DOSE CALCULATION

WEIGHTS AND MEASURES

1. Measures of weight (mass) in metric system

1Kilogram (Kg) = 1000grams (g)
1Gram = 1000miligrams (mg)
-3
1miligram (10 ) = 1000 microgram (mcg)
1microgram (10-6)= 1000nanogram (ng)

2. Measures of capacity (volume) in metric system

1litre (L) = 1000 milliliter (mL)
1ml = 1000 microliter (µL)
1 µl = 1000 nanolitre(nL)

3. Concentration and strength

➢1% solution =1g solute dissolved in 100 ml solvent (i.e 1%solution =1 gm/dl) Eg:
25%dextrose solution (25g dextrose in 100ml water)
➢1:1000 solution =1 gm solute dissolved in 1000ml solvent Eg: 1:1000KmNO4 solution (1gm
of KmNO4 in 1000 ml of water/solvent)
➢Molarity = it is expressed in units of moles/litre or milimoles /mililitre.
1 mole =molecular weight in grams (MW of HCL = 1+36 =37g)
Therefore 1 molar solution of HCL = 37 g of HCL in 1 litre water
DOSAGE FORMULAS TO CALCULATE DOSE IN CHILDREN
1. BASED ON AGE
Young’s formula: age in years/(age+12) X average adult dose
Dilling’s formula : age in years/20 X average adult dose

2. BASED ON BODY WEIGHT

Clark’s formula: weight in pounds/150 X average adult dose
Hamburger’s formula: weight in kg/70 X average adult dose

3. BASED ON BODY SURFACE (BSA)

BSA child dose: BSA in m2 of child/1.7m2 X average adult dose
BSA (m2) = (BW in kg)0.425X (Height in cm)0.725X 0.007184
Mosteller formula
BSA (m2) = √ht(cm) x weight(kg)/ 3600

DOSAGE FORMULA TO CALCULATE DOSE IN RENAL FAILURE

(For drugs with Predominant Renal Elimination)

Corrected dose= Normal dose X Measured creatinine clearance/Normal creatinine clearance

To calculate Creatinine Clearance
Cockcroft-Gault formula
Men :(140 - age) X Wt. in Kg / 72 X Serum creatinine
Women : multiply the above by 0.85

DRIP (DROP) Factor of IV Tubings

The size of a drop in an IV setup depends upon the width of the IV tubing: thinner tubing
produces smaller drops and wider tubing produces larger ones.
There are two major categories of IV tubing:
• Macrodrip tubing is wider and so produces larger drops. It is the tubing most commonly used
for routine IV administration, such as infusion of IV fluids that do not contain sensitive
medication. Macrodrip tubing comes in 3 sizes: 10 drops/mL, 15 drops /mL and 20 drops /mL.
• Microdrip tubing is narrower and so produces smaller drops. It is used for children and
infants, or to infuse sensitive medications where precision in the flow rate is essential. Microdrip
tubing (sometimes called minidrip) comes in only one size: 60 drops /mL
For an IV setup on a volumetric pump or other electronic infusion device, the flow rate measured
in mL/h. This rate is fed into the device without having to count drops in a drip chamber.
DOSE CALCULATION PROBLEMS

1. What is the quantity of Mannitol present in 60ml of 20% Mannitol?

Concentration of mannitol = 20gm/dl.

1dl= 100ml
Concentration of mannitol= 20gm/100ml
100ml contains 2gm of mannitol
60ml contains x gm of mannitol
Solution 100 = 60
20 x
Cross multiplication, x= 60×20 = 12g
100

2. How many µg of Adrenaline is present in a 30mL vial of 2% Xylocaine with adrenaline?

Adrenaline available as 1:200000

Quantity of adrenaline in 2,00,000ml= 1g

Quantity of adrenaline in 30ml = 1×30

200000

= 150μg
3. How many mmol of sodium bicarbonate are there in 100ml of an 8.4% solution?

8.4%solution means
8.4g in 100ml of solution
1. Molecular weight of sodium bicarbonate (NaHCO₃):
– Na: 23 g/mol; H: 1 g/mol; C: 12 g/mol; O₃: 48 g/mol
– Total = 84 g/mol
2. Convert grams to moles:

Convert moles to millimoles:

So, 1mmol= 84mg of sodium bicarbonate in 1000ml

Therefore 8.4g i.e., 8400mg = 8400/84 = 100mmol

4. A person with 50Kg body weight is to be given IV Thiopentone sodium in a dose of 3mg/Kg
body weight. The strength of the solution is 2.5%. What is the volume of the drug used?

Weight = 50kg

Dose of thiopentone sodium = 3mg/kg =3×50=150mg

Concentration of thiopentone = 2.5%=2.5g/100ml = 2500mg/100ml

Volume to be administered = x

x =150 ×100

2500

=6ml
5. A 30 year old man weighing 50Kg develops hypotension after myocardial infarction. He was
prescribed Inj. Dopamine 8µg/min/Kg. Calculate the rate of infusion in drops per minute if
strength of Dopamine ampoule(5mL) = 200mg

Weight = 50kg

Dose of dopamine = 8μg/min/kg

Total dose= 8 × 50 =400μg = 0.4mg

If 5ml contains 200mg dopamine

X ml contains 0.4mg

X = 5 × 0.4 = 0.01ml

200

1ml = 16 drops

0.01ml = 16 × 0.01 = 0.16 drops

6. For a 6 month old infant with moderate dehydration, 150ml of Ringer Lactate I.V. for 2 hours
followed by 150ml sodium chloride I.V. for 3 hours is to be given. The I.V. set yields 20
drops/ml. Calculate the drops per min. of both solutions.

• Ringer lactate 150ml in 2 hours

• 1 ml= 20 drops
• 150ml in 120 mins
• 150×20 = 3000
120 120
= 25 drops/ min
• Sodium chloride 150ml in 3 hrs
• 1 ml= 20 drops
• 150ml in 180 mins
 = 150×20
180
= 3000/180
= 16.6 drops/ min

7. A 22 year old lady with advanced pregnancy with anaemic, with a haemoglobin (Hb) of 7gm
%. Calculate the parenteral iron dosage for this patient. Body weight of the patient is 50kg.

Weight of pt - 50kg

Hb – 7gm/dl

Hb deficit = 14gm- 7gm

Iron requirement (mg) = 4.4 × body weight (kg) × Hb deficit

= 4.4 × 50 × 7

= 1540mg

8. Calculate the Paediatric dose of INH and Rifampicin for a 10 year old child using Dilling’s
formula. Adult dose of INH - 300mg OD and Rifampicin - 600mg OD

Dillings formula = childs age in years × adult dose

20

Dose of INH = 10×300 =150mg

20

Dose of rifampicin= 10×600 =300mg

20
9. Using Young’s Formula Calculate the dose of Paracetamol and Metronidazole for a 3 year old
child. Adult dose of Paracetamol is 500mg TID and Metronidazole is 400mg TID.

Youngs rule = childs age in years × average adult dose

childs age in years+12

child dose of paracetamol = 3 × 500

3 +12

= 500 =100mg

child dose of metronidazole = 3 x 400

3+12

= 1200 / 15

= 80mg

10. The adult dose of Gentamycin is 80mg/BD. How much Gentamycin should a 1 year old child
weighing 12kg receive? Calculate using body surface area formula.

Adult dose of gentamcin – 80mg

Weight of the child – 12kg

Approx height of 1yr old = 75cm

Child dose formula = BSA in m2 of child x average adult dose

1.7 m2

BSA = √height(cm) x weight(kg)/3600

Putting the weight and height in formula BSA is calculated

BSA = 0.5
 Child dose formula = BSA in m2 of child x average adult dose

1.7 m2

Child dose is 24 mg.

11. A 35 yr old male diagnosed to have acute maniac episode & was put on tab. Lithium
600mg/day. On day 7, the symptoms still persisted and the plasma concentration of lithium was
found to be 0.6 mEq/L. Calculate the revised dosage regimen for this patient. Desired plasma
concentration is 1.0 mEq/L.

Dose of lithium = 600mg/day

Plasma conc – 0.6 mEq/L

Desired plasma conc – 1 mEq/L

Revised dosage regimen = 1000mg/day

12. Calculate the Creatinine Clearance with the following data; Age:60 years, Weight: 54 Kg,
Normal serum creatinine= 0.6-1.2 mg/dL Creatinine Clearance Estimate by Cockcroft-Gault
Equation

Age of the patient – 60 yrs

Weight of the patient – 54kg

Normal S. creat = 0.6 – 1.2 mg/dl

Creatinine clearance (Cockcroft gault equation) =

[140-age x weight(kg)]/(72 x [Link])

• So, creatinine clearance is 60 mL/min for male

• For female = 60 x 0.85 = 51 mL/min

13. Calculate the creatinine clearance of a drug whose IV dose is 240mg and plasma
concentration is 6mg/ltr. Half life of the drug in 4hrs.
Ans. IV dose – 240mg
Plasma concentration – 6mg/ltr
Half life (T1/2) – 4hrs
Formula – T1/2= 0.693 × V/clearance
Clearance= 0.693×V/T1/2
To determine volume of distribution
V= drug administered IV/ plasma concentration
V= 240/6 = 40
Substituting,
Clearance of the drug= 0.693 × 40 /4
• = 6.93L/hour = 6.93 × 1000/60 mL/min = 115.5 mL/min.
• Hence creatinine clearance of the drug is 6.93 L/hour or 115.5 mL/min.

14. A 40-year-old male patient (body wt. 70 kg) has a serum creatinine of 4 mg/dL. He has
Proteus mirabilis-induced UTI, sensitive to Gentamicin. Calculate the Gentamicin dose which
should be administered to this patient. Gentamicin dose in a patient with normal renal function is
5 mg/kg once a day. Renal clearance of Gentamicin is 78 mL/min in a normal renal function
patient according to literature.

Age of the patient – 40 yes

Weight – 70kg
Serum creatinine – 4mg/dl
Normal dose of gentamicin – 5mg/kg
Normal renal clearance – 78ml/min
This is calculated using Cockroft-Gault Equation
Creatinine clearance (ml/min)
= [140-age (yrs)]× weight (kg)/72× serum creatinine (mg/dl)
= [140- 40]×70/ 72×4
= 100×70/72×4 = 7000/288 = 24.3ml/min
Normal gentamicin dosage for given patient’s weight is
= 70×5 = 350mg/day.
The present renal clearance of gentamicin is ~ 25ml/min.
Comparing with normal gentamicin renal clearance 78ml/min, it is reduced to 30%. From the
table, the clearance lie in 10-30, so, the dose should be reduced to 30%., 108mg/day.
• The gentamicin dose that should be administered is 108mg/day.

16. A male child of 11 years old weighing 30 kg develops anaphylactic shock due to Penicillin-
G administration. Calculate the amount of adrenaline to be given. Adrenaline is available as 1
mg/mL (1:1000) solution. What is the route of administration of adrenaline? Dose is 0.01 mg/kg

17. It has been prescribed to infuse 1 litre of normal saline (Sodium chloride 0.9%) over 8 hours
using a macro drip set. Calculate the rate of infusion i.e. no. of drops per minute.
18. It has been prescribed to infuse quinine 10 mg/kg in an adult weight 60 kg over 4 hours in
5% dextrose. Prepare infusion in 200 mL solution. Quinine is available as 600 mg/mL ampoule.
Calculate the rate of infusion i.e. no. of drops per minute.

19. You need to administer 400 mg of erythromycin PO. You have on hand a suspension of 125
mg/5 mL. How many mL should be given?

• Quantity of erythromycin in 5ml suspension = 125mg

• Quantity of erythromycin in X ml suspension = 400mg
X=400×5
125
X =16ml

20. A patient with 60Kg body weight is to be given Diazepam at a dose of 0.3mg/Kg body
weight. The strength of the solution is 5mg/mL. What volume of drug to be administered?

• Weight = 60kg
• Dose of diazepam = 0.3mg/kg =0.3×60=18mg
• Concentration of diazepam = 5mg/ml
 • Volume to be administered = x
x =18×1
5
=3.6ml

21. Heparin sodium, 1000 units/hour IV, is ordered for a patient with a blood clot in the leg. It is
supplied as 50,000 units in 500 mL of dextrose and water. How many milliliters per hour should
be set on the controller on the electronic infusion device?

• Dose of heparin to be given= 1000units/hr

• Quantity of heparin in 500ml= 50000units
• Quantity of heparin in x ml = 1000 units
X = 1000×500
50000
= 10ml

22. Prepare a solution of Lignocaine to be infused at a rate of 1mg/mL for a case of premature
ventricular depolarization. Lignocaine present as 2% solution in 30mL vial

Infusion strength – 1mg/ml

Strength of lignocaine – 2% soln in 30ml vial
2% sol = 2g in 100ml
1ml = 2000mg/ 100 = 20mg
By adding 19ml of NS to 1ml of lignocaine sol, prepared sol contains 1mg/ml.
23. The doctor orders a single dose of 360mg of ampicillin for a infant weighing 3.6kg.
Recommended ampicillin dose is 100mg/kg/dose. After reconstituting with sterile water the
ampicillin is available in a concentration of 500mg/5ml. Is the dose ordered correct for the
patient? What volume of ampicillin should you administer to the infant?

Dose to be given to child weighing 3.6kg -

100mg : 1kg/dose :: X : 3.6kg/dose
X = 360 mg
volume of ampicillin to be administer to the infant –
500mg : 5ml :: 360mg : X
X = 3.6ml

24. At 6 am a patient receives a pre operative infusion of 1000ml of DNS at 125ml/hr followed
by 1000ml of D5W at 100ml/hr. Whats the total infusion time.

Infusion time of first solution –

125ml : 1hr :: 1000ml : Xhr
X = 1000/125 = 8hr
Infusion time of second solution –
100ml : 1hr :: 1000ml : Xhr
X = 1000/100 = 10hr
Total infusion time = 8hr + 10hr = 18hr.

25. A 25yr old patient is admitted to your unit with DKA the doctors orders a continuous
infusion of 100U of regular insulin in 100ml NS at 12U/hr. Whats the infusion rate.

Solution strength - 100U : 100ml

12U/hr : X
100U : 100ml :: 12U/hr : X
X = 12ml/hr (infusion rate)
26. An infusion of norepinephrine containing 4mg in 250ml of D5W is running at 30ml/hr. How
many mcg of norepinephrine are infusing each minute.

4mg : 250ml :: Xmg : 1ml

X = 0.016mg/ml or 16mcg/ml
Determine the flow rate in ml/min
30ml : 60min :: Xml : 1min
X = 0.5ml/min
Microgram of drug patient is receiving per min
X = 0.5ml/min x 16mcg/ml = 8 mcg/min

27. A patient with supraventricular tachycardia is ordered esmolol hydrochloride at

50mcg/kg/min. The solution contain 2.5g esmolol in 250ml of D5W. The patient weigh 73kg.
How should the nurse set the pump to deliver the correct ml/hr so the patient receives the ordered
dose.

First determine dose in mcg per min.

73kg : X mcg/min :: 1kg : 50 mcg/min
X = 3650 mcg/min
Determine the volume infused per min.
3.65 mg : X ml :: 2500 mg : 250 ml
X = 0.365 ml/min
Finally, multiply by 60 min/hr to determine flow rate in ml/hr
0.365 ml/min x 60 min/hr = 21.9 ml/hr
Rounding off, the nurse should set pump to deliver 22 ml/hr