Dosage Calculations

Dr Sukanta Sen
Medical emergencies such as cerebral malaria, diabetic coma,
cardiogenic shock and many more require immediate treatment with
parenteral drug administration. Intravenous (i.v.) infusion is one of the
commonly preferred routes for this purpose. As one of the goals of
undergraduate training is to train students in managing patients, it is
mandatory that the students acquire a sound knowledge of certain basic
steps of intravenous drug infusion.
These include dose calculation ( viz., based on body weight and body
surface area) and clinical skills ( viz., proper collection of drugs from
ampoule/vial, introduction of drug into suitable diluting fluid, i.v. drip
setting, etc.).
As dose calculation is an important initial step in such clinical procedures, we
have emphasized it in relation to different aspects such as the following:
Total dose: The infusion rate will not differ in case of total dose administration
(e.g., infusion rate of quinine will remain the same for a 30, 50 or a 70 kg patient
since it is given in the dose of 10 mg/kg in 500 ml of 10% dextrose solution
which is to be administered over 4 h). In contrast to this, the infusion rate will
differ when drugs are to be given at the specified rates (e.g., infusion rate of
aminophylline will differ for a 30, 50 or a 70 kg patient since it is to be given in
the dose of 1 mg/kg/hr in 500 ml of normal saline).
Weight (mg/kg): The weight-based dose calculation (mg/kg) is more popular
despite certain disadvantages, viz., one needs to know the different doses
according to body weight (mg/kg) as well as according to the age of the patient.
Body surface area: Body surface area (BSA) is another method which is
considered as a more accurate basis for dose calculation since total body water,
extracellular fluid volume and metabolic activity are better paralleled by it. The
BSA of an individual can be calculated from the formula of Dubois [BSA (m 2) =
Body weight (kg)0.425 X Height (cm) 0.725 X 0.007184] or obtained from chart-
form/slide-rule nomograms based on body weight and height. Dose
recommendations in terms of BSA are available only for a limited number of
drugs (e.g., anticancer drugs) as this method is more cumbersome in clinical
practice.
Time: The dose of some drugs is calculated per minute and per hour (e.g.,
dopamine 5 mcg/kg/min and insulin 0.1 U/kg/h). The infusion rates differ for
different time duration in case of anticancer drugs like paclitaxel.
Average adult body weight:
The dose can also be calculated by using the average adult body weight (60-
70 kg) basis from the formula: [Individual dose = Body weight (kg)/70 ×
average adult dose].

Diluting fluid: Selection of a suitable diluting fluid is necessary for i.v.,

infusion. For example, 10% dextrose solution is being used for quinine
infusion, which prevents hypoglycemia due to hyperinsulinemia caused by
the powerful stimulatory effect of quinine on pancreatic beta cells, whereas
dopamine infusion is given with 5% dextrose (acidic pH) solution for its
compatibility and stability with the latter (i.e., 5% dextrose).
It’s important to remember any time we do calculations we must have our
measures in the same system and in the same sized units. The most common
system we will use is the metric system. Let’s review a few standard
conversions related to the metric system.
Remember the basic units are the meter (m), liter (L), and gram (g, gm, or
Gm).
1 milligram (mg) = 1000 micrograms (mcg) or 0.001 grams (g)
1 g = 1000 mg
1 kilogram (kg) = 1000 g
1 kg = 2.2 pound (lb)
1 liter (L) = 1000 milliliters (mL)
✓To convert larger to smaller, multiply by 1000, or move the decimal point
three places to the right.
✓ To convert smaller to larger, divide by 1000, or move the decimal point
three places to the left.
 Formulas for Calculating Medication Dosage

Where D (desired) is the dosage the physician ordered, A (available) is the dosage
strength as stated on the medication label, and Q (quantity) is the volume in which
the dosage strength is available (e.g. tablets, capsules, milliliters).
For example: we have an order for Ciplox 0.5 g PO b.i.d. We have available 250
mg capsules. The first thing to do is get like units of measurement. Since we have
250 mg capsules, let’s change our ordered dose to mg. We do this by moving our
decimal point three places to the right, so the dosage to give is 500 mg. Now we
can plug numbers into our formula.
Where the left side represents known quantities, the dose on hand (H), and the
vehicle (V), such as tablets, capsules, milliliters; and the right side represents the
desired dose (D) and the unknown amount to be given (X). Multiply the means (V
and D), and the extremes (H and X), then solve for X. So, using our previous
example where we need to give Ciplox 0.5 g PO b.i.d., and we have 250 mg
capsules available, we would work it as follows. (We still need to first convert to
similar measures, so we need to give 500 mg of Ciplox).
This will be utilized any time we are using a gravity infusion. Don’t forget the time
always needs to be in minutes and the volume always needs to be in mL. Here
are a few examples:
We need to give 1000 mL of D5W over 24 hours. Our tubing has a drop factor of
20 gtt/mL. Our total volume is in mL, so we don’t have to change it, but our time
is in hours. To convert our time to minutes, we need to multiply it by 60. So, our
total time in minutes will be 1440. Let’s plug our numbers into our formula.
We need to give 3 L of NS over 24 hours. Out tubing has a drop
factor of 15 gtt/ml. Now we need to change our 3 L to mL by moving
our decimal point (3000 mL) and our time to minutes (24 hours =
1440 minutes).
Plugging this into our formula gives us:
We will use this number shortly.
Our order is for 3 mcg/kg/min. Our patient weighs 70 kg. We need to
multiply 70 by 3 to find out the total mcg/min. 70 x 3 = 210, so we will be
giving 210 mcg/min.
Our pump rate is always mL/hour, so we need to multiply our mcg/min
by 60 to get mcg/h. 210 x 60 = 12,600, so we will be giving 12,600
mcg/h.
Now we have to find out how many mL contain our 12,600 mcg. We
will use our concentration number we got earlier.
12,600 mcg : X mL :: 3200 mcg : 1 mL 3200 X = 12,600 X = 3.9 mL
So, our IV pump rate will be 4 mL/hour.
A patient has propofol ordered at 30 mcg/kg/min. The propofol
concentration is 15 mg/mL. The patient’s weight is 75 kg. How many
mL/h should the IV pump be programmed for?
First, let’s get our units the same. If we have 15 mg/mL, that means we
have 15,000 mcg/mL.
Our order is for 30 mcg/kg/min. Our weight is 75 kg, so 75 x 30 = 2,250,
so we will give 2,250 mcg/min. Pumps are always mL/h, so 2250
mcg/min x 60 minutes/h = 135,000 mcg/h.
We have 15,000 mcg/mL, and need 135,000 mcg/hour so to find our
mL/h:
1 mL : 15,000 mcg :: X mL : 135,000 mcg 15,000 X = 135,000 X = 9
So, our pump rate will be 9 mL per hour.
Example. You have a 10-ml vial of aminophylline labeled "25 mg per ml".
How many milliliters must be injected to administer a dose of 125 mg?
How many milliliters must be injected from an ampule of
Prochlorperazine labeled "10 mg/2 ml" in order to administer a dose
of 7.5 mg?
Exercise:

You have decided to give i.v. infusion of aminophylline for a child (10
years old, 30 kg) suffering from acute bronchial asthma (Dose: 1
mg/kg/hr). Set an i.v. drip for this patient.
Ø Answer:

A. Calculate the required dose of Inj. aminophylline:

i.e. 30 mg of Inj. aminophylline (1 mg/kg)

B. Selection of fluid:

i.e. Normal saline

C. Aminophylline is available as 2.5% W/V in 10 ml ampoule, i.e. 250
mg/10 ml.

Introduce all 10 ml of Inj. aminophylline into 500 ml of normal saline

solution.
Now we have 250 mg in 500 ml of normal saline solution, i.e. 30 mg
will be present in 30/250 × 500 = 60 ml, which is to be administered in
1 h.

So, the desired rate of administration will be:

60 ml to be given in 1h (60 min),

i.e. 60/60 = 1 ml/min

Thus, in 1 min, 1 ml is to be given

1 ml = 16-20 drops in normal i.v. set

So, the rate of aminophylline administration will be 16-20 drops/min.

OR
Introduce all 10 ml of Inj. aminophylline into 500 ml of normal saline
solution.
i.e. 500 ml of normal saline solution contains 250 mg of aminophylline
So, 1 ml will have 1/500 × 200 = 0.5 mg of aminophylline.
For 0.5 mg of aminophylline, 1 ml is required
So, 30 mg will be present in 30/0.5 × 1 = 60 ml, which is to be administered
in 1 h.
So, the desired rate of administration will be:
60 ml to be given in 1 h (60 min)
i.e. 60/60 = 1 ml/min
Thus, in 1 min, 1 ml is to be given
1 ml = 16-20 drops in normal i.v. set
So, the rate of aminophylline administration will be 16-20 drops/min.
Problem:
Calculate the required dose for aminophylline infusion for a child
suffering from acute bronchial asthma (12 years old, 37 kg, BSA 1.25
m 2 Dose: 1 mg/kg/h).
Solution:
A. mg/kg basis:
i.e. 37 mg/h
B. Average adult body weight (60-70 kg) basis:
Formula: [Individual dose = Body weight (kg)/70 × average adult dose]
i.e. 37/70 × 70 = 37 mg/hr
C. BSA-based rule:
Formula: [Individual dose = BSA (m 2)/1.7 × average adult dose]
i.e. 1.25/1.7 × 70 = 51 mg/hr
Sample: MD orders 300 mg of Ibuprophen to be taken by a
6 kg infant every 4 hours.
Label
shows 75 – 150 mg/kg per day. Is the physician’s order within
normal range?
Solution: 6 x 75 = 450 mg (minimum dosage per day); 150
X6 = 900 (maximum dosage per
day)
24 ÷ 4 = 6 dosages : 300 x 6 = 1800
Answer: Dosage is not within range
[amount of fluid to be infused] x [drop factor] ÷ minutes to
infuse = gtts/min

Sample: Dr. A. orders your patient to receive 125 ml of D5W an

hour for the next 8 hours. The nursing unit uses tubing with a drop
factor of 10. What is the drip rate per minute?
Solution: Convert 1 hour to 60 minutes: 1250 x 10 gtts ÷ 60
minutes = 20.83 or 21 gtts/min
Answer: 21 gtts/min
Sample: Dr. B. orders a liter of D5W to run this 8-hour shift. The
drop factor is 15. What is the drip rate per minute?
Solution: 1 liter = 1000 cc of solution, next convert 8 hours to
minutes (8 X 60 minutes)
= 480 minutes
1000 cc x 15 gtts ÷ 480 minutes = 31.25 or 31 gtts/min
Answer: 31 gtts/min
A teenager who is badly dehydrated is to receive 1.5 L over
10 hours of rehydration fluid by IV infusion. The giving set
delivers 20 drops/mL. Calculate the drip rate.
Dilantin-125 (phenytoin) is available as 125 mg/5 mL.
Dilantin-125, 0.3 g PO, is ordered.
How much should the nurse administer to the patient?
Example : Furosemide is available as 40 mg in 1 mL. 10 mg is
ordered to be administered through an IV. What amount of
furosemide should the nurse administer?