mathematical aspects of intravenous therapy simon shah pharmacy department
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Mathematical Aspects of Intravenous Therapy
Simon ShahPharmacy Department
General Points
Use S.I. units at all times Grams (g) Milligrams (mg) Micrograms Nanograms Litres (l) Millilitres (ml)
Units
1kg contains 1000g 1g contains 1000mg 1mg contains 1000 micrograms 1 microgram contains 1000 nanograms 1l contains 1000ml
Concentrations
Different ways of expressing concentration:
Weight in volume Units in volume Percentages Molar Ratios
Weight in Volume
Expressed as - grams/litre (g/l)
mg/ml e.g. dobutamine 250mg/5ml digoxin 0.5mg/2ml morphine 10mg/ml pethidine 50mg/ml or 100mg/2ml
Units in Volume
Unit is a measure of biological activity i.e. 1 unit heparin is not equal to 1 unit
of insulin. Insulin 100 units/ml Heparin 1000 units/ml 5000 units/ml 5000 units/0.2ml
Percentages
1%w/v = 1g in 100ml (1000mg in 100ml)
5%w/v = 5g in 100ml (or 50g/l) 0.9%w/v = 900mg in 100ml (or 9g/l)
Potassium Chloride15%w/v = 15g/100ml = 1.5g/10ml10ml also contains 20mmol
Molar
Rarely used 1 molar = 1mole/litre 1 mole contains a certain number of
molecules, electrolytes etc. 1 molar solution = 1000mmol/lOften used by Biochemistry to report
results e.g. Na 139 mmol/l
Ratio
Concentrations expressed as 1 in..... means 1g in however many mls
1 : 1 solution contains 1g/ml 1 : 1000 is 1/1000th of this
Adrenaline 1 : 1000 = 1g/1000ml or 1mg/ml 1 : 10,000 = 1g/10,000ml or 1mg/10ml
Exception –Tuberculin -ratio based on units
Other points
Always make sure decimal points are preceded by a number e.g. 0.5mg not .5mg
Always think carefully about calculations
Always get a check on calculations
Calculations - Volumes
Volume required is based on proportions.
What you want (Dose) x Volume you have(ml)
What you have (Amount in vial)
e.g. morphine 10mg/ml. Dose required = 15mg Volume required = 15mg x 1ml = 1.5ml 10mg
Gentamicin 80mg in 2ml
Dose prescribed is 140mg What volume do you need?
You want 140mg x It is in 2mls You have 80mg
= 3.5ml
Aminophylline 250mg in 10ml
Dose prescribed is 210mg What volume is required?
You want 210mg x it is in 10ml You have 250mg
= 8.4ml
Infusions
Giving IV drugs by infusion requires two separate stages:
Preparation Administration
Infusions - Doses
Dose of a drug given will depend on two factors:
1. Concentration of infusion (mg/ml)2. Rate of administration (ml/hr)BOTH must be known for the dose to
be calculated. e.g. 2ml/hr on a prescription means
nothing.
Infusion Preparation
Two main methods:
1. Amount of drug added individualised to patient
2. Standardised solutions
Individualised Infusions
AMINOPHYLLINE INFUSION(Vials available as 250mg/10ml)
A 60kg patient is to receive an aminophylline infusion at a rate of 0.5mg/kg/hr for 24 hours
How much aminophylline injection (250mg/10ml) would you add to 1L of fluid and what rate would you set the pump at?
0.5mg/kg/hr = 30mg/hr = 720mg in 24 hrs
720 x 10 = 28.8ml 250 Add 28.8ml to 1L infusion fluid 1 litre over 24 hours = 42ml/hr
Standard Solution Infusions
AMINOPHYLLINE INFUSION-Standardised solution. e.g. 500mg in 500ml, i.e. 1mg/ml Dose is 30mg/hr therefore rate is 30ml/hr
Easier to adjust rate if dose changes Standardisation of preparation between
nurses
Dobutamine 250mg in 5ml
A 60kg patient is currently receiving dobutamine at a rate of 8 micrograms/kg/min...
How would you prepare the solution at what rate would you set the
syringe pump? Use a standard solution =
250mg/50ml
Standard solution preparation 250mg/50ml
Dose= 60 x 8 = 480 micrograms/minute= 480 x 60 = 28,800 micrograms/hour= 28,800/1000mg/hour= 28.8mg/hr
Dose = 28.8mg/hour
Infusion Concentration = 250mg in 50ml
Rate = 28.8mg/hour x 50ml = 5.8ml/hr 250mg
i.e. the rate you want (mg/hr) x volume it’s in (ml) the amount you have (mg)
Adrenaline 1:1000
How would you prepare a 50ml infusion of adrenaline 0.2mg/ml
it needs to be added to a 50ml syringe
Amount = Concentration x Volume= 0.2mg/ml x 50ml = 10mg in 50ml= 10ml of 1:1000 (1mg/ml)
Glyceryl Trinitrate 50mg/10ml
How would you prepare a 0.1mg/ml infusion of GTN?
needs to be added to a 500ml polyfusor Amount = Concentration x Volume
= 0.1mg/ml x 500ml = 50mg in 500ml polyfusor = 1 x 10ml ampoule
Heparin
Heparin is to be given at a dose of 30,000 units/day
How would you prepare the solution and what rate would you use?
Use a 1000unit/ml solution e.g. Pump-
Hep
Use a 1000unit/ml solution Draw up 30ml into syringe. Don’t dilute. 30,000 units/24 hours = 1250 units/hour 1250 units = 1.25ml therefore rate =
1.25 or 1.3ml/hr
What if the dose is increased to 40,000 units/day?
Summary Different units may be used Different uses of same calculation Doses depend on concentration and
rate Use standard solutions if possible Calculate carefully Get a check - redo calculation If not sure - Ask!