My Dominant Hemisphere

The Official Weblog of 'The Basilic Insula'

Infusion Confusion – How To Calculate Drug Infusion Rates

with 7 comments

Source, author and license

The erosion of math and analytical skills that occurs with medics is truly astounding. Not surprising some might argue, what with it being such a memory oriented field. One area that many medics struggle with is drug dosage calculations. In the ER, one often doesn’t have the luxury of time and instant thinking is absolutely critical. Numbers need to be played out in seconds and optimal drug regimens have to be formulated. I was helping a colleague understand calculations for dopamine infusion the other day and thought like sharing with you folks some of the things we talked about.

Dopamine is used especially in ER settings to increase perfusion/blood pressure by means of its vasopressor, inotropic and chronotropic effects. When re-establishing blood pressure in a patient,  attention not only needs to be paid to drugs that might be used but also fluid replacement for any amount of fluid loss from the body. Two questions need to be asked before starting a dopamine infusion:

  1. How much dopamine?
  2. How much fluid and how fast?

The usual dosage of dopamine is somewhere between 5-10 μg/kg/min. For the following example I’ll use 10 μg/kg/min.

1μg = 0.001mg.

For a patient weighing x kg, the dosage is therefore 0.01x mg/min. Now that you’ve established how much dopamine you need to infuse per minute, here comes the second part.

Suppose you intend to infuse y ml of fluid (as part of the dopamine infusion, i.e. aside from any other fluid infusions already in place). Say also that you’ve added z mg of dopamine to form the infusate. Dopamine is supplied in liquid form, so any amount of dopamine occupies a certain volume in ml, which in most situations is negligible.

y ml of infusate = volume of Normal Saline, etc. + volume of dopamine

If z mg of dopamine is contained in y ml of infusate,

0.01x mg dopamine is contained in [0.01x/z] * y ml of infusate.

Thus you’re interested in giving [0.01x/z] * y ml of infusate every minute and a simple formula is derived where:

rate of dopamine infusion in ml/min = [0.01x/z] * y

and therefore, z = [0.01x/(rate of infusion in ml/min)] * y

x = body weight in kg

z = amount of dopamine added in mg

y = total volume of infusate in ml

For any drug infusion:

rate of infusion in ml/min = [(total drug dose in mg/min)/(amount of drug added in infusate in mg)] * volume of infusate in ml

This infusate is typically given via an infusion set that specifies a unique drops per ml ratio. At our pediatrics ER for example, infusion sets come in two forms – microdrip infusion sets (1 ml = 60 drops) and macrodrip infusion sets (1 ml = 20 drops). Simply multiply the rate of infusion in ml/min with 60 or 20 to get the infusion rate in drops/min for micro and macro IV sets respectively.

As seen from the formula above, when deciding to add a given amount of drug to form the infusate, three things need to be fixed first:-

  1. Dose of drug in the mg/min format (should be appropriate to the clinical condition of the patient).
  2. Total volume of infusate in ml (again, this depends on the clinical condition and hemodynamic stability of the patient).
  3. Speed or rate of fluid replacement in ml/min (this is important as sudden fluid-volume changes in the body can be problematic in certain cases and you want to go for a rate that is optimal, neither too slow nor too fast.)

And with that I end this post. Hope readers find this useful. Comments and corrections are welcome!

Readability grades for this post:

Kincaid: 8.4
ARI: 7.9
Coleman-Liau: 10.2
Flesch Index: 65.7/100 (plain English)
Fog Index: 12.7
Lix: 39.4 = school year 6
SMOG-Grading: 11.6

Copyright © Firas MR. All rights reserved.

About these ads

Written by Firas MR

June 13, 2008 at 1:41 pm

7 Responses

Subscribe to comments with RSS.

  1. Dude, maybe you should just write a book on the subject…

    Noor

    June 15, 2008 at 11:33 am

  2. I think it’s something very simple to calculate. I understand one must pay more attention to the patient than his calculator.

    Maybe there needs to be a device that controls how much fluid per minute be administered to a person of certain weight.
    If I thought of it then there must be such a device out there in the wild !

    Jaffer

    June 15, 2008 at 2:14 pm

  3. ARN :

    ROFL! You know what, I just might! LOL!

    Jaffer:

    I KNOW it’s darn simple. Even kindergartenishly simple. Yet, many medics find themselves grappling with such basic neanderthalic math! In fact getting into medical school means you’ve long left the domain of arithmetic and logical reasoning. Which begs the question, are doctors really as intelligent as they are perceived to be?

    There are in fact electronic infusion pumps that can be calibrated without the use of one’s brain, but most hospitals in developing nations like India would not be equipped with that kind of technology.

    Firas MR

    June 15, 2008 at 3:58 pm

  4. [...] bookmarks tagged dominant Infusion Confusion – How To Calculate Drug Infusio… saved by 5 others     kagomegirlwhit93 bookmarked on 07/02/08 | [...]

  5. Is there more than one standard microdrip rate, or is 60gtt/min the only/standard drip rate for microdrip?

    mable

    December 12, 2009 at 5:46 pm

    • I’m not sure, but it’s always best to take a look at the packaging.

      Firas MR

      December 14, 2009 at 2:22 pm

  6. God i still cant understand,,,who can teach me in simple way,,,

    Eden

    February 26, 2010 at 8:17 am


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

%d bloggers like this: