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 (Desired dose)
H (Dose on hand)
V (Vehicle-tablet or liquid)

D
x V = Amount to Give
H
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 50 mg p.o. TID

Drug available-Dilantin 125 mg/5ml

D=50 mg H=125 mg V=5 ml

50 250
x5= = 2 ml
125 125
II. Ratio & Proportion: Oldest method used in calculating dosage.
Known   Desired

H : V :: D : X

    Means    

Extremes
Left side are known quantities
Right side is desired dose and amount to give

Multiply the means and the extremes

HX = DV
DV
X=
H
Example: Order-Keflex 1 gm p.o. BID
Drug available-Keflex 250 mg per capsule
D=1 gm (note: need to convert to milligrams)
1 gm = 1000 mg

H=250 mg
V=1 capsule

250 : 1 :: 1000 : X

250X = 1000

X= 1000
 250
X = 4 capsules

III. Fractional Equation

H D
=
V X
Cross multiply and solve for X.
H D
=
V X
HX = DV
DV
X=
H
Example: Order - Digoxin 0.25 mg p.o. QD
Drug Available - 0.125 mg per tablet

D=0.25 mg H=0.125 mg V=1 tablet

0.125 0.25
=
1 X
0.125X = 0.25
0.25
X=
0.125
X = 2 tablets
IV. Intravenous Flow Rate Calculation (two methods)
Two Step

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

ml/hr x gtts/ml(IV set)

Step 2 - = gtts/min
60 min
One Step
amount of fluid x drops/milliliter (IV set)
hours to administer x minutes/hour (60)
Example: 1000 ml over 8 hrs
IV set = 15 gtts/ml
Two Step
1000
Step 1 - = 125
8
125 x 15
Step 2 - = 31.25 (31 gtts/min)
60
One Step

1000 x 15 15,000
= = 31.25 (31gtts/min)
8 hrs x 60 480
V. How to Calculate Continuous Infusions

A. mg/min (For example - Lidocaine, Pronestyl)

Solution cc x 60 min/hr x mg/min
= cc/hr
Drug mg
    Drug mg x cc/hr    
= mg/hr
Solution cc x 60 min/hr

Rule of Thumb

Lidocaine, Pronestyl
2 gms/250 cc D5W
 1 mg = 7 cc/hr
2 mg = 15 cc/hr
3 mg = 22 cc/hr
4 mg = 30 cc/hr

B. mcg/min (For example - Nitroglycerin)

Solution cc x 60 min/hr x mcg/min
= cc/hr
Drug mcg
    Drug mcg x cc/hr    
= mcg/hr
Solution cc x 60 min/hr

Rule of Thumb

NTG 100 mg/250 cc

1 cc/hr = 6.6 mcg/min

NTG 50 mg/250 cc

1 cc/hr = 3.3 mcg/min

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

1. To calculate cc/hr (gtts/min)

Solution cc
x 60 min/hr x kg x mcg/kg/min = cc/hr
Drug mcg
Example: Dopamine 400 mg/250 cc D5W to start at 5 mcg/kg/min.
Patient’s weight is 190 lbs.
    250 cc    
x 60 min x 86.4 x 5 mcg/kg/min = 16.2 cc/hr
400,000 mcg
2. To calculate mcg/kg/min
      Drug mcg/ x cc/hr      
= mcg/kg/min
Solution cc x 60 min/hr x kg
Example: Nipride 100 mg/250 cc D5W was ordered to decrease your patient’s blood pressure.
The patient’s 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?
100,000 mcg x 25 cc/hr 2,500,000
= = 2.5 mcg/kg/min
250 cc x 60 min x 65 kg 975,000
A. How to calculate mcg/kg/min if you know the rate of the infusion
Dosage (in mcg/cc/min) x rate on pump
= mcg/kg/min
Patient’s weight in kg
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...

26.6 mcg/cc/min x 10 cc on pump
= 3.54 mcg/kg/min
Patients’s weight in kg (75 kg)
  = 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
mcg/kg/min x patient’s weight in kg
= rate on pump
dosage concentration in mcg/cc/min
For example:
 400 mg Dopamine in 250 cc D5W = 26.6 mcg/cc/min
3.5 mcg/kg/min x 75 kg
= 9.86 cc
26.6 mcg/cc/min
= 10 cc rounded up
ALWAYS WORK THE EQUATION BACKWARDS AGAIN TO DOUBLE CHECK YOUR MATH!

For example:
10 cc x 26.6 mcg/cc/min
= 3.5 mcg/kg/min
75 Kg
Dosage (in mcg/cc/min) x rate on pump
= mcg/kg/min
Patient’s weight in kg
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

26.6 mcg/cc/min x 10 cc on pump
= 3.54 mcg/kg/min
Patients’s weight in kg (75 kg)

Now do some practice exercises to check what you learned

A. Practice Problems:
A. 2.5 liters to milliliters
B. 7.5 grams to milligrams
C. 10 milligrams to micrograms
D. 500 milligrams to grams
E. 7500 micrograms to milligrams
F. 2800 milliliters to liters
G. 165 pounds to kilograms
H. 80 kilograms to pounds
B. Practice Problems: Use the method you have chosen to calculate the amount to give.
A. Order-Dexamethasone 1 mg
Drug available-Dexamethasone 0.5 mg per tablet
B. Order-Tagamet 0.6 gm
Drug available-Tagamet 300 mg per tablet
C. Order-Phenobarbital 60 mg
Drug available-Phenobarbital 15 mg per tablet
D. Order-Ampicillin 0.5 gm
Drug available-Ampicillin 250 mg per 5 ml
E. Order-Dicloxacillin 125 mg
Drug Available-Dicloxacillin 62.5 mg per 5 ml
F. Order-Medrol 75 mg IM
Drug Available-Medrol 125 mg per 2 ml
G. Order-Lidocaine 1 mg per kg
Patient’s weight is 152 pounds
H. 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:
 A. Dopamine 400 mg in 250 cc D5W to infuse at 5 mcg/kg/min. The patient’s weight is 200 pounds. How many cc/hour would this be
on an infusion pump?
B. 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?
C. A Nitroglycerin drip is ordered for your patient to control his chest pain. The concentration is 100 mg in 250 cc D 5W. The order is to
begin the infusion at 20 mcg/min. What is the rate you would begin the infusion on the infusion pump?
D. 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?
E. 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.
F. 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 don’t 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
A. 2500 mL
B. 7500 mg
C. 10,000 mcg
D. 0.5 gm
E. 7.5 mg
F. 2.8 L
G. 75 kg
H. 176 lbs
B. Practice Problems
A. 2 tablets
B. 2 tablets
C. 4 tablets
D. 10 mL
E. 10 mL
F. 1.2 mL
G. 69 kg = 69 mg
H. 130 mg for 4 doses
C. Practice Problems
A. 41.6 (42)
B. 20.8 (21)
C. 75
D. Practice Problems
A. 17 cc/hr
B. 6.65 mcg/kg/min
C. 3 cc
D. 186.5 mcg/min
E. 30 cc/hr
F. 3 mg/min