Shitalem Tadesse

Outlines
 Introduction
 Aims of drug administration
 Terminology
 Parameter for drug calculation
 Drug conversions
 Drop rate calculation
 Conversion of drug dosage to ml/hr.
 Conversion of mL/hour back to a dose
 Calculating the length of time for IV infusions

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Objectives
 At the end of this discussion participants will be able to:
 Discuss the aims of drug calculation in ICU
 Discuss key parameter during drug calculation in ICU
 Explain types of drug calculation in ICU
 Determine Drip rate calculations (drops/min)
 Clarify Conversion of dosages to mL/hour
 Explain Conversion of mL/hour back to a dose
 Discuss and Calculate the length of time for IV infusions

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4 Basic ICU training 09.08.2016 E.C
Introduction
 Drug dosage calculations are required when the ordered is
different from what is available on hand to administer
 There are two main types of infusion rate calculations these are:
 Drops/min is mainly encountered when infusions are given
under gravity as with fluid replacement
 mL/hour is encountered when infusions have to be given
accurately or in small volumes using infusion or syringe pumps

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Giving sets
 There are two types of giving sets:
 The standard giving set (SGS) has a drip rate of 20 drops
per ml for clear fluids and 15 drops per ml for blood
 The micro-drop giving set or burette has a drip rate of 60
drops per ml.
 The drip rate of the giving set is always written on the
wrapper if you are not sure

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Aims of giving drugs in ICU
 Critical
care medications are used for :
 Improve oxygenation
 Maintain blood pressure
 Correct an abnormal heart beat
 Dissolve clots in the arteries in the heart
 Ensure patient safety
 Optimize drug therapy

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Con…t
 Minimize treatment variability
 Facilitate effective monitoring
 Compile with guidelines and protocols
 Support interprofessional collaboration
 Minimize treatment variability

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Con…t
 Tocalculate the milliliter per hour infusion rates from
milligram per minute and microgram per minute dosages,
gather this information
• The amount of medication in the IV bag
• The amount of fluid (diluent) in the IV bag
• The ordered rate of infusion (milligram per minute or
microgram per minute

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Con…t

 Delivery of the correct medication, dose, and infusion rate

and time is essential for safe and therapeutic intravenous
medication administration
 Accurate dosage calculation are an essential component of
total nursing role in safe administration of medication

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Patient Rights
 The Right patient
 The Right drug
 The Right dose
 The Right time
 The Right route
 The Right documentation
 The Right to refuse treatment

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Precaution to see order sheet of medication

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Terminology
 FLOW RATE: is the volume per unit time usually expressed as ml/hr. can be ml/min
or ml/sec
 DRIP RATE: is the number of drops per unit time usually expressed as drops/min (dpm)

 DOSE: amount of drug per unit time given to the patient expressed as mg/min, g/hr. or

IU/min
 CONCENTRATION: amount of the drug in a given volume usually expressed as
mg/ml, g/l or IU/ml
 DROP FACTOR: is the number of drops per unit volume
 TITRATION: adjustment of the IV medication dosage within prescribed parameters to
achieve a desired effects

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Con…t
 The first step in determining IV flow-rate calculations is:
 Check the medication label
 Compare the label to the medication administration record
for the correct patient, medication, dose, time, and route
 Perform this comparison a total of three times before you
begin the infusion
 Be sure to clarify any questionable orders
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Key parameters during drug calculation
 Some of the key  Pharmacokinetics
parameters to consider  Therapeutic drug
during drug dosage in the monitoring
ICU includes:  Clinical condition
 weight  Route of administration
 Age  Allergies
 Renal function  Concomitant medications
 Liver function

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Drug calculation conversions
 1 liter = 1000 ml
 2%=2g/100ml=20mg/ml
 1 kg= 1000g
 40%=
 1g= 1000
40g/100ml=400mg/ml
mgs=1,000,000g
 1:1000=1g/1000ml
 1 mg=1000 g
=1mg/ml
 1:10,000=1g/
10,000ml=0.1mg/ml
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17 Basic ICU training 09.08.2016 E.C
Con...t
 It is important to follow the manufacturer’s guidelines for the
length of time for an infusion to be administered
 Calculations must be accurate to prevent complications from
the medicines being administered too quickly
 For example, if vancomycin is administered too quickly, the
patient may experience ‘red man syndrome
 RMS is characterized by flushing, erythema and pruritus,
usually affecting the upper body, neck and face; in extreme
cases, hypotension and angioedema may occur.

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Types of drug calculation in ICU
 There are several common types of drug calculations
performed in ICU including:
 Dose calculations
 Infusion rate calculations
 Titration calculation
 Renal dosing calculations

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1. Drip Rate Calculations (drops/min)

 In all drip rate calculations you have to remember

that you are simply converting a volume to drops
and hours to minutes
Drop rate =Total fluid(ml) x drop factor
time (h) x60

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Example

 1000ml of sodium chloride 0.9% is to be given over 8 hours:

what drip rate is required using a standard giving set (SGS),
20 drops

Drop rate =1000ml x 20 = 41.7 = 42 drop/min

8 x60

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2. Conversion of dosages to mL/hour

 Formula method
 Amount desired (D)
 Quantity or volume (Q)
 Amount on hand (H)

D XQ = Y ( Required)
H
o Ordered amount of drug x pt.'s weight x (60minutes/hr.) / Drug
concentration

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 Ml/hr.= Body weight x dose x 60 min.
Concentration of drug

Concentration of Drug = mg x 1000

volume of the solution

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Remember
 If the dosage calculation is in mg/min or mcg/min add 60
minutes into the formula
 If the dosage calculation is in mg/hr or mg/kg/hr, remove 60
minutes from the formula
 If the dosage calculation does not require weight, remove
weight from the formula

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Example

1. You have an order noradrenaline 0.1mcg/kg/min. patient weight 60kg

and you have a bag of 4mg in 500ml.

 What rate do you set the perfuser at ml/hour?
 Amount desired=0.1mcg x 60 x 60 =360mcg/hr.
 Amount on hand =4mg

unit quantity = 500 ml

 Required =?ml/hr
 D(360mcg) x q(500 ml)/H(4000mcg) = 45 ml/hr
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Exercise
 You have an order to run dopamine at 10mcg/kg/min. Your IV bag has 300
mg dopamine in 300 mL. Your patient weighs 70 kg.
o What rate will you set for your perfuser?
o What rate will you set for your IV?

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Con…t

Given
 Order =10 mcg/kg/min
 Weight= 70 kg
 Drug concentration= 300 mg of dopamine in 300 ml of IV fluid

Required
 Calculate the rate at which you set the perfuser
 Calculate the drop rate at which you set the IV drip

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Con…t
 First let’s calculate how much dopamine is ordered for the patient
 The order is 10mcg/kg/min
 10mcg * 70(the patient’s weight)* 60 (because there are 60 minutes in an
hour)= 42,000mcg.
 Then let’s change this in to ml
 The drug concentration is 300mg in 300 ml of fluid then we first convert mg in
to mcg (micro gram).
 1mg = 1000mcg
 300mg = ?
 300 mg =300,000mcg

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Con…t
 Then we calculate how many mcgs are there in 1 ml of fluid.
 300,000 mcg of dopamine is present in 300 ml of fluid. so
 300,000 mcg = 300 ml
 ? = 1ml
 So 1ml of the fluid contains 1000 mcg of dopamine.
 Coming back to our patient, the order is 10mcg/ kg /min which 42,000
mcg/hr. (from the above calculation)
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Con…t
 Finally we will convert 42, 000 mcg of dopamine in to ml
 If 1 ml of the prepared drug contains 3000 mcg of dopamine, how much ml is
42,000 mcg ? then
 1ml = 1000mcg
 ? = 42,000mcg

42 ml/hour
 So we will set the perfuser at 42 ml/ hour, since perfusers operate on hourly basis.
 If we do not have a perfuser we can give the drug via IV drip.
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Con…t
 Here is the formula to calculate the drop rate at which the IV can run
 Drop rate = amount of fluid to be given * drop factor (which is 20 gtt per
ml)/ time in minute
 Drop rate = 42 ml * 20/60 =13.5 drops per minute
 Approximately 14 drops per minute)

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3. Mr. x, with ECG and cardiac enzymes proven AMI developed
cardiogenic shock three days post admission to coronary care unit. 250 ml
of N/S as a bolus dose was tried but the BP didn’t come up. Finally,
dopamine was ordered to be initiated at a rate of 5g/kg/min. If you dilute
200mg of dopamine in to 195ml of N/S. At what rate should the infusion be
started?
(wt=60kg, 1 ampoule dopamine=200mg/5ml)

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 Answer
 Diluted Concentration = 200mg/200ml = 1mg/ml = 1000g/ml
 Weight = 60kg
 Desired dose =5g/kg/min

ml/hr. = 60kg x 5mcg/kg/min x 60

1000mcg/ml
ml/hr.=18ml/hr.

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Conversion of mL/hour back to a dose

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Example
 A 70  Amount on hand =400mg
kg patient is taking
unit quantity = 200 ml
dopamine 21ml/hr. The bag has
 Required =21ml/hr
labeled as 400mg dopamine in
 Amount desired=?
200 ml NS.
 D = 21 ml/hr x 400mg/(200 ml x
 What is the dose the patient
70)=0.6 mg/kg/hr
taking? = 10 mcg/kg/min

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 Your patient has a dobutamine IV drip running.
 The IV rate is 30 mL/hour.
 The IV bag has 500 mg of dobutamine in 250 mL of fluid.
 Your patient weighs 65 kg.
 How many mcg/kg/min is your patient receiving?

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 Ordered amount of drug = X
 Dose/mL (Drug concentration) = 500/250 = 2 mg/mL
 Convert to mcg = 2000 mcg/mL
 Patient weight 65 kg
 D = 30 ml/hr x 2000mcg/ml /(65kgX60min)

=15 mcg/kg/min

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 1:10,000 strength means that in every 10,000ml of solution you will find
1g of Adrenaline. Therefore, how many mg of Adrenaline would there
be in 10mL of 1:10,000 Adrenaline?

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Answer

 1:10,000 means that 1g of adrenaline is dissolved in 10,000mL.

1g = 10,000mL

1000mg = 10,000mL

Divide both sides by 1000

1mg = 10mL

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 A 1% (w/v) solution means that in every 100mL of solution you will find
1g of drug. Therefore, how many g of Glucose would there be in 500mL
of 5% Glucose?

Glucose 5% 500ml

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Percentage concentration
 The most common one you will come across is the
percentage concentration, w/v (weight in volume)
 This is when a solid is dissolved in a liquid and
means the number of grams dissolved in 100 mL:
 % w/v = number of grams in 100 mL

 A 1% (w/v) solution means that in every 100mL of

solution you will find 1g of drug
100mL = 1g
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Exercise
1. What is 5% w/v in 1000ml means?
 Answer
 There is 5g in 100ml
 Therefore 5gx10=50g weight in volume

2. WORKED EXAMPLE
 How much sodium bicarbonate is there in a 200 mL
infusion sodium bicarbonate 8.4% w/v?

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Pediatrics Example
 A 12 kg child patient needs maintenance fluid of 1100 ml run over 24
hours.
 How is the fluid prepared?
 What rate will you set for your IV?

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Con…t
 Maintenance fluid preparation
 From NS and 40% dextrose
 1/3 NS and 2/3 dextrose 10%
 367 NS+ 733D10%
 733D10%= 75% NS + 25% D40%

=550 ml NS+183 ml D40%

550 ml NS+367 ml NS=917 ml NS

917 ml NS+183 ml D40% =1100 ml

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Con…t
 From 85% of DW5% +15% of D40%

623ml DW5%+110mlD40%=733mlD10%

Drop rate =Total fluid(ml) x drop factor

Time (h) x60

Drop rate = 1100x20 = 15.2 =15 drop/min

24x60

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Con…t

 A 7 year old child is ordered to put on insulin 20 IU/hr. perfusion.

 Concentration is 20,000 IU in 250 ml of fluid
 What rate will you set for your perfuser?

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 Ordered amount of drug = 20 units/hr.
 Dose/mL (Drug concentration) = 20,000/250 = 80 units/mL
 Convert? Not necessary
 Patient weight NA

ml/hr. = 20U x wt.NA x min NA = 0.25ml/hr.

80U/ml
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4. Calculating the length of time for IV infusions

 A 500 ml infusion of sodium chloride 0.9% is being given

 The rate at which the infusion is being run is 42 drops/min
 How long will the infusion run at the specified rate (SGS)?

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Given
 Volume of the infusion = 500 ml
 Rate (drops/min) = 42 drops/min
 Drip rate of giving set = 20 drops/ml

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 First convert the volume to drops by multiplying the volume of the infusion
by the number of drops/ml for the giving set: 500 × 20 = 10,000 drops
 Next calculate how many minutes it will take for 42 drop= 1 minute
 Calculate how many minutes it will take to infuse the total number of drops:
10,000 drops will take = 238 min
 Convert minutes to hours by dividing by 60: 238 min = 3.97 hours 3 hours
58 minutes
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Answer: An infusion of 500ml of sodium chloride 0.9% at a rate of 42
drops/min will take approximately 4 hours to run.
 Number of hours the infusion is to run =

Volume of the infusion x drop factor

Rate (drops/min) x60
= 500ml X 20
42drop/min X 60
= 3.96 = 3 hours and 0.96 hours (0.96X60)
3 hours and 58min

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 A 1 liter infusion of sodium chloride 0.9% is being given .
 The rate at which the infusion is being run is 83 mL/hr.
 You start the infusion at 8 am on 15/24.
 When will the infusion be complete?

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Given
 Volume of the infusion = 1000 mL
 Rate (ml/hr.) = 83 ml/hr.
 Required= time the infusion run?

1000x20=12.06 hours

27.6

8 am+12 hrs.=20 (8pm)

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 The order is to give Dobutamine infusion to give at 10mcg/kg/min patient
weight is 81kg.
 You have 250ml of bag of dobutamine with 2mg/ml.
 How long will it take for the infusion to complete?

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 First calculate the ml/hr.
 Order=10mcg/kg/min
 Patient weight=81kg
 Concentration 2mg/ml =2000mcg/ml

10mcg/kg/min X 81kg X60 = 24.3 ml/hr.

2000mcg/ml

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 Next use the formula
 Number of hours the infusion is to run

= Volume of the infusion x drop factor

Rate (drops/min) x60

250ml x20= 10.42 hr. (0.42X60=25)

8 drop/min

Answer= 10 hrs. and 25 min

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Summary
 Drug dosage calculations are required when the ordered is different from what
is available on hand to administer
 Weight, age, renal function ,liver function ,clinical status, concomitant
medications, route of administration are some key factors during drug
calculation in ICU
 There are several common types of drug calculations performed in
ICU including: Dose calculations , Infusion rate calculations ,Titration
calculation and Renal dosing calculations

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References
 Robert Lapham, drug calculations for nurses a step by step
approach,4th edition
 ChatGPT and Midjourney

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 THANK YOU

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