HES 005 Drug Dosage Calculation

Terms & 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 mIU/ml
• DROP FACTOR: is the number of drops per unit volume.
Expressed as drops/ml
• TITRATION: adjustment of the IV medication dosage
within prescribed parameters to achieve a desired
effects.
Measurement Systems
• Three main types
– Apothecary
– Household
– Metric
VOLUME Metric Apothecary Household
4000ml 1gal(4qt)
1L (1000ml) 1qt (2pt)
500ml 1pt (16fl oz)
240ml 8 oz 1 glass/measuring cup
180ml 6oz 1 teacup
30ml 1 oz (8 dr) 2 tbsp
15ml ½ oz (4 dr) 1 tbsp (tablespoon)
5ml 1 dr (60M) 1 tsp (Teaspoon)
1ml 15 M 15 gtt
1 M(minim) 1 gtt(drop)
180mL 6 oz 1 teacup
WEIGHT 60-65 mg 1 gr -
1 g (1000mg) 15gr -
1kg (1000g) - 2.2 ib
1mg (1000mcg) - -
LENGTH 2.5cm - 1 inch

CALCULATION METHODS
• Various methods are used for solving medication
calculation
• The most common methods are:
 Formula,
 Proportion
 Dimensional Analysis
• No one method is best for solving every type of
problem. Several good approaches are available,
however and one of the best is dimensional analysis
• Rule #1 in drug calculations - STICK TO
ONE METHOD!
Routes
• IM– Intramuscular
• IO– Intraosseous
• IV– Intravenous
• IVP– Intravenous Push
• ID – Intradermal
• IN – Intranasal
• IP – Intraperitoneal
• IT – Intrathecal
• IVPB – Intravenous piggyback
• p.o – By mouth
• SC / SubQ – Subcutaneous
• SL – Sublingual
• top. – Topical
• vag. – Vaginally
Measurements
• Kg – kilogram
• gm – gram
• mg – milligram
• mcg – microgram
• mEq - milliequivalent
• L – liter
• mL – milliliter
• µg – microgram
• gtt – drop
• µgtt – micro drop
• tbsp – tablespoon
• tsp – teaspoon
• mg/dL – milligrams per deciliter
BODY SURFACE AREA
• Use either a normogram chart to fine the
body surface area or
• Body surface area BSA=√ 𝑤𝑒𝑖𝑔ℎ𝑡 (𝑘𝑔) ×ℎ𝑒𝑖𝑔ℎ𝑡(𝑐𝑚)
3600
Recommended Volume for
Administration Per Sites:
• Intradermal = 0.1 - 0.5 ml (allergy testing)
• Subcutaneous injection = 0.5 - 1.0 ml per
site
• Intramuscular injection = 2.5 - 3.0 ml per
site (1 ml in the deltoid)
• IV injection (IV push) = 1 – 60 ml
Conversions
Solid Conversions Liquid Conversions
• gr 1 = 60 mg • 30 mL = 1 oz
gr 15 = 1 g 1 tsp = 5 mL
2.54 cm = 1 in 1 standard measuring cup
2.2 lb = 1 kg = 240 mL
Conversions
Mass Volume
• mcg ← mg ← g ← kg ( x • mcL ← mL ← L ← kL ( x
by 1,000 ) by 1,000 )
mcg → mg → g → kg ( ÷ mcL → mL → L → kL ( ÷
by 1,000 ) by 1,000 )
lb ← kg ( x by 2.2 ) Time
lb → kg ( ÷ by 2.2 ) • min ← hr ( x by 60 )
min → hr ( ÷ by 60 )
Temperature Conversions
• Medication orders often use Centigrade temperature.
• The relationship of centigrade 0C and Fahrenheit 0F
degrees is
• To convert from Fahrenheit to Centigrade, use this formula:
 °C = (°F − 32) ÷ 1.8
 °C = (°F − 32) ÷ 95
• To convert from Centigrade to Fahrenheit, use this formula:
 °F = (°C × 1.8) + 32
9
 °F = (°C × ) + 32
5
Calculating Tablet Dosages
• In calculating tablet dosages, the following
formula is useful
𝐷𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑎𝑔𝑒
Number of tablets =
𝑠𝑡𝑜𝑐𝑘 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ
Example:-
Orders 1,500 mg of calcium carbonate for the
patient. The drug is available in 250 mg tablets. How
many tablets should be given to the patient?
1500 𝑚𝑔
Number of tablets = =6 tablets
250 𝑚𝑔
Calculating Mixtures and Solutions
The following formula is useful in calculating
mixtures and solutions:
𝐷𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑎𝑔𝑒
Amount of solution to be given= x Stock volume
𝑠𝑡𝑜𝑐𝑘 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ
The orders 375 mg of cefuroxime for the patient. The drug is available
in 750 mg vial. You plan to dilute it in 10 mL of sterile water. How much
should you give to your patient?
375 𝑚𝑔
• Amount of solution to be given = x 10 ml
750 𝑚𝑔
• = 0.5 mg x 10 ml = 5 ml
Calculate IV Rate – mL per hour
and minute
• It is easy to calculate the running rate of IV
fluids in terms of mL per hour or mL per
minute:
• ML per hour or minute = TimeTotal IV Volume
(Hour or Minute)
• Start venoclysis with D5 0.9 NaCl 1 L to be
infused for 16 hours. How many mL of the IV
fluid should you infuse per hour?
• 1 L ÷ 16 hours = mL per hour
[1 L x 1,000]
•
16 hours = 62.5 mL per hour
Calculate IV Rate – drops per
minute
• Calculating for drops per minute is simple with the
following formula:
– Drops Per Minute = Total IV Volume x Drop Factor
Time (Minute)
Example
• The physician orders to start venoclysis with D5 0.3 NaCl 1 L
solution. The IV fluid will be infused for 14 hours and the drop
factor of the macrodrip used is 20. It should be regulated to how
many drops per minute?
[1 L x 1,000]
– Drops Per Minute = x 20
[14 hours x 60]
– [1,000 mL ÷ 840 minutes] x 20 = drops per minute
– 1.19 x 20 = 23 to 24 drops per minute
Calculate IV Rate – Remaining
Time of Infusion
• Calculating for the remaining time of infusion for a certain IV
fluid is possible with the following formula:
Volume remaining (in ml)
• Minutes Remaining =
Drops per minute
x Drop Factor
Example
• A patient has 350 mL of Plain 0.9 NaCl solution as IV infusion
regulated at 20 drops per minute. Drop factor 10 was used for
the patient’s macrodrip set. Considering the IV fluid level of the
patient, for how many minutes will it run?
350 mL
• Minutes Remaining =
20 Drops per minutex 10
= 175 minutes or 3 hours

Paediatrics Drug Calculation
1. Proportion to age
A. Young’s formula
𝑎𝑔𝑒 (𝑦𝑒𝑎𝑟𝑠)
𝑑𝑜𝑠𝑒 𝑓𝑜𝑟 𝑎 𝑐ℎ𝑖𝑙𝑑 × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠
𝑎𝑔𝑒 + 12
= 𝑒
The above formula is used for calculating the doses for children less than 12
years of age (1-12years)
B. Dilling’s formula
𝑎𝑔𝑒(𝑦𝑒𝑎𝑟𝑠)
𝑑𝑜𝑠𝑒 𝑜𝑓 𝑎 𝑐ℎ𝑖𝑙𝑑 × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
20
=
The above formula is used for calculating the doses of a child in between 4 -20
years of age
C. Fried’s formula
𝑎𝑔𝑒 𝑖𝑛 𝑚𝑜𝑛𝑡ℎ
𝑑𝑜𝑠𝑒 𝑓𝑜𝑟 𝑎 𝑐ℎ𝑖𝑙𝑑 𝑠 × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠
150
= 𝑒
1. Calculation base on body surface area
A. Catzel rule:
𝑠𝑢𝑟𝑓𝑎𝑐𝑒 𝑎𝑟𝑒𝑎 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑
𝐷𝑜𝑠𝑒 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑐ℎ𝑖𝑙𝑑 = × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
𝑠𝑢𝑟𝑓𝑎𝑐𝑒 𝑎𝑟𝑒𝑎 𝑜𝑓 𝑎𝑑𝑢𝑙𝑡
The average body surface area for an adult=1.73m2
Hence
𝑠𝑢𝑟𝑓𝑎𝑐𝑒 𝑎𝑟𝑒𝑎 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑
𝐷𝑜𝑠𝑒 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑐ℎ𝑖𝑙𝑑 = × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
1.73𝑚2
1. Calculation base on body weight:
A. Clark’s rule
𝑤𝑡 𝑖𝑛 𝑙𝑏
𝐷𝑜𝑠𝑒 = × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒(𝑚𝑔)
150𝑙𝑏
𝑤𝑡 𝑖𝑛 𝑘𝑔
𝐷𝑜𝑠𝑒 = × 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒(𝑚𝑔)
70𝑘𝑔
The rule is applicable only when child dose is less than 150lb or 70kg
FLUID THERAPY
• In fluid therapy maintenance is calculated using 4, 2, 1 formula
(Holliday - Segar’s Formula): This was standard looking at
maintenance daily fluid requirement of health children
 4ml/kg/hr. for first 10 kg,
 2ml/kg/hr. for next 10 kg
 1ml/kg/hr. for remaining kilogram weight.
• This can be simplified by using formula
• Maintenance fluid requirement (ml/hr) = {60+ (Weight kg-20)}
ml/hr for weight ≥20 kg
• Example: 65 kg women who is nil per Os will require
 Fluid required= 60 + (65-20)
 60+45
 105ml/hr of intravenous infusion
• Similarly 70 kg who had fasted over (night) 8hrs for elective surgery
will have deficit of
• Fluid deficit = 60 + (70-20)
• =60 + 50 ml
• =110 ml/hr
 Hence total fluid deficit is 110 ml/hr ×8 hr=880 ml
References
• Finkel, R., Clark, M. A., Cubeddu, L. X., Harvey, R.
A., & Champe, P. C. (2009). Lippincott’s
illustrated reviews : pharmacology. Lippincott
Williams & Wilkins, Cop.
• Rosenfeld, G. C., & Loose, D. S.
(2014). Pharmacology. Lippincott Williams &
Wilkins.
• Clayton, B. D., & Willihnganz, M. J. (2017). Basic
pharmacology for nurses. Elsevier.
THANK YOU

HES 005 Drug Dosage Calculation

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Terms & Terminology

• FLOW RATE: is the volume per unit time usually

LENGTH 2.5cm - 1 inch

= 175 minutes or 3 hours

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