INTRODUCTION

It is important that you are able to do calculations confidently, as mistakes may result in the
patient receiving the wrong dose which may lead to serious consequences for the patient.
Patient safety depends on accurate I.V. drug dosing; precise calculations are essential to this
process. Nurses shouldn't be apprehensive when I.V. drug dosages are presented in practice.

CONVERSION TABLE TO MEMORISED

Metric Volume Weights: Apothecary/ Household to Metric

 1 L= 1000 mL 1 gr = 60 mg
15 gr = 1 g
 Metric Weight 2.2 lbs = 1 kg
 1000 mcg = 1 mg Solutions
 1000 mg = 1 g 1 g per 100 mL = 1% solution
 1000 g = 1 kg 25 g per 100 mL = 25 % solution
 Length 100 g per 100 mL = 100% solution
1 inch = 2.5 centimetres

 1 mL = 1cc 15 mL = 3 tsp 2 c = 1 pt
 1 mL = 15 gtts 15 mL = 1 Tbs 1000 mL = 1 qt
 1 mL = 15 minims 30 mL = 1 oz 32 oz = 1 qt
 1 mL = 60 micro drops 1 Tbs = 3 tsp 1 L = 1 qt
 4 mL = 1 dram 8 dram = 1 oz 1 L = 1000 mL
 5 mL = 1 tsp 240 mL = 1 c 4 qt = 1 gal
500 mL = 1 pint
COMMON ABBREVATIONS USED IN ADMINISTRATION

Term Abbreviation
Intravenous IV
Piggy-back PB
Drop/drops gtt/gtts
Hour hr
Minutes min
Drops per minute gtts/min
Drops per millilitre gtts/ml
Milliliters per hour ml/hr
Water H2O, W
5% dextrose water D5W
10% dextrose water D10W
Normal saline (0.9%) NS
One half normal saline (0.45%) ½NS
Ringer’s Lactate solution RS
Lactated Ringer’s solution LS

Macrodrip tubing administers a larger drop and may be used for 10 gtts/mL,
15 gtts/mL or 20 gtts/mL. Microdrip tubing administers 60 gtts/mL. These are called
drop factors. The drop factor is the number of drops contained in 1 milliliter.

CALCULATION OF IV DRIP RATES :IV INFFUSSION RATES

FORMULA

𝐀𝐦𝐨𝐮𝐧𝐭 𝐨𝐟 𝐟𝐥𝐮𝐢𝐝 (𝐦𝐋) /𝐓𝐨𝐭𝐚𝐥 𝐭𝐢𝐦𝐞 𝐨𝐟 𝐢𝐧𝐟𝐮𝐬𝐢 𝐨𝐧 (𝐦𝐢𝐧) x Drop factor (gtts/mL) = IV
infusion rate (gtts/min)

Note: drops are always rounded to the nearest whole number.

Example:
The physician has ordered D5W 1200 milliliters in 12 hours using 15 drops per
millilitre infusion rate. What is the IV infusion rate in drops per minute?
Given:
 Amount of fluid: 1200 mL
 Total time of infusion: 12 hrs
 Administration set drop factor: 15 gtts/Ml
 IV infusion rate: ? gtts/min

 Step 1: Convert 12 hours into minutes.

 12 hrs x 60 min/hr = 720 min
  Step 2: Use the formula above to calculate the IV infusion rate.
 IV infusion rate = 1200 /720 x 15 = 100 4 = 25
 Therefore, the IV infusion rate is 25 drops per minute.

EXERCISE
 The physician has ordered D10W 15 litters in 15 hours using 12 drops per milliliter
infusion rate. What is the IV infusion rate in drops per minute?

DREUG DOSAGE CALCULATIONS

 Formula:
Amount DESIRED (D)/ Amount on HAND (H) X QUANTITY (Q) = Y (Tablets Required)

 Note: When medication is given in tablets, the QUANTITY = 1 since the

amount of medication available is specified per (one) tablet.

Example 1: Toprol XL, 50 mg PO, is ordered. Toprol XL is available as 100 mg per

tablets. How many tablets would the nurse administer?

Step 1: Determine your givens. Amount desired (D) = 50 mg Amount on hand (H) = 100
mg tablets Quantity = 1

Step 2: Plug in what you know into the formula and simplify. 50mg ---------x 1= 0.5 tablets
100mg

Three milligrams of Haldol IM are ordered for your patient. On your unit, Haldol
is available in 2 ml ampules that contain 5 mg/ml. What amount will you give?

500 mg of Ampicillin solution is ordered; available solution contains 125

mg/5cc. How much will you give?
500 ------------- 125X5 ------ 1=2500 --------- 125= 20 cc

DOSAGE CALCULATIONS BASED ON BODY WEIGHT

Dosage calculations based on body weight are required when the

dosage ordered and administered is dependent on the weight of the patient. For example,
many pediatric drugs are ordered and given per weight (usually in kg). Dosage calculations
based on body weight are calculated in two main stages.

Stage 1: Using the formula below, calculate the total required dosage based on given the
body weight.
Weight (kg) x dosage ordered (per kg) = Y (required dosage)

Stage 2: Apply the D/H x Q formula to calculate the actual amount of medication to
be administered.
 Example 1: Medrol 4 mg/kg is ordered for a child weighing 64.8 lb. Medrol is
available as 500 mg/4mL. How many milliliters of medication must the nurse
administer?

Step 1: Determine your givens Weight: 64.8 lb

Dosage ordered: 4mg/kg
Available on hand: 500 mg/4mL

Step 2: Convert 64.5 lb to 64.8 lb ÷ 2.2 lb/kg = 29.45 kg Therefore, the

kg since the infant’s weight infant’s weight is 29.45 kg.
is given in pounds (lb) but
the dosage ordered is
in mg per kilogram.
Step 3: Calculate the required dosage Weight (kg) x Dosage Ordered (per kg) = Y
(mg) of medication based on the (Required dosage) 29.45 kg x 4 mg/kg = 117.8 mg
child’s weight. Therefore, the required dosage of medication is
58.64 mg.
Step 4: Calculate the volume of Amount desired/ amount on handx Quantity
medication (mL) to be administered = Y 117.8 mg/ 500 mg x 4 mL = 0.942 mL
based on what’s available on hand.

Example 1: Salbuterol 2 mg/kg is ordered for a child weighing 28kg. Salbuterol is available
as 500 mg/2mL. How many milliliters of medication must the nurse administer?

 CALCULATIN OF FLOW RATE FOR AN INFUSION PUMP

 Infusion pumps do not have a calibrated drop factor. The flow rate depends on
the volume of fluid ordered and the time of infusion.

 FORMULA:
Volume (ml)
1. ------------------- = Y (Flow rate in ml/hr)
2. Time (h)

 EXAMPLE 1 : 1200 ML D5W IV IS ORDERED TO INFUSE IN 10

HOURS BY INFUSSION PUMP. CALCULATE THE FLOW RATE IN
MILILITER PER HOUR

Step 1: Volume: 1200 mL Time: 10 h

Determine your givens
 Step 2: Volume (ml) ------------------- = Y (Flow
Since the volume is given in mL and the rate in ml/hr) Time (h)
time is given in hours, the flow rate can
be calculated in one step using the
formula.
Step 3: Use the formula to calculate the 1200 (ml) ------------------- = 120
IV flow rate (gtts/min). ml/hr 10 (h)

 PREPARING PARENTERAL MEDICATIONS FROM

DRUGS SUPPLIED AS A POWDER (RECONSTITUTION)
On the drug label or the package insert will state the diluents to be used and
the exact amount to be added. When adding a solution or diluents to the powder, you
will notice that the directions will state the volume and dose after the solution has been
added.

For example, the directions may read to add 1.8 mL of normal saline to a vial and
when added to the powder, the solution contains a total of 2 mL, and after reconstitution
the vial contains 250 mg/mL. The reconstituted amount is what you would use to solve
the dose amount. In this case 250 mg/mL is the dosage supply amount you would use
to solve this problem.

 Use the formula method:

A patient is to receive Penicillin 200mg IV every 6 hours. The label on the vial
reads: add 1.8 mL of sterile water diluents. On the label it states, after reconstitution the vial
will contains 250 mg/mL( the dosage supply amount).

 Use the formula method to calculate the dose: D/H X V =A

 200 mg/250 mg X 1 mL = 0.8 mL 250 mg
 You would prepare 0.8 mL to administer in the IV to your patient.

 PEDIATRIC CALCULATION

Accuracy is always important when calculating and administering medications. For

infants and children, accuracy takes on a greater importance. A miscalculation may be
dangerous due to the small body size, weight, and body surface area of the infant or
child. In addition, infants and children differ in their rate of drug absorption,
distribution, metabolism, and excretion when compared to adults. It is vital to follow
pediatric protocols and guidelines, and use references to verify medication orders to
ensure that drug dosages are correct. The safe dose range (SDR) is the upper and lower
limits of the dose range as stated by the drug manufacturer and is reported in an
approved drug reference.

The safe dose range is usually expressed in milligrams per kilograms (mg/kg) of body
weight. When preparing to administer a drug to a child, you must first calculate the
daily (24 hour) drug dose ordered by the physician based on kilograms of body weight,
and then verify the calculated dose with the range stated in an approved drug reference.
Each prescribed dose of medication for a child must be calculated, and you must check
the prescribed dose against the SDR to make sure that it is an acceptable safe dose for
the child.

 Two methods are used to calculate paediatric dosages

 Body weight using mg/kg
 Body surface area (BSA)

Formula Method
 Example: Your patient weighs 40 pounds and the physician has ordered Ceclor
by mouth every 8 hours.

 Step 1: Convert First, convert the child’s weight into kilograms by dividing the
child’s weight in pounds by 2.2
 The formula is: 2.2 lbs = 1 kg
 The child’s weigh is 40 lbs, so divide: 40 lb divide by 2.2 lbs/kg = 18.18 kg

Step 2: Compute
Now determine the medication dose for the SDR using a calculator and the current
pediatric recommendations. Multiply the minimum dose by the weight of the child in
kilograms to determine the medication dose. Then, take the maximum dose times the
weight of the child in kilograms to get the safe range. Finally, compare the 24 hour
prescribed dose with the recommended SDR found in an approved drug reference.

 The drug order:

 Ceclor suspension 200 mg orally every 8 hours
 Medication available:  Ceclor suspension 125 mg/5 mL
 Child weight: 40 pounds (18.18 kg)
 The SDR is 6.7 to 13.4 mg/kg every 8 hours
 Minimum safe range: 18.18 kg X 6.7 mg = 121.8 mg
 Maximum safe range: 18.18 kg X 13.4 mg = 243.6 mg
 The safe dose range is 121.8 to 243.6 mg every 8 hours. Therefore, 200 mg
every 8 hours is a safe dose.

CALCULATION OF DAILY FLUID REQUIREMENTS FOR THE

PEDIATRIC PATIENT
Maintenance fluids are those fluids needed daily for bodily function. Overhydration or
dehydration (underhydration) can pose a great danger to the infant or young child.
Therefore understanding daily fluid requirements is essential for the pediatric nurse.
Use the formula below to calculate daily requirements.

DAILY FLUID REQUIREMENTS IN THE FRIST WEEK OF LIFE

(ML/KG)
 AGE DAYS <1000g 1000-1500g >1500g
1. 80 80 60
2. 100 95 75
3. 120 110 90
4. 130 120 105
5. 140 130 120
6. 150 140 135
7. 160 150 150

PEDIATRIC FLUID REQUIREMENTS

Patient weight Maintenance fluid requirements in 24 hours

0-10 kg 100 mL/kg/24 h
10-20 kg 1000 mL + 50 mL/kg (for every kg >10 kg) .
>20 kg 1500 mL + 20 mL/kg (for every kg >20 kg)

To calculate the milliliters per hour, as when the patient receives IV fluids,
simply divide the calculated amount of fluids required in 24 hours by 24 to obtain
the amount of fluids needed per hour

Example 1:
An infant weighs 20 pounds. Calculate the hourly IV fluid rate for this infant.

Weight 20 lb = 9.1 kg
Calculation 9.1 kg 3 100 mL/kg/24 h = 910 mL/24 h
Daily fluid requirement 910 mL/24 h

IV fluid formula:
Total volume to be infused / Total time for infusion in hours = x mL/h .
Calculation 910 mL/ 24 h = 37.9 mL/h
Fluids per hour 37.9 mL/h

After the newborn period, some drugs are quickly metabolized by the liver,
which may require that the child have large doses or more frequently administered.

 In children, difficulty in evaluating the desired effect and the hydration status
of the child.
 There are various formulas exist – the formulas often take the child’s age,
weight, body surface and medication amount into consideration.
Surface area of child
Child dose = ---------------------------- x normal adult dose
1.7 m2

 For example: ordered Ampicillin for a child weighing 12 kg. the normal adult
dose for Ampicillin is 250mg. calculate child’s dose.
 Solution:
 Child dose = 0.54 m2 / 1.7 m2 x 250mg
= 0.54/1.7 = 0.3
 Child dose = 0.3 x 250mg = 75mg
 For example, child weighed 14 kg ordered 5mg/kg.

DRUG CALCULATION FORMULLA

Fried’s formula
infant dosage (<1 year) Infant’s age in months
----------------------------------------------------------- x average adult dose
150 months

Clark’s rule:
Weight of child in pounds
--------------------------------- x average adult dose
150 pounds

Surface area rule:

Surface area of the child in (sq.m)
-------------------------------------------- x average
adult dose

 1.73

Parenteral dosage:
Dose ordered
----------------- x quantity in hand (ml) = volume to be given
Dose available

IV fluid flow rate:

Total volume to be infused (ml)
-------------------------------------------- x drop factor =
flow rate/ minute
 Total time of infusion in minutes

Ordered dose of medication in microgram/minute= Volume to be infused x concentration

-------------------------------------------------------------------------------------------------
Weight in kg x 60 minute

Insulin dosage:

 What we want
 --------------------- x number of division on the given syringe
 What we have

Concentration:
Dose of medication (mg)
---------------------------------- x 1000
volume to be infused

young’s rule:

 it is used in calculating the dosage of medicines ordered for children over

year of age up to 12 years
age of the child (in years)
---------------------------------- x adult dose = child dose
Age of child (in year)

For example:
 Adult dose of castor oil is one ounce (8 drops) or 30 ml
 For a 4 year old child= 4x30/4+12= 75 ml

Clarks rule:
Calculated (according to the weight of the child, therefore it can be used for children
of all age)

Weight of child in pounds

------------------------------------------ x average adult dose
150 pounds
(1 kg = 2.20 pounds)

 For example child’s weight = 30 pounds

 Adult dose = 1/6th grain

 = 30/150 x 1/6 = 1/30 grain = 0.2 mg

 For eg, weight – 40 kg = 40/156 x 10 = 0.26 mg

Adult dose = 10 mg

 Fried’s formula – infant dosage (<1 year)

Infant’s age in months

----------------------------- x average adult dose
150 months

 For example:
 Age = 6 months
 Adult dose = 1/6
 6/150 x 1/6 = 1/150 grain = 0.44 mg

Exercise
A client is ordered 50 milligrams of Amitriptyline. 25 milligram tablets are available.
How many tablets will you give?

50 milligrams
-----------------
25 milligrams = 2 tablets

A client is ordered 62.5 micrograms of Benztropine Mesylate. 0.25 mg tablets are

available. How many tablets will you give?

0.0625 milligrams
-------------------------
0.25 milligrams = 0.25 tablets

A client is ordered 35 milligrams of Codeine phosphate by subcutaneous injection. 50

milligrams in 1 millilitre of liquid for SC Injection is available. How many millilitres
will you administer?

35 X 1
-----
50 X 1 =35
------
50 = 0.7 ml
 A client is ordered 75 milligrams of Aminophylline intravenously. 250 milligrams in
10 millilitres of liquid for IV Injection is available. How many millilitres will you
administer?

75 X 10 750
---------- = ------ = 3 ml
250X1 250

Calculate the drip rate for 100 mls of IV Fluids to be given over a half hour via a giving
set which delivers 10 drops/ml.

100 mls X 10 drops/ml

----------------------------
30 min

1000 drops
------------------
30 min = 33 drops / min

Calculate the drip rate for 500 mls of Normal Saline to be given over 4.5 hours via a
giving set which delivers 15 drops/ml.

500 mls X 15 drops/ml

----------------------------
270 min

7500 drops
--------------- =
28 drops / min 270 min

 Three litres of Hartmans (Lactated Ringer's) is charted over 12 hours. The drop
factor is 15. The IV has been running for 9 hours. 800 mls remain. How many
drops per minute are needed so that the IV finishes in the required time?

800 mls X 15 drops/ml 12000 drops

---------------------------- = ---------------------
180 min 180 mins

= 67 drops / min
 Three litres of Normal Saline is charted over 12 hours. The drop factor is 15. The IV
has been running for 9 hours and 45 minutes. 500 mls remain. How many drops per
minute are needed so that the IV finishes in the required time?

500 mls X 15 drops/ml 7500 drops

---------------------------- = ------------------
135 min 135 mins = 56 drops / min