𝑟𝑠 𝑡𝑜 𝑎𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑒𝑟
Ex. - noted on the container in which it is packaged
You receive an order to administer 1 000 ml of fluid over FORMULA FOR CALCULATING MILLILITERS PER HOUR
8 hours. The fluid is to run via an infusion pump. How (ml/hr)
many ml/hr will you program into the medicine in order 𝑇𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒
= 𝑚𝑙/ℎ𝑟
to deliver 1 000 ml in 8 hours? 𝑇𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒
𝐴𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 1 000 𝑚𝑙 FOMRULA FOR CALCULATING DROPS PER MINUTE
= = 125 𝑚𝑙/ℎ𝑟 𝑔𝑡𝑡𝑠
𝐻𝑜𝑢𝑟𝑠 𝑡𝑜 𝑎𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑒𝑟 8 ℎ𝑟 𝑉𝑜𝑙𝑢𝑚𝑒 × 𝐷𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 ( )
Calculate the flow rate for an IV of 1 820 ml normal saline 𝑅𝑎𝑡𝑒 = 𝑚𝑙 = 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
IV to infuse in 15 h by controller. What is the flow rate? 𝑇𝑖𝑚𝑒 (𝑚𝑖𝑛)
𝐴𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 1 820 𝑚𝑙 𝑢𝑔𝑡𝑡𝑠
𝑉𝑜𝑙𝑢𝑚𝑒 × 𝐷𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 ( )
𝐻𝑜𝑢𝑟𝑠 𝑡𝑜 𝑎𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑒𝑟
=
15 ℎ𝑟
= 121.33 𝑚𝑙/ℎ𝑟 ≈ 121 𝑚𝑙/ℎ𝑟
𝑅𝑎𝑡𝑒 = 𝑚𝑙
Gravity Flow 𝑇𝑖𝑚𝑒 (𝑚𝑖𝑛)
- consider the drop factor (drops/ml) of the tubing FORMULA FOR INFUSION TIME
𝑇𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑚𝑙)
being used to administer the fluid 𝑇𝑖𝑚𝑒 = = ℎ𝑟
𝑚𝑙
- must be a whole number 𝑀𝑖𝑙𝑙𝑖𝑙𝑖𝑡𝑒𝑟𝑠 𝑝𝑒𝑟 ℎ𝑜𝑢𝑟 𝑏𝑒𝑖𝑛𝑔 𝑖𝑛𝑓𝑢𝑠𝑒𝑑 ( ℎ𝑟 )
Ex.
The physician orders Lactated Ringer’s IV at 150 mL/h.
The drop factor is 15 gtt/mL. Find the flow rate in
gtts/min.
V = 150 mL
T = 60 min
Drop Factor = 15 gtts/mL
𝑔𝑡𝑡𝑠
𝑉𝑜𝑙𝑢𝑚𝑒 × 𝐷𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 ( )
𝑅𝑎𝑡𝑒 = 𝑚𝑙
𝑇𝑖𝑚𝑒 (𝑚𝑖𝑛)
𝑔𝑡𝑡𝑠
150 𝑚𝐿 × 15
𝑅𝑎𝑡𝑒 = 𝑚𝑙 = 37.5 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 ≈ 38 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
60 𝑚𝑖𝑛
Your patient needs 2L of saline IV over 4 hours for a
patient with deficient fluid volume. How many milliliters
per hour will you set on a controller?
V = 2 L = 2 000 mL
T = 4 hr
𝑇𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 2 000 𝑚𝐿
= = 500 𝑚𝐿/ℎ𝑟
𝑇𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 4 ℎ𝑟
A patient is receiving 250 mL normal saline IV over 4
hours, using tubing with a drip factor of 10 gtts/mL. How
many drops per minute should be delivered?
V = 250 mL
Drop Factor = 10 gtts/mL
T = 4 hr = 240 min
𝑔𝑡𝑡𝑠
𝑉𝑜𝑙𝑢𝑚𝑒 × 𝐷𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 ( )
𝑅𝑎𝑡𝑒 = 𝑚𝑙
𝑇𝑖𝑚𝑒 (𝑚𝑖𝑛)
𝑔𝑡𝑡𝑠
250 𝑚𝐿 × 10
𝑅𝑎𝑡𝑒 = 𝑚𝑙 = 10.4 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 ≈ 10 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
240 𝑚𝑖𝑛
A patient is ordered to received 1 000 mL of NSS to be
administered at 125 mL/hr. How many hours will pass
before you change the IV bag/bottle?
V = 1 000 mL
mL/hr = 125 mL/hr