A glance at numerical relationships

Ratios, fractions, and proportions describe relationships between numbers.

Ratio is a quick way to compare numbers. It uses a colon between the numbers in relationship.
Ex.: 3:5 8:12 4:7
Fraction, as we all know, is a part of a whole or a portion of a certain number. It uses a
slash between numbers in the relationship.
Ex.: 2/3 4/5 6/8

A proportion is an equation written in the form stating that two ratios are equivalent. For
instance, to show that 3:6 is equal to 9:18, we would write:
3:6::9:18 or 3/6 = 9/18
2:3::4:6 or 2/3 = 4/6
5:8::10:16 or 5/8 = 10/16

Major problem solvers

For dosages computation, we use ratios, fractions, and proportions most of the time. We will be using them in
calculating I.V. infusion rates, administering medication, converting weights between systems of measurement, and
in performing many other related tasks.

RATIOS AND FRACTIONS

Ratios and fractions are numerical ways to compare anything. We can’t simply ignore them. We use them every day,
whether we realize it or not.

Bring it on! Do the comparison!

If 1 pad has 20 tablets, then the number of pads compared to the number of tablets is 1 to 20.
In ratio, it is written as: 1:20
In fraction, it is written as: 1/20

Want more? Just go on!

If there are 5 nurses for every 35 patients in a hospital, what would be the ratio? What would be the fraction?
In ratio, it is written as: 5:35
In fraction, it is written as: 5/35 or 1/7

MATH TIP!
The terms of a ratio are the numerator (always to the left of the colon) and the denominator (always to the right of the
colon) of a fraction. Like fractions, ratios should always be in lowest term.

PROPORTIONS
A proportion is an equation of two ratios which can also be expressed as two fractions.

Using ratios in proportions

When using ratios in a proportion, a double colon serves as a separator. Double colon shows equality between the
two ratios.
In the example previously given, the ratio of pads with the tablets is 1:20, then 2 pads have 40 tablets. In proportion,
it is written as:
1 pad : 20 tablets :: 2 pads : 40 tablets or 1:20 :: 2:40

Go marathon using ratios in proportions!

On the second example, there are 5 nurses for every 35 patients and the ratio is 5:35. We can therefore say that
there are 10 nurses for 70 patients. In a proportion, we can express the comparison as:
5 nurses : 35 patients :: 10 nurses :: 70 patients or 5:35 :: 10:7

Using fractions in proportions

A proportion that can be expressed using ratios can also be expressed using fractions. Let’s
refer to the examples given before.
1 pad has 20 tablets which means that 2 pads have 40 tablets. Using fractions, we can write the
proportion as:

Or

Enjoy using fractions in proportions

There are 5 nurses for every 35 patients which equals to 10 nurses for 70 patients. We can
express this in fraction as:
 Or

Math Tip: We use colon for ratios while we use forward slash or horizontal bar for fractions. Double
colon (::) used for ratios also means equal (=) used for fractions.

WHAT IS AN “X”?

Finding the value of X is very important in dosage calculations. X is the unknown amount or
quantity we are going to compute so we can identify what is being asked for in an equation.

Steps in Solving the Value of X Using Ratios in Proportion

1. Prepare the equation.

2. Start with the solution by doing a multiplication.
Note: The product of the means is equivalent to the product of the extremes. Means are the
middle quantities while the extremes are the external quantities
3. Solve for the value of X.
4. Double check your work by completing the equation.

Example 1:

How many nurses will take charge of 15 patients if 6 nurses handle 30 patients? Step

1. Prepare the equation.

X : 15 patients :: 6 nurses : 30 patients

Step 2. Start with the solution by doing a multiplication. Multiply the means (middle) using the
left side and multiply the extremes (external items) using the right side. Put an equal sign
between both sides.

15 patients x 6 nurses = X x 30 patients

Step 3: Solve for the value of X. In the given problem, the value of X refers to 15

patients x 6 nurses = X x 30 patients

90 = 30 X

90 / 30 = X

or

X = 3 nurses

Therefore, 3 nurses will take charge of 15 patients while 6 nurses handle 30 patients.

Step 4: Double check your work by completing the equation.

3 nurses : 15 patients :: 6 nurses : 30 patients

 Example 2:

Find the value of X using the equation given below:

2500 mg : 10 tablets :: X : 3 tablets
To compute,
10 tablets x X = 2500 mg x 3 tablets 10
X = 7500 mg
X = 7500 / 10
X = 750 mg
Check and complete the equation
2500 mg : 10 tablets :: 750 mg : 3 tablets

Steps in Solving the Value of X Using Fractions in Proportion

1. Prepare the equation.

2. Start with the solution by doing cross multiplication.
3. Solve for the value of X.
4. Double check your work by completing the equation.

Example 1:

How many nurses will take charge of 15 patients if 6 nurses handle 30 patients?

Step 1. Prepare the equation.

Step 2. Start with the solution by doing a cross multiplication.

15 patients x 6 nurses = X x 30 patients

Step 3: Solve for the value of X. In the given problem, the value of X refers to 15

patients x 6 nurses = X x 30 patients

90 = 30 X

90 / 30 = X

or

X = 3 nurses

Therefore, 3 nurses will take charge of 15 patients while 6 nurses handle 30 patients.

Step 4: Double check your work by completing the equation.

Example 2:

Find the value of X using the equation given below:

To compute, cross multiply first.

 10 tablets x X = 2500 mg x 3 tablets 10
X = 7500 mg
X = 7500 / 10
X = 750 mg

Check and complete the equation

 We use a colon ( : ) or a double colon ( :: ) in ratios

 We use a forward slash ( / ) or a horizontal bar (---------) in fractions

 Proportion is an equation showing 2 sets of equal ratios

 The middle items in a proportion is called ―means‖

 The external items in a proportion are called ―extremes‖

 X in an equation which stands for the missing or unknown value

A GLANCE AT MEASUREMENTS AND CONVERSIONS

Dosage calculations involve measurements and conversions of the formulation, ingredients, and components of drugs.
Measurements and conversions must be calculated accurately to ensure that we will be able to give the correct
dosage to our patients.

Below is a table of most commonly used measurements with its corresponding conversions.

DOSAGE CALCULATION CONVERSIONS

1 liter (L) 1000 milliliters (ml)
1 ounce (oz) 30 milliliters (ml)
1 ounce (oz) 2 tablespoons (tbsp)
1 milliliter (ml) 1 cubic centimeter (cc)
1 gram (g) 1000 milligrams (mg)
1 pint 500 milligrams (mg)
1 milligram (mg) 1000 micrograms (mcg)
1 kilogram (kg) 1000 grams (g)
1 kilogram (kg) 2.2 pounds (lb)
1 inch (in) (") 2.5 centimeters (cm)

8 ounces (oz) 1 cup (c)

8 ounces (oz) 240 milliliters (ml)
grains (gr) X 650 milligrams (mg)
240 milliliters (ml) 1 cup (c)
1 coffee cup 6 ounces
1 cup 8 ounces
1 quart 1 liter
1 quart 2 pints
1 centimeter 10 millimeters
1 glass 12 ounces
Convert Celsius to Fahrenheit
multiply by 1.8 then add 32
Convert Fahrenheit to Celsius subtract 32 then divide by 1.8

DRUG DOSE CALCULATION USING MEASUREMENTS / CONVERSIONS

Formula:

Example 1. Doctor orders 5 mg of morphine to be administered intravenously to a patient with

substernal chest pain. You have 1 ml vial that contains 10mg of morphine (10 mg/ml). How many
milliliters are you going to have to draw up into a syringe and push IV into your patient’s IV line
port?

What are given?

Desired Dose – 5 mg of morphine IV

Concentration – 10 mg
Volume on Hand – 1 ml

What is asked? Dosage to be given to the patient, in ml

Formula:

METRIC CONVERSIONS
There are instances when we need to convert a unit of measurement to another when calculating
for drug dosages.

The metric system of measurements is based on a number of basic measures or units. Take a
quick look at the table below.

QUANTITY UNIT SYMBOL

length metre m
mass gram g
volume litre l
time second s

Large and small amounts of these units often have a prefix. Also, some common units of
measurement are prefix symbol multiplication factor.

MULTIPLICATION
PREFIX SYMBOL FACTOR
mega m 1,000,000
kilo k 1,000
hector h 100
deka da 10
unit g, m, l, or s 1
deci d .1
centi c 0.01
milli m 0.001
micro mcg or µ 0.000001
 For conversion of one metric unit to another will require us to move the decimal place to the left or
to the right.

To know how many decimal places to move, follow these steps:

1. Write the metric scale.

2. Find out what the two units in the problem are.
3. Count the number of units from the given one to the desired one.

Example 1.

Convert .1 decigrams to micrograms

The decimal place is moved 3 places to the right using mg

-- kg -- hg -- dag -- g -- dg -- cg -- mg -- mcg Therefore, 0.1

dg = 1000 mg

Example 2.

Convert 250 millilitres to litres

The decimal place is moved 3 places to the left ml

-- kl -- hl -- dal -- l -- dl -- cl -- ml -- mcl Therefore,

250 ml = 0.250 l

Still a lot of health professionals are having difficulty with drug calculations. Is it because they
don’t like Math? Before administration, some drugs require some sort of calculation and some of
which requires simple to complex conversion. Don’t make life complicated. Look for the best
alternative measurement system which could make all the difference and make things easy for
you.

CALCULATING ORAL DRUG DOSAGES

A Glance at Oral Drugs

These substances which are administered orally can be in the form of tablet, capsule, or liquid.
Oral drugs are mostly available in a limited number of strengths or concentrations. It is, therefore,
very important that you have the skill to calculate prescribed dosages for different drug forms.

Interpreting Oral Drug Labels

For you to administer an oral drug safely, you must make sure that it is the correct drug with the

right dosage. Therefore, it is very vital that you would be able to read and interpret oral drug
labels.

1. Identify the Drug Name

Know the difference between the brand name and generic name. Verify the generic name first. If
the drug has two names, the generic name usually appears in lowercase print and
sometimes in parentheses.
The generic names are the active ingredients in the medicine. Whether the brand name of
generic name is used, be very careful when reading the label to avoid errors.

Important:
Pay attention to the active, or generic name, since too much of an active ingredient can be
harmful if you take more than one product with the same active ingredient without knowing it.

2. See the Dosage Strength

After identifying the drug name, look for the dose strength on the label.

Important:
Pay close attention to the labels of two same drugs which may look exactly alike aside from that
of the dose strength. One of them might indicate 125mg and the other one is 250mg. Be keen in
checking the dose strength because it forms part of the dosage calculation.

3. Check the Expiration Date

You also have to check the expiry date. It is a vital information which is sometimes overlooked.

Tip:
For best shelf life, store all medications in a cool, dry place.

Calculating Drug Dosages

Most of the time, you will use ratios in proportion to compute for drug dosages. At this point in
time, you should already be familiar in dealing with the equation using ratios in proportions.

Rules in Calculating Drug Dosages

Remember the rules to accurately calculate drug dosages and eliminate errors as well.

1. Use the correct units of measure to avoid errors in calculating doses.

2. Be careful in placing decimal and zero.
3. Double-check strange answers.

Steps in Calculating Drug Dosages Using Ratios in Proportion

1. Prepare the equation by using ratios in proportion.

2. Start with the solution by considering that the product of the means is equivalent to the
product of the extremes. Means being the middle items and extremes being the external
items.
3. Solve for the value of X.
4. Double check your work by completing the equation using ratios in proportion.

Example 1:

How many ml of a medicine are in two bottles if one bottle has 60 ml?

Step 1. Prepare the equation by using ratios in proportion.

1 bottle : 60 ml :: 2 bottles : X

Step 2: Start with the solution by considering that the product of the means is equivalent to the
product of the extremes. Means being the inner items and extremes being the external items.

60 ml x 2 bottles = 1 bottle x X

Step 3: Solve for the value of X. In the given problem, the value of X refers to 60 ml

x 2 bottles = 1 bottle x X

120 ml = 1 X

or

X = 120 ml

Therefore, the 2 bottles contain 20ml of medicine.

Step 4: Double check your work by completing the equation using ratios in proportion.

1 bottle : 60 ml :: 2 bottles : 120 ml

Example 2:

How many mg of a drug are in 4 capsules if 3 capsules contain 1500 mg?

Equation:
3 capsules : 1500 mg :: 4 capsules : X
Solution:
 1500 mg x 4 capsules = 3 capsules x X

6000 mg = 3 X

X = 6000 mg / 3

X = 2000 mg

• Always read the drug labels carefully.

• Identify the difference between the brand and generic name.
• Paying close attention to the dosage strength is very vital in calculating the dosage for oral drugs
• Expiry date is an important information as well in interpreting the drug labels.

A GLANCE AT RECTAL DRUGS

Rectal drugs are medications prepared specifically for insertion into the rectum. They could be in the form of cream,
lotion, or ointment. Administering the drugs rectally is best for patients who cannot take drugs orally. Rectal drugs
include enemas and suppositories.

Interpret Rectal Drug Labels

As we administer medicines to our patients, it is vital to read drug labels at all times. Paying close attention to the drug
labels helps us calculate the dosage we will give to our patients.

- identify the drug name / generic name

- check for the dose strength
- expiration date

Types of Rectal Drugs

1. Enema - the injection of liquid into the rectum through the anus for cleansing, for stimulating evacuation of the
bowels, or for other therapeutic or diagnostic purposes

2. Suppository - a small piece of medicated substance, usually conical, ovoid, or cylindrical, introduced into a
body passage, as the rectum or vagina, where body heat causes it to melt

Dosage Calculation for Rectal Drugs

Suppository is considered to be the most used form of rectal medicine. By calculating the number of suppositories we
give to the patient, we will use the ratios in proportion method.

Example 1:

Calculate for a suppository dosage supposing a patient needs 250 mg of a suppository and the package label says
125 mg.

Using ratios in proportion, we will find the value of X (number of suppository needed) and our equation will be written
as follows:

1 suppository : 125 mg :: X ( # of suppository needed) : 250 mg

Let us compute…

125 mg x X ( # of suppository needed ) = 1 suppository x 250 mg 125

mg ( X ) = 1 x 250 mg

125 mg ( X ) = 250 mg

X = 250 mg / 125 mg

X = 2 suppositories

To sum it up, we will have to give 2 suppositories to the patient since 2 suppositories equal 250
mg.

Example 2:

A doctor asked the nurse to give the patient 20 mg of suppository. The suppositories on the shelf
show 10 mg each. How many pieces of suppository should you give to the patient?

This is how to solve it using ratios in proportion method. Let our equation be read as: 1

suppository : 10 mg :: X ( # of suppository needed ) : 20 mg

Let us compute for X which is the number of suppository needed

10 mg x X = 1 suppository x 20 mg 10

mg ( X ) = 1 x 20 mg

X = 20 mg / 10 mg

X = 2 suppositories

Since the patient needs 20 mg of suppository, we will give him / her 2 suppositories with 10 mg
each. To check, 2 suppositories multiplied to 10 mg will give us 20 mg of suppository.

 Make sure to read or interpret the labels carefully.

 The two types of rectal drugs are enema and suppository.
 Suppository is the most commonly used rectal drug.
 Using ratios in proportion method is the best way to calculate the dosage for rectal
drugs.

A GLANCE AT CALCULATING PEDIATRIC DOSAGES FOR ORAL DRUGS

In calculating drug dosages for pediatric patients, we have to bear in mind that children are
completely different from adults. An inaccurate dosage is more likely to harm a child than that of
an adult.

Administering Pediatric Oral Drugs

Infants and young children who can hardly take tablets or capsules are given oral drugs in the
form of liquid. In some cases wherein liquid medicines are not available, you may crush a tablet
and mix it with a little amount of liquid. If the medication is mixed in a large amount of liquid (full
bottle), the child will not get the entire dose if he is unable to finish the liquid.

Important:
Do not mix crushed tablet with breast milk and infant formula because it may lead to feeding
refusal in the future.

Devices Used in Giving Out Pediatric Oral Drugs

 cup - can be used by bigger children

 dropper - usually used for infants

 syringe - usually used for infants

  hollow-handle spoon - usually used for toddlers

Safety Key Points in Giving Medications to Children

 Check the child's mouth to ensure that he has swallowed the oral drugs.
Carefully mix oral drugs that come in suspension form

 .

Tips in Calculating Safe Pediatric Drug Dosages

 Use a calculator in solving equations.

 Ask advice from a formulary or consult a drug handbook to verify a drug dose. If still in doubt,
call a pharmacist.
 Keep a record of your patient's weight in kilograms so you do not have to estimate it or weigh
him all the time.

Methods Used in Calculating Pediatric Doses

1. Body Surface Area (BSA) Method - also called the dosage-per-kilogram-of-body-weight

method; considered to be the most accurate and safest method in calculating pediatric doses

2. Clark's Rule - uses child's weight to calculate approximate dosage

3. Young's Rule - normally used for children who are two years of age or more

4. Fried's Rule - normally used for children who are two years of age or less

Body Surface Area (BSA) Method

We will have to use the nomogram to determine a child's BSA then setup an equation using the
formula.
Here is the formula:

Average adult dose ( child's BSA in m² ÷ average adult BSA ) = Child's dose in mg
Note: Average adult BSA = 1.73 m²

Sample:
We have to compute for a child's dose who weighs 40 lbs. and 36" tall. What is the safe drug
dose if the average adult dose is 500mg. Using the nomogram, the child's BSA is 0.72 m².

Computation Based on BSA Method

500mg ( 0.72 m² ÷ 1.73 m² ) = child's dose in mg 500mg

( .42 ) = child's dose

500mg ( .42 ) = 210mg

child's dose = 210mg

Clark’s Rule

Clark's Rule uses Weight in lbs., NEVER in kg.

Here is the formula:

Adult dose (child's weight ÷ 150) = Approximate child's dose

Simple Sample:
We have to compute for a 2-year old child's dose who weighs 28 lbs. wherein the adult dose is
500mg.

Computation Based on Clark's Rule

500mg ( 28 ÷ 150 ) = approximate child's dose

500mg ( .19 ) = approximate child's dose 500mg ( .

19 ) = 95mg

approximate child's dose = 95mg

Young’s Rule for Children from 1 to 12 years old

Young’s Rule uses age in years.

(which makes it easier to remember, the word young refers to age)

Here is the formula:

Adult dose [ child's age in year ÷ ( child's age in year +12 ) ] = Approximate child's
dose

Same Simple Sample:

We have to compute for a 2-year old child's dose who weighs 28 lbs. Wherein the adult dose is
500mg. Note that the weight has no bearing using Young's Rule.
Computation Based on Young's Rule

500mg [ 2 ÷ ( 2 + 12 ) ] = approximate child's dose

500mg ( 2 ÷ 14 ) = approximate child's dose 500mg ( .

14 ) = approximate child's dose

500mg ( .14 ) = 70 mg

Approximate child's dose = 70 mg

Fried’s Rule for Infants and Children up to 2 years

Fried's Rule uses age in months.

Here is the formula:

Adult dose ( child's age in months ÷ 150 ) = Approximate child's dose

Still the Same Simple Sample:

We have to compute for a 2-year old child's dose who weighs 28 lbs. wherein the adult dose is
500mg. Note that the weight has no bearing using Fried's Rule.

Computation Based on Fried's Rule

500mg [ ( 2 x 12 months ) ÷ 150 ] = approximate child's dose 500mg

( 24 ÷ 150 ) = approximate child's dose

500mg ( .16 ) = approximate child's dose 500mg

( .16 ) = 80 mg

Approximate child's dose = 80 mg

Important:
Every medical caregiver, including the medical assistant needs to be familiar with these
rules.

 Children need special medication and require special care because of their size,
metabolism, and other factors.
 Choose the best device for administering pediatric oral drugs
 Be familiar with all the methods used in calculating pediatric doses
- Body Surface Area (BSA) Method
- Clark's Rule
- Young's Rule