Dose calculation & setting

up an intravenous drip
Dr. Munmun Mukherjee
North Bengal Medical College
 Prefixes recommended by SI units
Prefix Symbol Factors by which quantity to be Example of Example of
multiplied to be expressed in units of mass units of
base units volume

Tera T 1012
Giga G 109
Mega M 106
Kilo k 103 Kilogram(kg)
Hecto h 102
Deca Da 101
Deci d 10-1 decilitre
Centi C 10-2
Mili m 10-3 miligram mililitre
Micro µ 10-6 microgram microlitre
Nano N 10-9
Pico P 10-12
Metrology (Weight and measures)
1. Measures of mass (weight)
 1kg= 1000 g = 2.2 pounds(lb)
 1g = 1000 mg
 1mg =1000 mcg
 1 grain (gr) =1 g

2. Measures of capasity (volume)

 1 litre = 1000 mL
 1 ml =1000 µl
 1 ounce(oz) by volume = 30 mililiters (mL)
 1 pint = 500 mL
 1 quart ( qt) = 1000 Ml
 1 minim = 1 drop(gtt)
Some household measures (average)
1 tea spoonful = 5ml
1 dessert spoonful = 10 ml
1 table spoonful = 15 ml
1 cup = 150 ml
1 glass = 250 ml 8 oz
1 drop of water = 0.05 ml =50 µl
1 ml of water = 15 drops.
Concentrations
There are generally three ways of expressing concentration:
Concentration expressed in weight per unit volume
 Concentration expressed in percentage
Concentration in ratio or parts

Weight per unit volume- Used frequently in liquid

pharmaceutical preparation. Example- if a preparation of
paracetamol oral drop has a strength of 125 mg/ml , it
means that every ml of the preparation would contain 125
mg of paracetamol. Occationally it may be expressed as
weight per defined volume . Thus, the strength of a
paracetamol may be 125 mg / 5 ml – its concentration
therefore 25 mg/ ml.
Percentage concentration
 Percentage concentration denote the amount of the ingredient of interest in
100 parts of the product.

 The concentration of solution as percentage can be expressed in three ways –

 1 . Weight in weight(w/w):
 1% w/w means 1 part of solid is mixed with 99 g of another solid to make one
part in 100 parts of the finished product e.g. 1 g in 100 g.
 Example- 1% sulphur ointment means 1 g of sulphur is present in 100 g of
the ointment.

 2. Weight in volume (w/v) :

 1% w/v means 1 part in solid (solute) dissolved in a liquid (solvent) to
prepare 100 parts by volume of a solution.
 Example- 1 g of solid dissolved in solvent to prepare 100 ml of solution i.e. 1
g in 100 ml. A 5% w/v dextrose solution contains 5 gm of dextrose in every
100 ml solution.
Percentage solution
 3. Volume in volume (v/v):
 1% v/v means 1 part by volume of a liquid is dissolved in another liquid to prepare 100
parts by volume of a solution .
 Example- 1 ml of liquid in 100 ml of solution . i.e. 1 ml in 100 ml. or 10 ml/litre. A 70% v/v
isopropyle alcohol solution contains 70 ml of isopropyle alcohol in every 100 ml of
solution.

 Conversion of units of weight and volume

 1. How many miligrams are there in 1 g of neomycin ?

 Ans : To convert 1 gram to milligrams

 1 gm = 1 x 1000 = 1000 mg.

 2. Calculate the initial dose of chloroquine ( 10mg/kg) required for an adult patient
weighing 60 kg.

 Ans-Dose = 10(mg) x 60 (kg) =600 mg.

 Each tab of chloroquine contains 150 mg base .
 So, no of tablets= 600/150 = 4 tab
Percentage solution
Solutions of various strengths
Percentage Strength Percentage Strength

1% 1 in 100 0.1% 1 in 1000 = 1 mg/ml

2% 1 in 50 0.01% 1 in 10000 = 0.1 mg /ml or

100 µg/ml
5% 1 in 20 0.001% 1 in 100000= 10 µg /ml

10% 1 in 10 0.0001% 1 in 1000000 = 1 µg /ml or 1

part per million ppm.
Concentration expressed in ratio or parts
Concentration used in ratio or parts – for very dilute
but potent solutions.
It denotes the number of parts of the ingredient of
interest present in a given number of parts of the
preparation .
Example- 1: 1000 adrenaline solution means solution
containing 1 gm of adrenaline in 1000 ml , which is
equivalent to a concentration of 1 mg /ml or 0.1% w/v .
Similarly , a 1: 10,000 potassium permanganate
solution is equivalent to concentration of 0.1 mg /ml of
potassium permanganate.
Stock solutions
 Stock solutions are used to obtain the amount of active ingredient that is needed to make a
preparation .
 Useful if the amount required is so small that it can not be easily weighed on a standard
balance.

 Principle- to ensure that patients receive the correct dosing.

 Formula-
 Vs x Cs = Vw x Cw
 Ws x C s = Ww x C w
 V= volume, C= Concentration , w= weight
 Subscript s and w refers to stock preparation and working preparation respectively.

 Example- If 200 ml of a 0.02% potassium permanganate solution is to be dispensed and this

is to be prepared by diluting a 2% stock solution , then the quantity of stock solution
required would be
 Volume required = Vw x Cw = 200 x 0.02 = 2 ml
 Cs 2
Body weight of a child
 Always weigh the child to obtain its body weight.

 Some simple facts-

 Baby usually weighs double its birth weight by 5 months which trebles
by 12 months . Thus if a baby weighs 3.5 kg at birth , it is likely to weigh
7 kg at 5 months and 10.5 kg on its 1st birthday.

 Formula for body weight estimation

 Weight (kg) = Age (in completed months) + 9
2
 Age 1 year or above up to 12 years.
 Weight (kg) =[ Age (in completed years ) + 4 ] x 2
 Thus, a 7 month old boy is likely to weigh around 8 kg , a 3 year old boy
around 14 kg and 7 year old girl around 22 kg .
Ideal body weight (IBW)
 Ideal body weight refers to the lean body mass , which is the body
weight without the weight of the excess adipose tissue .
 The concept of IBW was first introduced by Devine in 1974 to allow
estimation of the drug clearances in obese patients . IBW can also be
estimated from the desirable body mass index (BMI). The desirable
BMI , for both men and women , ranges between 18.5 and 25.0 kg/m2.

 Formula for IBW –

 Robinson formula:
 IBW for men= 51.65 kg + 1.85 kg/ inch over 5 ft
 IBW for women = 48.67 kg + 1.65 kg / inch over 5 ft
 Bonner formula:
 IBW for men = [( 0.9 x height in cm )- 88] kg
 IBW for women : [(0.9 x height in cm ) -92] kg.
Drop factor of intravenous infusion set
Drop factor refers to the number of drops to every
milliliter that the device can allows Drip set and blood
transfusion sets meant for adult use typically have
drop factors of 15 or 20 , meaning that one has
counted 15 or 20 drops that have passed through , 1 ml
of fluid has flowed out . Pediatric drip sets (popularly
called microdrip sets) typically have a drop factor of
60.
Infusion rate (drops/ min)
= Volume(ml) x Drop factor( drops/ml)
 Duration of infusion (min)
 Dosing of topical medicaments
 The amounts of topical preparation required to thoroughly cover parts of the body
( one application ) are as follows:
 Face and neck – 15 g
 Trunk (front and back): 30 g
 One arm : 15 g
 One hand : 7.5 g
 One leg: 30 g
 One foot : 15 g
 Whole body: 90 g (light application)

 FTU- has been advocated in dermatological practice as a measure .

 FTU- The amount of topical medicament, expressed from a tube with a 5 mm
diameter nozzle . That span the length from the distal skin crease to the tip of the
index finger . It is equivalent to 0.5 gm of the preparation.

 Ribbon length – Preparation comes with a paper or plastic applicator having a ruled
line for measuring the dose . The applicator is placed on a flat surface and the
ointment is squeeze out on it , measuring the amount specified in the prescription .
The applicator is then placed on the skin of the chest with ointment side down.
Calculating the dose
Dose – Quantity of drug to be administered to achieve a desired
therapeutic effect.
Dose calculations involve calculation of the following:
Amount of drug based on the patient’s body weight
Amount of drug based on the patient’s body surface area (BSA)
 Rate of drug administration( amount per unit time)

Dose calculation based on body weight – always preferable

actually weigh the patient unless the weight has been checked or
recorded recently. For children , it is possible to estimate the
approximate weight for age.
For obese adults – it is preferable to use the Ideal body weight
(IBW) rather than actual body weight for dose calculation.
Calculating the dose
 Calculation based on BSA- Applied for dose calculation of
cytotoxic anticancer drugs, which have low therapeutic indices.
The formula commonly used to estimate BSA are as follows:
 Du Bois formula:
 BSA ( m 2) = 0.007184 x Weight (kg)0.425 x Height (cm)0.725
Mosteller formula:
BSA(m2) = √ Height in (cm) x Weight (kg)
3600
BSA(m2) = 4 x Weight (kg) + 7
90 + weight (kg)
Average BSA have been estimated and are generally taken to be as
follows : newborn- 0.25 m2, Child of 2 years- 0.5 m2, Child of 9
years – 1.07 m2, Child of 10 years – 1.14 m2, Child of 12- 13 yrs- 1.33
m2 , Adult women- 1.6 m2, Adult man – 1.9 m2.
Calculation based on BSA
Example- Recommended starting dose of imatinib in the
treatment of chronic myeloid leukaemia in the chronic phase is
340 mg/ m2 daily in children . Given that imatinib is available as
100 mg tablets , how many tablets would need to be procured for a
1 month treatment period for a 14 year old boy with body surface
area of 1.45 m2.

ANS- Starting dose of imatinib is 340 mg/ m2 daily.

Body surface area of 14 year old boy is 1.45 m2.
Dose required for 14 year old boy – 340 x 1.45 = 493 mg
 ≈ 500.
Dose required for 1 month – 500 x 30 = 15000 mg.
Imatinib tablet available as 100 mg.
Number of tablet required for 30 days = 15000/100 = 150.
Calculation based on BSA
Example- A 9 year –old girl with polyarticular juvenile
ideopathic arthritis has been prescribed methotrexate 15
mg/ m2 once weekly. Her body surface area is estimated to
be 0.92 m2 . Methotraxate is available as 2.5 mg tablets.
What is the weekly dose , and how many tablets would be
required weekly ?
Ans- Dose of Methotrexate 15 mg/m2 once weekly.
BSA of 9 year old girl – 0.92 m2.
Dose required for 9 year old girl 15 x 0.92 = 13.8 mg once
weekly
Methotrexate available as 2.5 mg tablet.
Number of tablets required weekly = 13.8/2.5 = 5.5 .
Calculation of concentration
1. Weight /mass per volume of solution e.g. mg per 1 ml, mg/10
ml, mmol/l.
2. Units per volume of solution e.g. units per ml.
3. Percentage solution i.e. weight of the drug in grams present in
100 ml of solution. E.g. normal saline solution is 0.9% sodium
chloride.

Example: Prescribe dose of a drug x is 0.5 g. It is available as 20%

means 20 gm in 100 ml. Calculate how many ml will contain 500
mg drug x ?

Ans- 500 mg = 0.5 gm.

20 gm drug present in 100 ml
0.5 gm drug present in 100 x 0.5/20 = 2.5 ml
Calculation of concentration
Example- Adrenaline is available as 1 ml ampoule in
strength of 1: 1000 solution. Calculate the volume
required to administer 0.5 mg.

Ans- 1 gm is present in 1000 ml = 1 gm/1000ml

= 1000 mg/ 1000 ml = 1 mg/ 1 ml.
Thus 0.5 mg in 0.5 ml.
Dose calculation in molar concentration
Mole and gram mole : one mole of a substance is molecular
weight and it is called one gram mole if expressed in grams.
Example- Sodium bicarbonate (NaHCO3)
Molecular weight (MW) of NaHCO3-
Weight of individual elements: Na= 23, H= 1, C= 12, and O =
16 X 3 =48, Thus MW=23 + 1 + 12 + 48 =84.
Molar solution (Mol) : If one mole of a substance is dissolved
in one litre of distilled water it is called one molar solution.
One molar solution of NaHCO3 means 84 grams of sodium
bicarbonate dissolved in one litre (1000 ml) of distilled water.
Dose calculation in molar concentration
 Milimolar solution (mMol) : One milimolar solution of NaHCO3
means 84 mg of sodium bicarbonate dissolved in one litre or 1000 ml
of distilled water . Millimole is also called milliequivalent (mEq).

 Example- In a patient of acidosis 50 mEq of bicarbonate has to be given

by i.v. route . Calculate the amount of solution required in this patient .
Sodium bicarbonate is available as 7.5 % solution.

 Ans-50 meq means= 50 x 84 mg = 4200 mg.

 7.5% solution means 7.5 g is present in 100 ml
 So, 7.5 x 1000 =7500 mg is present in 100 ml.
 Since 7500 mg present in 100 ml
 So, 1 mg present in 100/7500 ml
 4200 mg is present in 100/7500 x 4200 ml = 56 ml.
Calculation of oral doses
 Dose- It is the appropriate amount of a medicine taken at a time or
regularly over a period of time to produce a definite response in a patient.

 Guidelines-
 1. Check the amount of drug present each tab or capsule i.e. strength.
 2. Confirm units used such as miligrams (most common) or micrograms,
 3. Confirm the dose mentioned in prescription and expressed in
medicine lebel.
 4. If units of strength in prescription and medicine lebel are different
then convert them to same unit.
 5. If units are same then calculate the required dose as follows-
 6. No of tablets = Dose required x quantity
Strength of tablet/ capsule
Calculation of oral doses
Guidelines-
7. Quantity is taken as one if it is tablet or capsule .
8. Once you are sure that the units are same , divide the
required dose by the strength of the tablet or capsule.
9. Number of tablet or capsule = Dose x 1
Strength of capsule/tab.
Example- Erythromycin is prescribed as 500 mg four
times a day orally. Tablet erythromycin is available as
250 mg . Calculate number of tablets for each dose.
Ans- Number of tablets needed for each dose = 500mg
x 1 /250 mg = 2 tablets.
Calculation of I.V. Drug doses
General guidelines-
1. For drug in solution form ; check the amount of drug in 1 ml and
total amount in the container.
2. Confirm the dose units used.
3. Take precautions for using drugs for which doses are prescribed in
international units such as heparin and insulin.; the international
should never be abbreviated as i.u. to avoid misreading.
4. Make sure that the dose units are same in prescription and
medicine level.
5. If the prescription and the medicines level have different units of
strength; convert in the same unit.
6. When units are same, then calculate as
Volume= Dose x Volume of solution in ample
Amount of drug in ampoule
 I.V. bOLUS
Administration of drug after calculation of volume
Example- Frusemide is available as 80 mg/2 ml. It is
prescribe to administered 20 mg i.v. Bolus. What
amount of frusemide should be administered?

ANS- Amount desired(D) = 20 mg

 Amount on hand = 80 mg
Quantity = 2 ml
Volume = 20 mg x 2 ml
80 mg
= 0.5 ml.
 I.V. bOLUS
Administration of drug after dilution
Example- Aminophylline is available as 250 mg/ 2 ml
ampoule. It is prescribed to administer 250 mg slow i.
v. After dilution with 20 ml of normal saline ,i.e.
Strength of 12.5 mg/ml is required. How much normal
saline need to added in syringe?

Ans- Amount desired= 250 mg

 Quantity = 2 ml
 Dilution required is up to 20 ml.
 Thus, additional volume added = 20- 2 = 18 ml.
I.V. infusion
Advantages-
The administration of drug can be continued as long
as desired. Effect is over rapidly on discontinuation.
Abrupt rise and toxic level in plasma is avoided.
Excess level that may touch toxic level is prevented.

Disadvantages-
Continuous monitoring is required ; rate of infusion
has to be adjusted as per the requirement.
Local venous thrombosis may occur on prolonged
infusion and infection of i.v. Catheter.
Calculation of infusion rates for infusion
devices
 Principles-
 1. Rate of infusion and their control are required for all the infusions.
This can be achieved by using an infusion pump or syringe pump or
syringe driver.
 2. Always check manufacturer’s instruction or hospital policy to ascertain
the use of correct administration set and correct programming of device.
 3. Administration device should only be used trained and competent
persons regarding use of that particular device.
 4. The following parameters should be checked at regular intervals when
using any rate control device.
 Volume given
 Volume remaining
 Rate of administration
 Condition of the patient and administration site.
Calculation of infusion rates for
infusion devices
5. Repeat the above checks before and after the duty of
doctor is changed.
6. The rate may be expressed or prescribed in terms of
Volume .e.g. Ml per hour or ml per min or
Amount of drug ; e.g. Mg per min or international units per
hour
Example- A patient has been administered 200ml/ h of 5%
dextrose solution for 2.5 hours. How much volume of
dextrose patient has received?
Formula- volume = rate (ml/h) x time (h)
Here, Rate = 200 ml/h, Time = 2.5 h ;
Volume = 200 x 2.5 = 500 ml.
Calculation of rate of infusion
Guidelines-
1. Infusion rate depends on gravity if flow control device is not
used. Flow rate can be measured by counting drops per min
which can be modified as per the requirement .
2. Drip set is important to check the number of drops per ml
infused.
3. A macro drip set and blood administration set deliver 15 drops
per minute while micro drip set about 60 drops per minute.
4. It is very important to check the strength of formulation /
drug available, dilution required, rate of infusion and duration
of infusion as applicable.
 Rate(ml/h) = Volume(ml)

Time(h)
Calculation of drip rate for intravenous infusion
Example- 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.

Ans- 1 litre = 1000 ml ; 8 hours = 8 x 60 = 480 minutes.

Rate = 1000 ml = 2 ml/min
480 min
=2 x 15 =30 drops/ min
Calculation of rate of infusion for
diluted solution
Example- 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.

Ans- Dose required= 10 x 60 = 600 mg;

Mix one ampoule of 600 mg 200 ml of 5 % dextrose
Volume = 200 ml ; Time = 4 hour = 4 x 60 min
 = 240 minutes.
Rate = 200 ml = 0.83 ml / min = 0.83 x 15
 240 min
 = 13 drops/ min
 Calculation of rate of infusion when
rate is given as mg/kg/hr
Example- Aminophylline has been prescribed to be
administered as i.v. Infusion at a rate of 0.8 mg/ kg/ hour. In an
adult patient weighing 70 kg . How will you prepare infusion
solution and calculate the rate of infusion ? Aminophylline is
available as 250 mg/ 10 ml ampoule.

 Ans- Adult patient weight 70 kg.

 Aminophylline rate of infusion – 0.8 mg/kg/hour.
Aminophylline available as 25 mg/10 ml ampoule
Step 1.
Convert the rate of infusion in to mg/min i.e. 0.8 x 70
60
Calculation of rate of infusion when rate
is given as mg/kg/hr
Step 2- prepare infusion solution: Mix 250 mg ( 10 ml
aminophylline ) in 490 ml of normal saline (0.9% w/v)
. Remove 10 ml of saline to compensate 10 ml
aminophylline added to keep vol of infusion 500 ml .
Strength of infusion solution as mg/ml 250 /500
Step 3- Amount ( volume) per minute
= Rate of infusion = 0.8 x 70 x 500
Strength of solution 60 x 250
= 5.6 ml/min
3
Calculation of rate of infusion when rate
is given as I. U./kg/hr
Example- Insulin has been prescribed to be administered
as i.v. Infusion at rate of 0.1 international unit(i.u.) /kg/
hour in an adult patient weighing 60 kg . How will you
prepare infusion solution and calculate the rate of infusion
? Insulin (plain or regular ) is available as 40 i.u. /ml.

 Ans- Adult patient weight 60 kg .

Insulin rate of infusion 0.1 i.u./kg/hr
Insulin available as 40 i.u./ml.
Step 1- 0.1 i.u/kg/hr = 0.1 x 60 i.u./minute
60
Calculation of rate of infusion when
rate is given as I.U./kg/hr
Step 2- Prepare infusion solution – mix 40 i.u. (1 ml
regular insulin ) in 500 ml of normal saline (0.9% w/v)
Strength of solution = 40/500
 Step 3- Amount (volume) per minute
 = Rate of infusion
 Strength of sollution
 = 0.1 x 60 x 500
 60 x40
 = 5 ml/min
 4
Calculation of i.v drug doses for children and
neonates
 Guidelines
 1 . Calculations required in preparation and administration of infusion
for children are complex . Calculations should be checked carefully.

 2. Most of the injections are formulated for adults. The dose required
for infant and neonates may be as small as one tenth (1/10) to one
hundredth (1/100) of content of one ampoule/ vial.

 3. When calculating the infusion volume , keep in mind the average
daily fluid intake of child . Thus , more concentrated infusion solution
may be required.

 4. Make sure that infusion / diluent prescribed is appropriate for the

child e.g. If normal saline is used the sodium content may be as much
as total daily sodium requirement of child.
Calculation of i.v drug doses for children
and neonates
5. The injections which are in powdered form and
reconstituted before injection the amount of powder add to
volume of final solution . Thus , when dose needed is less than
the full content the ‘displacement value ‘ must be considered .
The displacement value may be different in different brands
and mentioned on the packaged insert .

Example – Ampicillin 250 mg vial of brand has displacement

value of 0.2 ml per vial. This implies 250 mg powder will
contribute to 0.2 ml volume . Thus, if 2 ml water for injection
(WFI) is added to vial. The solution made will contain 250 mg
ampicillin in 2.2 ml . Thus to prepare solution 250 mg in 2 ml
add only 1.8 ml of WFI.
Calculation of i.v drug doses for children and
neonates
Example- A child aged 6 years receives infusion of
sodium chloride (0.9%) at a rate of 1 ml per hour over
24 hours . Sodium chloride 0.9% contains 150 mmol
Na per litre (1000 ml) . How many mmols of Na would
a child receive?

ANS- The volume received in 24 hours = 1 x 24 = 24

ml.
The mmol in 24 ml of saline = 150 x 24 = 3.6 mmol.
 1000
Dose calculation in patients with renal failure
Maintenance dose- maintenance dose is dependent on
clearance; thus on t1/2 of drug and calculated as follows.
MD= target Cp x CL (after i.v. administration)
Cp-plasma concentration, CL- clearance
Since clearance is reduced in renal failure , reduction of MD is
required. Maintenance dose can be calculated on the basis of
creatinine clearance for the drugs which are excreted unchanged
such as aminoglycosides, digoxin etc. If creatinine clearance is
50% of normal value then MD should be reduced to 50% of
usual standered dose of gentamicin.
Dose (ri) = Dose x CL(ri) ri= renal insufficiency.
Normal creatinine clearance= 120-140 ml/ min.
CL cr < 75% of normal value indicates renal impairment .
Dose calculation in patients with renal
failure
Creatinine clearance can be calculated by Cockroft
Gault’s formula as follows
Creatinine clearance for males = {140 – age(years) x
weight (kg) / 72 x serum creatinine (mg/dl)
For females, multiply by o.85
Dose adjustment in renal dysfunction ( based on
creatinine clearance of patient )
CL cr (ml/min) Volume Dose reduction(%)
50-70 70
30-50 50
10-30 30
5- 10 20
Thank you