Pediatric Dosage Calculations: Essential Math for Nurses

PEDIATRIC MATH 88

PEDIATRIC MATH A child is not the same patient as an adult. Not only do we have no idea what a child’s response may be to a medication new to them, but the dose must be adjusted to allow for the enormous variety in size of pediatric patients, from the tiny 2.5 pound premature infant to the 17-year-old high school student. There are two ways in which pediatric doses allow for this: dose is based on the child’s weight (mg per Kg), or on the child’s M. It is your responsibility as the nurse to be sure the dose you are going to give is safe for the child. So let’s look first at how to calculate the size of the child’s body, using the M~ M2 formula NOTE: If pt information is given in inches YV WtinKg x htincm and pounds, it must be converted to meiric 3600 for these calculations. The M2 formula gives the body surface area. M? is meters squared. Now, a basic rule. Basic rules If your problem gives you a range for the medication dosage, utilize that range in determining whether or not a doctor’s order is safe for the pediatric patient. If the problem gives you no range, the doctor’s order must be the dose you have calculated, or it is considered unsafe. Any time the order is unsafe, you would have to call the MD and get a revision of the order. [There are areas of pediatric medical care (such as pediatric oncology) in which some faculties may allow you to give the dose if it falls between 90 and 110% of the original order — that is, the doctor’s order plus or minus 10 percent, and any 89

number within that range would be considered a safe dose. However, do not assume this is the case at your facility, without further instructions!] Some further information: If a patient’s size is given in feet and inches, you must still use inches only to calculate the M2. Say your patient’s height is given as 3°4” (three feet four inches). Using your conversion factor, you can calculate inches = 12 inches x 3 feet = 36 inches 1 foot But the patient is 3 feet four inches tall, or 36 + 4 = 40 inches tall. You can now correctly calculate your M?, converting the inches into cm. If a patient’s weight is given in Ib and oz (pounds and ounces), you must convert it to 1b to calculate the M2. Say your patient’s weight is 6 Ib 9 oz. Again, use your conversion factor to determine what portion of a Ib the 9 oz is. Your patient weighs 6 1b plus 9/16 Ib (since a Ib =16 0z). Now turn this into a decimal: b = _11b_ x 90z = 0.56 b, so your patient weighs 6.56 Ib. 16 oz. You can now convert this to Kg and proceed with your calculations. Now let’s look at a couple of other areas for which you will have pediatric problems: maintenance fluids, and NG replacement fluids. Rounding: Rounding in pediatric math will be to two places (hundredths, so take to three and round to two places) in the answers, not to one place as in Fundamentals or TV math. This is because small changes in dose can make large changes in results in some of these very small patients. 20

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Maintenance fluid problems The doctor may order the child to receive maintenance fluids. The order is based on the child’s weight: the more the child weighs, the more fluid they receive over a 24-hour period. The usual order is as follows (the 100-50-20 order): 100 ml/kg for the first 10 kg of the child’s weight 50 ml/kg for the next 10 kg of the child’s weight 20 ml/kg for every kg or portion of a kg of the child’s weight over 20 kg How to solve maintenance problems 1. Look at this order for a moment. If a child weighs less than 10 kg, only the first portion of the order pertains. For a child weighing 8.8 kg, then: 100 ml x 8.8 kg = 880 ml, to be given over 24 hours kg 2. Bring the second part of the order in for a larger child. Say the child weighs 14 kg. The first portion of the maintenance will always be the same: 100 ml x 10kg = 1000 ml kg Now add the second part of the order for the balance of the child’s weight: 14 kg less the 10 kg already dealt with by the first portion of the order leaves 4 kg. 50 ml x4 kg = 200 ml kg so the patient will receive 1000 ml + 200 ml = 1200 ml over 24 hours. 91

3. For a child weighing more than 20 kg, you will need to utilize all three parts of the maintenance order, as shown below for a child weighing 39 kg: Il 100 ml x 10 kg = 1000 ml kg 50ml x 10kg = 500 ml kg So we have accounted for the first 20 kg of the child’s weight. Notice that for the first 20 kg of any patient’s weight, the total will always be the same: 1000 ml + 500 ml = 1500 ml Now we must deal with the remainder of the patient’s weight. The child weighed 39 kg. We have dealt with the first 20 kg, so 39 - 20 = 19 kg remaining. 20ml x 19kg = 380 ml kg So this child’s total maintenance fluid will be 1000 + 500 + 380 ml = 1880 ml over 24 hours. Example: The doctor has ordered maintenance fluids for your 24.5 kg patient, using the usual 100-50-20 order. How much fluid should the patient receive in the next 24 hours? 100 ml/kg x 10 kg = 1000 ml 50 ml’kgx 10kg = 500 ml 20ml/kgx4.5kg = 90 ml 1590 ml 92

NOTE: The doctor may also order some variant of the basic maintenance fluid order. For example, he may order ¥ maintenance fluids, or 1.5 X maintenance fluids. You then calculate the basic maintenance fluid amount, and multiply it, for example, by 0.5 or 1.5, depending on the doctor’s order. Example: The doctor has ordered 1.5x maintenance fluids for your 48.6 kg patient. How much should your patient receive in the next 24 hours? 100 ml/kg x 10 kg = 1000 ml 50 ml/kgx 10kg = 500ml 20 ml/kg x 28.6 kg = 572 ml for a total of 2072 ml. But the order is for 1.5x maintenance, so your answer must be 2072 x 1.5 = 3108 ml Bolus fluids and NG replacement Bolus fluids A patient may be admitted who is suffering from dehydration. This may be the result of a variety of causes: exposure to heat, lack of intake of fluid, vomiting, diarrhea. The cause doesn’t matter. What does matter is that the doctor will probably not only order IV fluids, he may well also order a bolus given. The order might be written; 1L normal saline given over four hours, then D5NS at 100 ml/hr. This would be treated like any other IV problem: how much is ordered, and over what period of time, to determine the flow rate you must set for the bolus. In the example above: 1000ml/4 hr = 250 ml per hour. Then the IV fluid would need to be changed, and the flow rate reduced according to the doctor’s orders. 93

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NG replacement fluids An adult may not be bothered much by NG tube suctioning, unless the volume suctioned is very great. However, even small amounts lost to the NG by small children can be significant, and may need to be replaced. The doctor will write orders for the replacement, and may well order a fluid with electrolytes to help replace those lost to the NG. If so, the replacement fluid may or may not be the same as the I'V fluid the patient has running. Ifit is the same fluid, simply take the amount suctioned the previous shift, divide it by 12, and add that to the flow rate for the fluid infusing, as in the following problem. Example: The patient has D51/2NS with 20 mEq of potassium running at 50 ml an hour. He had 120 ml of fluid suctioned out in the previous 12-hour shift. At what rate should you set the pump in order to continue the ordered infusion plus replace the fluid suctioned with D51/2NS with 20 mEq KCI? 120 ml/12 hr = 10 ml/hr for replacement of fluid lost to the NG Current infusion rate = 50 mi/hr + 10 ml/hr = 60 ml/hr What if the replacement fluid ordered is not the same as that currently infusing? Then you would simply run the replacement fluid in separately. This cannot be done as a piggyback, because the primary fluid would stop while the piggyback ran in. 1t could be done through a Y-site, so both fluids could run in at the same time, through a separate IV site, through a separate pump, or through another port of the same central line. Example: Your pediatric patient has had gastric surgery and now has an NG tube to low wall suction. This tube has suctioned 50 ml on the last shift. Your orders are to replace the drainage with D51/2NS with 20 mEq KCI over 12 hours. The current peripheral IV is D5W infusing at 40 ml/hr. 94

50ml/12 hr = 4.17 ml per hour for the replacement fluid, while the primary fluid ordered would continue to infuse at 40 ml/hr. Your choices for how to do this are given above. Another possibility for your pediatric patient: The doctor might order peripheral IV to run in at the fluid maintenance rate (or some multiple thereof), rather than giving a set rate in his order. Example: The doctor ordered NG replacement fluid (D51/2NS with 20 mEq of KCI over 12 hours) for 100 ml suctioned out the previous shift. The child weighs 50 pounds and is 38 inches tall. His regular IV fluid is D5W with multivitamins, to run at 1.5x the fluid maintenance rate. What rate would you set for each fluid? Replacement fluid: 100ml/12 hr = 8.3 ml/hr Regular fluid: 100ml/kg x 10 kg = 1000 ml (50 1b =22.73 kg) 50 ml/kgx 10kg = 500 ml 20 ml/kg x 2.73 kg=__54.6 ml 1554.6 ml x 1.5 2331.9 ml over 24 hours = 97.16 ml/hr 95

54. Orders: NS at 100 ml/hr Levaquin 500 mg in 100 ml (infuse over 60 min.) daily Ancef 1 g in 100 ml (infuse over 30 min.) 3 times daily Cipro 500 mg in 50 ml (infuse over 30 min.) 2 times daily a. Calculate flow rate for each of the antibiotics. b. Calculate drip rate for each of the antibiotics. c. Calculate the total input. PEDIATRICS 55. A medication has been ordered at 60 mcg/Kg/min for your pediatric patient. The medication comes in 25 ml vials containing 1 g of medication. It is to be mixed to create a solution of 1000 mg in a 500 ml bag. The child weighs 30 Kg. a. How many ml of the medication should be added to the 500 ml bag to get the ordered strength? 119

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b. How many mg of the medication should the child receive per hour? c. What flow rate should be set to infuse the medication per the doctor’s order? 56. Your teen-aged patient has ovarian cancer. The initial round of the medication ordered is to be given at 260 mg/M?/day in four divided doses for 21 days. The medication comes in 50 mg capsules. Your patient weighs 118 Ib and is 63 in tall. How much should she receive per dose? How many capsules will this be per dose? 57. 70 mg every 6 h of a medication is ordered for a 17 Ib 9 oz child. The literature states safe dosage is 30 mg/Kg/day. The available medication: 500 mg in 250 ml of 0.45NS. a. What is the child’s weight in Kg? b. How many mg/day will the child receive by the MD’s order? c. Isthe doctor’s order safe, per the literature? 120

d. What will be the ml per dose, by the doctor’s order? 58. A 54-pound child has an order for 250 mg of an antibiotic four times daily. The antibiotic comes at 100mg/5 ml, with the usual dose 15 — 40 mg/kg/day in three divided doses. a. What is the per dose range, according to the literature? b. Is the doctor’s order safe? c. How many ml should the child receive per dose, by the MD’s order? 59. Your fragile 13-month-old HIV-positive patient has developed a herpes simplex infection. The doctor has ordered acyclovir sodium 30 mg/Kg/day in three divided doses. The child weighs 26 pounds and is 28 inches long. a. What is her M2 ? b. Label dose is 750 mg/M? per day for 7 days. What is the per dose and per day safe dose for this child? 121

60. 61. 62. c. Is the doctor’s order safe? Your patient weighs 17 Kg and is 82 cm tall. What is his M?? The patient is to receive 2 — 5 mg/M? of a medication. Based on the M? you just calculated, what is the safe dose range? A child weighing 8 1b 7 oz is to receive a medication at 6 mcg/Kg/min. The medication is available 100 mg in 100 ml. At what rate would you set a pump to infuse the correct amount? The child weighs 44 1b. The medication’s safe dose is 15 to 25 mg/Kg/day in four divided doses. The doctor has ordered 100 mg/dose. Is his order safe? 122

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63. 64. 65. A child has been admitted. The child is 3 feet 8 in tall and weighs 55 Ib. Her medication has been ordered at 14 mg/M? per dose. How much will you give per dose? The child has an NG tube which has drained 135 ml in the past 12 hours. IV fluids are ¥ NS at 40 ml/hr. Replacement fluids ordered are 2 NS with 20 mEq potassium. At what rate will you set the pump to replace the fluid lost to the NG tube? Your pediatric patient has an antibiotic ordered which is available at 300 mg/10 ml in a suspension. The patient weighs 16.9 Kg. The usual dose is 20 — 30 mg/Kg/day in three divided doses. The doctor has ordered 250 mg/dose. Is this dose safe? Questions 66 and 67 are related 66. The medication is available in a concentration of 100 mg/5 ml in 10 ml vials. The directions indicate you are to dilute 30 mg of the medication in 50 ml of D5W. How much of the medication should be added to the 50 ml of D5W to get the desired dilution? 123

67. 68. 69. 70. Your 15.4 Kg patient is to receive 8 mcg/Kg/min of the above medication. How much will they receive per hour? What flow rate would you set to infuse this dose? The pediatric patient is currently receiving NS at 35 ml/hr. She has lost 112 ml of fluid to NG suctioning on the previous 12-hour shift. The MD has ordered replacement fluids of DSNS. At what rate will you set the pump or pumps to follow the doctor’s orders? The doctor has ordered 70 mg of a medication every 12 hours. The child weighs 11 1b 5 oz. The drug dosage for the medication is 25 mg/Kg/day in divided doses. Is the dose the doctor ordered safe? What is the M? of a patient weighing 48.7 Kg who is 142.8 cm tall? 124

71. 72. 73. 74. 75. The MD has ordered 1.5x maintenance fluid for your 29.54 Kg patient. At what rate will you set the pump to infuse these fluids over the next 24 hours? The child has ¥, maintenance fluids ordered. He weighs 11.1 Kg. How much should he get in the next 24 hours? What flow rate would you set to deliver this? What is the M? of a patient who is 55 inches tall and weighs 68 pounds? The doctor has ordered a 500 ml bolus dose of D51/2NS for your pediatric patient, who currently has D51/2NS infusing at 35 ml/hr. At what rate will you set the pump to infuse the bolus dose over the next 4 hours? Your patient is 70 inches tall. She weighs 78 1b. She is to receive 24 mg/M? per dose of an ordered medication. How much will you give? 125

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76. 77. 78. Your pediatric patient is to get IV maintenance fluids for the next 24 hours, according to the customary 100-50-20 order. The child weighs 31 Kg. How much fluid will he receive over the next 24 hours? At what rate will you set the pump to achieve this? The 5-year-old patient, who weighs 52 1b, has a severe ear infection, and the doctor has prescribed amoxicillin in a liquid form with a concentration of 125 mg in 5 ml. The usual dose is 20 — 40 mg/kg/day in three divided doses. The doctor has ordered 300 mg every 6 hours. a. What is the safe range? b. Is the doctor’s order safe? Your 7-year-old patient currently has D5NS infusing at 25 ml/hr. He has an NG tube which has drained 78 ml in the previous shift. Replacement fluids are DSNS with 10 mEq KCl1. At what rate will you set the pump to replace the lost fluids during your 12-hour shift? 126

79. 80. 81. 82. The medication ordered should be given at 30 mg/Kg, according to your reference. Your patient weighs 34.5 Ib. The doctor has ordered 500 mg daily. Is his order safe? Your pediatric patient has a body surface area of 1.32 M2, The medication has been ordered at 5 mg per M2. a. What dose will the child receive? b. The medication is available in a solution 300 mg/50 ml. How much will the child receive per dose? Your 8-month-old patient weighs 15.91 Kg. The medication has been orered at 40 mg twice a day. The safe pediatric dose has been determined to be 5-8 mg/Kg/day. Is the doctor’s order safe? The medication in the previous problem is available 20 mg/5 ml. Based on the doctor’s order, how much will the child receive per dose? 127

83. Your 5-month-old patient has had abdominal surgery and now has an NG tube, which has drained 88 ml on the previous shift. IV fluids infusing are D51/2NS with 10 mEq KCI, at 45 ml/hr. The doctor’s order for replacement fluids: D51/2NS with 10 mEq KCl. At what rate will you set the pump(s) to replace the lost fluid over the next 12 hours? 84. The 6-year-old, 22 Kg patient has had a severe allergic reaction to a medication and has hives. Benadryl 25 mg/10 ml has been ordered for the itching. The pediatric dose has been determined to be 5 mg/Kg/day. The doctor has ordered 30 mg every 6 hours as needed. a. What is the safe dose for this child? b. Is the doctor’s order safe? c. How much of the Benadryl will the child get per dose, if the MD’s order is followed? 85. The child is 58 inches tall and weighs 102 pounds. He is to receive a medication at 12 mg/M? daily. How much will he get per dose? 128

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86. 87. 88. 89. The 8-year-old post-op patient has received an accidental narcotic overdose, and is now unresponsive. The doctor orders 0.5 ml Narcan to counteract the narcotic. The child weighs 66 pounds. Safe dose is 0.005 to 0.01 mg/Kg, and the Narcan is available 400 mcg/ml. What is the safe range, and is the doctor’s order safe? The child, who at 62 cm weighs 7.2 Kg, has been admitted with pneumonia. Several of his ordered medications are based on the child’s BSA. Calculate his M2 The doctor has ordered 2x maintenance fluids for your cachectic (very underweight) patient. The patient weighs 42 Kg. How much fluid will you give this patient in the next 24 hours? Y our pediatric cancer patient is to receive doxorubicin 30 mg a week. The child is 42 in. tall and weighs 57 Ib. The medication is available 25 mg in 50 ml of DSW. Safe dose is 20 — 30 mg/M? once a week. Is the doctor’s order safe? 129

55. 56. 57. 58 D08 Pediatrics, p. 119 a. ml =25 ml/1000 mg x 1000 mg = 25 ml b.mg/hr = 60 mcg/Kg/min x 30 Kg = 1800 mcg/min x 1 mg/1000 mcg = 1.8 mg/min x 60 min/hr = 108 mg/hr c. ml/hr = 525 ml/1000 mg x 108 mg/hr = 56.7 ml/hr M2 =+/160.02 x 53.64/3600 = V2.3843 = 1.54 M2 Mg = 260 mg/M? x 1.54 M? = 400.4 mg per day /4 doses = 100.1 mg/dose cap = 1 cap/50 mg x 100.1 mg/dose =2 caps/dose a.171b90z=17.561b Kg=1Kg/221bx 17.561b=7.98 Kg b. mg =70 mg/6 hr x 24 hr/day = 280 mg c. mg = 30 mg/Kg x 7.98 Kg = 239.4 mg Order is unsafe. d. ml =250 mg/500 mg x 280 mg = 140 ml/4 doses = 35 ml a. mg=15mg/Kgx 1 Kg/2.2 Ibx 54 1b = 368.18 mg/day /3 = 122.73 mg/dose mg =40 mg/Kg x 1 Kg/2.2 1b x 54 1b = 981.82 mg/day /3 = 327.27 mg/dose b. Order is unsafe (safe per dose but not per day) MD ordered 4 doses/day. c. ml =5 ml/100 mg x 250 mg = 12.5 ml (would not give/is unsafe) a. M2=+71.12 x 11.82 /3600 = v/0.23351 = 0.48 M? b. mg = 750 mg/M?/day x 0.48 M? = 360 mg/day / 3 = 120 mg/dose c. Officially, the order is not safe, since it is not exactly what we calculated. Unofficially, there is a good possibility the facility and the MD would agree it could be given, because it is so close (98.5% of our calculated safe doses). There would be discussion, and the decision would need to be documented, unless there is a protocol in place allowing it. 60. M2 =17 x 82/3600 = 0.38722 = 0.62 M? mg =2 mg/M? x 0.62 M?=1.24 mg mg= 5 mg/M?x 0.62 M?>=3.1 mg 61. 6 mcg/Kg/min x 3.84 Kg = 23.04 mcg/min x 1 mg/1000 mcg = 0.02304 mg/min x 60 min/hr = 1.38 mg/hr ml/hr = 100 ml/100 mg x 1.38 mg/hr = 1.38 ml/hr 150

62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 025 73. 74. 75. 76. mg = 15 mg?kg x 1 Kg/2.2 1b x 44 1b =300 mg/day /4 = 75 mg/dose mg = 25 mg/Kg x 1 Kg/2.2 1b x 44 Ib = 500 mg/day/4 = 125 mg/dose Yes, the order is safe. M2 =+/111,76 x 25/3600 = V0.77611 = 0.88 M? mg = 14 mg/M? x 0.88 M? =12.32 mg ml/hr = 135 ml/12 hr = 11.25 ml/hr for replacement fluids. Previously running fluids will continue to run at 40 ml/hr on a separate pump. mg = 20 mg/Kg/day x 16.9 Kg =338 mg/day /3 = 112.67 mg/dose mg = 30 mg/Kg/day x 16.9 Kg = 507 mg/day / 3 = 169 mg/dose MD’s order of 250 mg/dose is unsafe. ml =5 ml/100 mg x 30 mg = 1.5 ml 8 meg/Kg/min x 15.4 Kg = 123.2 mcg/min x 60 min/hr = 7392 mcg/hr x 1 mg/1000 mcg = 7.39 mg/hr ml/hr = 51.5 ml/30 mg x 7.39 mg/hr = 12.69 ml/hr ml/hr = 112 m1/12 hr — 9.33 ml/hr for replacement fluids. Previously running fluids will continue to run at 35 ml/hr on a separate pump. mg = 25 mg/Kg/day x 1 Kg/2.2 Ib x 11.31 Ib = 128.52 mg/day /2 = 64.26 mg/dose Doctor’s order is unsafe. M2 = /48.7 x 142.8/3600 = v1.93177 = 1.39 M? 100 ml/Kg x 10 Kg = 1000 ml; 50 ml/Kg 10 Kg = 500 ml; 20 mg/Kg x 9.54 Kg = 1690.8 ml total x 1.5 =2536.2 ml (Note that for future answers, this will be abbreviated simply as 100 x 10 = 1000, etc.) ml/hr = 2536.2 mi/24 hr = 105.68 ml/hr 100 x 10 =1000 ml; 50 x 1.1 = 55 ml, total 1055 ml/2 = 527.5 ml ml/hr = 527.5 ml/24 hr = 21.98 ml/hr M2 =139..7 x 30.91/3600 = V1.19948 = 1.1 M? ml = 500 m1/4 hr = 125 ml/hr for bolus dose + 35 ml/hr exact same fluid already running, so can add them together = 160 ml/hr for next 4 hours M2 =/177.8 x 35.45/3600 = v1.75084 = 1.32 M? mg = 24 mg/M? x 1.32 M? = 31.68 mg 100 x10 = 1000ml; 50 x 10 = 500 ml; 20 x 11 = 220 ml; total 1720 ml ml/hr = 1720ml1/24 hr = 71.67 ml/hr 151

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77. 78. 79. 0. g1. 82. 83. &4. 85. 86. 87. 88. 89. a. mg=20mg/Kg/day x 1 Kg/2.2 1b x 52 1b =472.73 mg/day = 157.58 mg/dose mg = 40 mg/Kg/day x 1 Kg/2.2 1b x 52 1b = 945.45 mg/day = 315.15 mg/dose b. Dr.’s order is unsafe; it is safe per dose but not per day (ordered 1200 mg/day). If any part is unsafe, the order is unsafe. ml/hr = 78 ml/12 hr = 6.5 ml/hr for replacement fluids Previously running fluids will continue at 25 ml/hr on separate pump. mg =30 mg/Kg x 1 Kg/2.2 1b x 34.5 Ib =470.45 mg. Order is unsafe a. mg=>5mg/M?x 1.32 M?= 6.6 mg b. ml=50ml/300 mgx 6.6 mg=1.1m mg =5 mg/Kg x 15.91 Kg = 79.55 mg/day / 2 = 39.78 mg/dose Mg =8 mg/Kg x 15.91 Kg = 127.28 mg/day / 2 = 63.89 mg/dose The order is safe. ml =5 ml/20 mg x 40 mg =10 ml ml/hr = 88 ml/12 hr = 7.33 ml/hr replacement fluids + 45 ml/hr current (identical) fluids = 52.33 ml/hr. The fluids are identical, so can run together through the same pump for the next 12 hours. a. mg=>5 mg/Kg/day x 22 Kg =110 ml/day b. 30 mg/dose x 4 doses = 120 ml/day MD’s order is too high, both per day and per dose. c. ml= 10 ml/25 mg x 30 mg = 12 ml (Would not give, is unsafe.) M2 =+/147.32 x 46.36/3600 = v/1.89715 = 1.38 M? mg = 12 mg/M? x 1.38 M? = 16.56 mg mg = 0.005 mg/Kgx 1 Kg/2.21b x 66 1b = 0.15 mg mg=0.01 mg/Kgx 1 Kg/2.21bx 66 Ib=0.3 mg How much did the MD order? mg = 400 mcg/ml x 0.5 ml =200 mcg = 0.2 mg so order is safe. M2 =62 x 7.2/3600 = V0.124 = 0.35 M2 100 x 10 = 1000 ml; 50 x 10 = 500 ml; 20 x 22 = 440 ml so total 1940 ml x 2 = 3880 ml M2 =/106.68 x 25.91/3600 = v/0.7678 = 0.88 M? mg = 20 mg/M? x 0.88 M2 = 17.6 mg; 39 mg/M? x 0.88 M? = 26.4 mg The order is unsafe. 152

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Reconstitution problems, p. 140 ml =75 ml/1000 mg x 600 mg = 45 ml ml =2 ml/90 mg x 1000 mg = 22.2 ml ml =52 ml/300 mg x 120 mg = 20.8 ml ml = 1 ml/300 mg x 3000 mg = 10 ml needed. 5 already in vial; add 5 ml ml =1 ml/250 mg x 2000 mg = 8 ml ml/hr = 108 ml/45 min x 60 min/hr = 144 ml/hr 6. ml =45 ml/750 mg x 450 mg = 27 ml 7. ml=1ml/225 mg x 1000 mg = 4.4 ml ml/hr = 104.4 ml/45 min x 60 min/hr =139.2 ml/hr 8. ml =1 ml/20 mg x 32 mg = 1.6 ml 9. ml=1ml/250 mg x 1500 mg =6 ml. 2 ml in vial, so add 4 ml 10. ml=2ml/350 mgx 1000 mg = 5.7 ml 11. ml=25ml/2000 mg x 1000 mg = 12.5 ml mb/hr = 262.5 ml/hr 12. ml=15ml/200 mg x 75 mg = 5.6 ml 13. ml=20ml/3.5gx1.5g=8.6 ml ml/hr = 108.6 ml/45 min x 60 min/hr = 144.8 ml/hr 14. ml=1ml/115 mgx 450 mg = 3.9 ml 15. ml/hr =260 ml/1400 mg x 700 mg/hr = 130 ml/hr 16. ml=2ml/150 mgx 2500 mg = 33.3 ml ml =2 ml/150 mg x 300 mg =4 mg/6 hr x 24 hr/day = 16 ml/day 17. ml=1ml/500 mg x 3500 mg =7 ml; have 5 in vial so add 2 ml 18. ml=1ml/50 mgx 100 mg=2 ml 19. ml=1ml/60 mgx 750 mg = 12.5 ml ml/hr = 262.5 ml/750 mg x 30 mg/hr = 10.5 ml/hr 20. ml=1ml/10 mgx 30 mg=3 ml ml/hr = 53 ml/40 min x 60 min/hr = 79.5 ml/hr 21. ml=3ml/400 mgx 750 mg = 5.6 ml ml/hr = 105.6 m1/30 min x 60 min/hr = 211.2 ml/hr 22. ml=7ml/1200 mg x 600 mg = 3.5 ml 23. ml=1ml/65 mgx 200 mg=3.1 ml 24, ml=1ml/300 mgx 1500 mg =5 ml G R 153

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25. ml=3ml/150 mg x 250 mg =5 ml ml/hr = 105 m1/250 mg x 40 mg/hr = 16.8 ml/hr 26. ml=1ml/60 mgx 500 mg= 8.3 ml 27. ml=1ml/75 mgx 1200 mg =16 ml ml =1 ml/75 mg x 350 mg = 4.7 ml 28. ml=5ml/2.5gx1.5g=3ml ml/hr = 53 mI/30 min x 60 min/hr = 106 ml/hr 29. ml =35 ml/500 mg x 40 mg = 2.8 ml 30. ml = 1 ml/5000 units x 2000 units = 0.4 ml 154

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