Converting units

All weights, volumes and times in any equation must be in the same units. With weights the unit changes every thousand. For example, you need 1000 micrograms
(mcg) to make 1 milligram (mg) and 1000 milligrams to make one gram (g) (Box 2).
Type B calculations
These are infusion rate calculations.
For example:
Prescription states 30 mg/hour
You have a bag containing 250mg in 50ml
At what rate (ml/hr) do you set the pump?
These are the same as type A calculations, only once you have worked out the volume that contains the amount of drug you need, you set the pump to give that
amount per hour.
In this instance, work out how many ml contain ONE mg of drug
Using the WIG equation:
30 x 50 / 250 = 6ml
Therefore the calculation shows that, to give 30mg per hour, the infusion pump rate would need to be set at 6ml per hour.
This calculation is straightforward when the rate you want (30mg/hour) and the amount of the drug in the bag (250mg) are both in the same units (mg).
However, if the infusion required that 600 micrograms were to be infused each hour instead, this would first need to be converted into mg before the infusion rate was
calculated, that is, 600 micrograms = 0.6mg.
The equation for infusion rate calculation is dose stated in prescription (milligrams per hour) times volume in syringe (in millilitres) divided by the amount in the
syringe (in milligrams) equals the infusion rate (millilitres per hour), or:
Dose (mg/hr) x volume in syringe (ml) / Amount in syringe (mg) = Infusion rate
Type C calculations
Infusion rate is required, but dose is mg per kg.
For example:
Prescription states 0.5mg/kg/hour
You have a bag of 250mg in 50ml
Your patient weighs 70kg
At what rate (ml/hr) do you set the pump?
To do this calculation you still use the WIG equation as above, but with one extra step to work out the what you want.
First you need to convert the mg per kg into total mg by multiplying it by the patients weight.
So for a person who weighs 70kg, 0.5mg per kg is the same as 35mg. Once you have calculated this, the infusion rate can be worked out as in the Type B
calculations.
In this instance:
0.5mg/kg/hr x 70kg x 50ml / 250mg = 7ml/hr
Type D calculations
Infusion rate required, but dose is in mg/kg/min.
For example:
Prescription states 0.5mg/kg/min
You have a syringe of 250mg in 50ml
Your patient weighs 70kg
At what rate (ml/hr) do you set the pump?
As before, you will need to calculate what you want by multiplying the amount per kg by the patients weight. In this case:
0.5mg x 70kg = 35mg
This time, however, the prescription states the rate per minute. The pump demands that the rate be set in ml per hour, therefore the rate per minute will need to be
converted before the equation can be completed, by multiplying 35 by 60; that is, 35mg/min (35 milligrams per minute) is converted to 2100mg/hr (2100 milligrams
per hour).
From here, once again we use the type B calculation to find the infusion rate, which as shown will be 420ml/hr.
2100 x 50 / 250mg = 420ml/hr
Type E calculations
Infusion rate is required, but the dose is in mcg/kg/min.
For example:
Prescription states 3 micrograms (mcg)/kg/min
You have a syringe of 100mg in 50ml
Your patient weighs 70kg
At what rate do you set the pump (ml/hr)?

As before, what you want is calculated by multiplying the amount per kg by the patients weight, that is:
3mcg/kg for a 70kg person is 210mcg
Next the prescription rate needs to be converted into rate per hour, that is,
210mcg/min = 12 600mcg/hr
The prescription is in micrograms, but in your syringe you have milligrams. Both need to be in the same units, so you must convert one to the other, in this case mcg
to mg. 12 600mcg/hr is the same as 12.6mg/hr.
The calculation is then as follows:
12.6 x 50 / 100 = 6.3ml/hr
Conclusion
A UKCC council meeting in Belfast in June 2000 expressed concern at the lack of basic maths skills (Coombes, 2000; Duffin, 2000) among nurses.
The risk of error was felt to be unacceptably high, especially in paediatric nursing, where the necessity for calculating dosages according to body weight increases
calculation complexity.
The GCSE Mathematics pass at Grade C or above, or equivalent, a compulsory entry requirement for nurse training, was not felt to be adequate preparation for
nursing training, and Hutton (1998a) agrees with this.
An anonymous author described personal experience of a drug error (Anon, 2000) and how it almost cost her loss of registration. She was lucky enough to have
managers who offered her support, and helped with her realisation of the need for urgent basic maths revision.
Open reporting systems and no blame cultures are recommended by the UKCC (2000) and are helpful in changing ways of working (Alderman, 1997). Reported
learning initiatives (Coombes, 2000; Wilson, 2000) are welcome indications of a growing number of practical solutions.
Question 1:
Precription for IV ampicillin 200mg
You have a vial of 500mg in 10ml
What volume contains the dose you need?
Question 2:
Prescription for IV digoxin 187.5mcg
You have a vial of 0.5mg in 2ml
What volume contains the dose you need?
Question 3:
Precription for IV aminophylline 350mg in 100ml to be given over 30 minutes
You have some vials, 250mg in 5ml
What volume of aminophylline injection do you add to the bag?
What rate do you set the pump at (ml/hour)?
Question 4:
Prescription for dopamine 2mg/kg/hour
You have a 70kg patient and a syringe of 800mg in 50ml
What rate do you run the syringe at (ml/hour)?
Question 5:
Prescription for IV doxapram 0.1mg/kg/minute
You have a 90kg patient and a bag of 500mg in 250ml
What rate do you run the syringe at (ml/hour)?
Question 6:
Prescription for IV noradrenaline 10mcg/kg/minute
You have a 60kg patient and a syringe of 16mg in 50ml
What rate do you run the syringe at (ml/hour)?
Question 7:
You need to give 500mg of dextrose
You have a 250ml bag of 5% dextrose
How many ml do you need to give?
Question 8:
You need to give 5ml of 0.375% bupivacaine
You have a 10ml ampoule of 0.5% bupivacaine and some water for injections
Answers
Answer 1
WIG: 200mg x 10ml / 500mg = 4ml
Answer 2

0.5mg = 500mcg
WIG: 187.5mcg x 2ml / 500mcg = 0.75ml
Answer 3
WIG: 350mg x 5ml / 250mg = 7ml
60 min x 100ml / 30 min = 200ml/hour
NB When you need ml/hour the equation is:
60 x ml to infuse / Duration of infusion
Answer 4
Prescription really says:
2mg/kg/hour
2mg x 70kg = 140mg/hour needed
WIG: 140mg x 50ml / 800mg = 8.75mlSo 8.75ml per hour
Answer 5
Prescription really says: 0.1mg/kg/minute
0.1mg x 90kg = 9mg/minute
9mg/minute = 9 x 60mg/hour = 540mg/hour
WIG: 540mg x 250ml / 500mg = 270ml
So, 270ml per hour
Answer 6
Prescription really says: 10mcg/kg/min
10mcg x 60kg = 600mcg/min
600mcg x 60 min = 36000mcg/hr
36000 / 1000 = 36mg/hr
WIG: 36mg x 50ml / 16mg = 112.5ml
So, 112.5ml per hour
Answer 7
5% means 5g in 100ml, which is the same as 5000mg in 100ml
WIG: 500mg x 100ml / 5000mg = 10ml
Answer 8
We need 5ml of 0.375% solution. This would contain 0.375g in 100ml. So in 5ml there would be 0.375g x 5ml / 100ml = 0.01875g (18.75mg) (line 1)
We have a 0.5% solution (which contains 0.5g (500mg) in 100ml)
We need 18.75mg.
WIG 18.75mg x 100 / 500 = 3.75ml
So, the 18.75mg we need is contained in 3.75ml of our 0.5% solution
So, we take 3.75ml (18.75mg), top it up to 5ml with WFI, and we then have 18.75mg in 5ml (which is 0.375% as shown in line 1)

Common Conversions:
1 Liter = 1000 Milliliters
1 Gram = 1000 Milligrams
1 Milligram = 1000 Micrograms
1 Kilogram = 2.2 pounds

Methods of Calculation
Any of the following three methods can be used to perform drug calculations. Please review all three methods and select the one that works for
you. It is important to practice the method that you prefer to become proficient in calculating drug dosages.
Remember: Before doing the calculation, convert units of measurement to one system.
I. Basic Formula: Frequently used to calculate drug dosages.

D = dose ordered or desired dose

H = dose on container label or dose on hand
V = form and amount in which drug comes (tablet, capsule, liquid)
Example: Order-Dilantin 50mg p.o. TID
Drug available-Dilantin 125 mg/5ml

II. Ratio & Proportion: Oldest method used in calculating dosage.

Left side are known quantities

Right side is desired dose and amount to give
Multiply the means and the extremes

Example: Order-Keflex 1 gm p.o. BID

Drug available-Keflex 250 mg per capsule

III. Fractional Equation

H
V= D
X
Cross multiply and solve for X.

Example: Order - Digoxin 0.25 mg p.o. QD

Drug Available - 0.125 mg per tablet

IV. Intravenous Flow Rate Calculation (two methods)

Two Step
Step 1 - Amount of fluid divided by hours to administer = ml/hr

One Step

Example: 1000 ml over 8 hrs

IV set = 15 gtts/ml
Two Step
Step 1 - 1000 divided by 8 = 125

Step 2 -

One Step

IV. How to Calculate Continuous Infusions

B. mcg/min (For example - Nitroglycerin)

C. mcg/kg/min (For example - Dopamine, Dobutamine, Nipride, etc.)

1.

To calculate cc/hr (gtts/min)

Example: Dopamine 400 mg/250 cc D5W to start at 5 mcg/kg/min.

Patients weight is 190 lbs.

2. To calculate mcg/kg/min

Example: Nipride 100mg/250 cc D5W was ordered to decrease your patients blood pressure.
The patients weight is 143 lbs, and the IV pump is set at 25 cc/hr. How many mcg/kg/min of Nipride is the patient

receiving?

V. How to calculate mcg/kg/min if you know the rate of the infusion

For example:
400mg of Dopamine in 250 cc D5W = 1600 mcg/cc 60 min/hr = 26.6 mcg/cc/min
26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400mg in 250cc of IV fluid. You need this
to calculate this dosage concentration first for all drug calculations. Once you do this step, you can do anything!
NOW DO THE REST!
(If you have a 75 kg patient for example...)

= 3.5 mcg/kg/min (rounded down)

B. How to calculate drips in cc per hour when you know the mcg/kg/min that is ordered or desired

For example:
400 mg Dopamine in 250 cc D5W = 26.6 mcg/cc/min

ALWAYS WORK THE EQUATION BACKWARDS AGAIN TO DOUBLE CHECK YOUR MATH!

For example:

400mg of Dopamine in 250 cc D5W = 1600 mcg/cc 60 min/hr = 26.6 mcg/cc/min

26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400 mg in 250 cc of IV fluid. You need this to calculate this
dosage concentration first for all drug calculations. Once you do this step, you can do anything!
NOW DO THE REST!!
(If you have a 75 kg patient for example)

Now do some practice exercises to check what you learned

A. Practice Problems:
1. 2.5 liters to milliliters
2. 7.5 grams to milligrams
3. 10 milligrams to micrograms
4. 500 milligrams to grams
5. 7500 micrograms to milligrams
6. 2800 milliliters to liters
7. 165 pounds to kilograms
8. 80 kilograms to pounds
B. Practice Problems: Use the method you have chosen to calculate the amount to give.
1. Order-Dexamethasone 1 mg
Drug available-Dexamethasone 0.5 mg per tablet
2. Order-Tagamet 0.6 gm
Drug available-Tagamet 300 mg per tablet
3. Order-Phenobarbital 60 mg
Drug available-Phenobarbital 15 mg per tablet
4. Order-Ampicillin 0.5 gm
Drug available-Ampicillin 250 mg per 5 ml
5. Order-Dicloxacillin 125 mg
Drug Available-Dicloxacillin 62.5 mg per 5 ml
6. Order-Medrol 75 mg IM
Drug Available-Medrol 125 mg per 2 ml
7. Order-Lidocaine 1 mg per kg
Patients weight is 152 pounds
8. Order- 520 mg of a medication in a 24 hour period. The drug is ordered every 6 hours.
How many milligrams will be given for each dose?
C. Practice Problems:
1. Order-1000 ml over 6 hrs

IV set 15 gtts/ml

2. Order-500 ml over 4 hrs

IV set 10 gtts/ml

3. Order-100 ml over 20 min. IV set 15 gtts/ml

D. Practice Problems:

1. Dopamine 400 mg in 250 cc D5W to infuse at 5 mcg/kg/min. The patients weight is 200 pounds. How many
cc/hour would this be on an infusion pump?
2. A Dopamine drip (400mg in 250 cc of IV fluid) is infusing on your 80 kg patient at 20 cc/hour. How many
mcg/kg/min are infusing for this patient?
3. A Nitroglycerin drip is ordered for your patient to control his chest pain. The concentration is 100 mg in 250 cc
D5W. The order is to begin the infusion at 20 mcg/min. What is the rate you would begin the infusion on the
infusion pump?
4. A Nitroglycerin drip (100mg in 250 cc D5W) is infusing on your patient at 28 cc/hour on the infusion pump. How
many mcg/min is your patient receiving?
5. A procainamide drip is ordered (2gms in 250 cc D5W) to infuse at 4 mg/min. The patient weighs 165 pounds.
Calculate the drip rate in cc/hour for which the infusion pump will be set at.
6. A Lidocaine drip is infusion on your 90 kg patient at 22 cc/hour. The Lidocaine concentration is 2 grams in 250 cc
of D5W. How many mg/min is your patient receiving?

Summary
Many nurses have difficulty with drug calculations. Mostly because they dont enjoy or understand math. Practicing drug calculations will
help nurses develop stronger and more confident math skills. Many drugs require some type of calculation prior to administration. The drug
calculations range in complexity from requiring a simple conversion calculation to a more complex calculation for drugs administered by
mcg/kg/min. Regardless of the drug to be administered, careful and accurate calculations are important to help prevent medication errors. Many
nurses become overwhelmed when performing the drug calculations, when they require multiple steps or involve life-threatening drugs. The
main principle is to remain focused on what you are doing and try to not let outside distractions cause you to make a error in calculations. It is
always a good idea to have another nurse double check your calculations. Sometimes nurses have difficulty calculating dosages on drugs that
are potentially life threatening. This is often because they become focused on the actual drug and the possible consequences of an error in
calculation. The best way to prevent this is to remember that the drug calculations are performed the same way regardless of what the drug is.
For example, whether the infusion is a big bag of vitamins or a life threatening vasoactive cardiac drug, the calculation is done exactly the same
way.
Many facilities use monitors to calculate the infusion rates, by plugging the numbers in the computer or monitor with a keypad and getting
the exact infusion titration chart specifically for that patient. If you use this method for beginning your infusions and titrating the infusion rates,
be very careful that you have entered the correct data to obtain the chart. Many errors take place because erroneous data is first entered and
not identified. The nurses then titrate the drugs or administer the drugs based on an incorrect chart. A method to help prevent errors with this
type of system is to have another nurse double check the data and the chart, or to do a hand calculation for comparison. The use of computers
for drug calculations also causes nurses to get rusty in their abilities to perform drug calculations. It is suggested that the nurse perform the
hand calculations from time to time, to maintain her/his math skills.

Answers to Practice Problems

A. Practice Problems
1. 2500 mL
2. 7500 mg
3. 10,000 mcg
4. 0.5 gm
5. 7.5 mg
6. 2.8 L
7. 75 kg
8. 176 lbs
B. Practice Problems
1. 2 tablets
2. 2 tablets

3. 4 tablets
4. 10 mL
5. 10 mL
6. 1.2 mL
7. 69 kg = 69 mg
8. 130 mg for 4 doses
C. Practice Problems
1. 41.6 (42)
2. 20.8 (21)
3. 75
D. Practice Problems
1. 17 cc/hr
2. 6.65 mcg/kg/min
3. 3 cc
4. 186.5 mcg/min
5. 30 cc/hr
6. 3 mg/min