Critical care drug infusion

ICU MEDICATIONS

1. Adrenaline
Strength 1mg / 1ml
Compatibility NS, D5W.
Dilution 2 mg (2 amp) *50 ml
Concentration
40 mcg/ ml

Dose 0.04–1 mcg/kg/minute
Stability
 24 hr.
 Epinephrine is sensitive to light and air; protection from
light is recommended


Dose (mcg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
0.025 1.1 1.5 1.9 2.3 2.6 3.0 3.4 3.8
0.05 2.3 3.0 3.8 4.5 5.3 6.0 6.8 7.5
0.075 3.4 4.5 5.6 6.8 7.9 9.0 10.1 11.3
0.1 4.5 6.0 7.5 9.0 10.5 12.0 13.5 15.0
0.125 5.6 7.5 9.4 11.3 13.1 15.0 16.9 18.8
0.15 6.8 9.0 11.3 13.5 15.8 18.0 20.3 22.5
0.175 7.9 10.5 13.1 15.8 18.4 21.0 23.6 26.3
0.2 9.0 12.0 15.0 18.0 21.0 24.0 27.0 30.0
0.25 11.3 15.0 18.8 22.5 26.3 30.0 33.8 37.5
0.3 13.5 18.0 22.5 27.0 31.5 36.0 40.5 45.0
0.35 15.8 21.0 26.3 31.5 36.8 42.0 47.3 52.5
0.4 18.0 24.0 30.0 36.0 42.0 48.0 54.0 60.0
0.45 20.3 27.0 33.8 40.5 47.3 54.0 60.8 67.5
0.5 22.5 30.0 37.5 45.0 52.5 60.0 67.5 75.0

2. Noradrenaline
Strength 4mg / 4ml
Compatibility D5W.
Dilution 4 mg (1 amp) * 50 ml
Concentration
80 mcg/ ml

Dose 0.01–3 mcg/kg/minute
Stability
 24 hr.
 keep away from light ,don’t use if brown coloration
(oxidized),

Dose (mcg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
0.025 1.1 1.5 1.9 2.3 2.6 3.0 3.4 3.8
0.05 2.3 3.0 3.8 4.5 5.3 6.0 6.8 7.5
0.075 3.4 4.5 5.6 6.8 7.9 9.0 10.1 11.3
0.1 4.5 6.0 7.5 9.0 10.5 12.0 13.5 15.0
0.125 5.6 7.5 9.4 11.3 13.1 15.0 16.9 18.8
0.15 6.8 9.0 11.3 13.5 15.8 18.0 20.3 22.5
0.175 7.9 10.5 13.1 15.8 18.4 21.0 23.6 26.3
0.2 9.0 12.0 15.0 18.0 21.0 24.0 27.0 30.0
0.25 11.3 15.0 18.8 22.5 26.3 30.0 33.8 37.5
0.3 13.5 18.0 22.5 27.0 31.5 36.0 40.5 45.0
0.35 15.8 21.0 26.3 31.5 36.8 42.0 47.3 52.5
0.4 18.0 24.0 30.0 36.0 42.0 48.0 54.0 60.0
0.45 20.3 27.0 33.8 40.5 47.3 54.0 60.8 67.5
0.5 22.5 30.0 37.5 45.0 52.5 60.0 67.5 75.0

3. Dobutamine
Strength 250 mg / 20 ml
Compatibility D5W, NS
Dilution 250 mg (1 amp) *50 ml
Concentration
5000 mcg/ ml

Dose
2–20 mcg/kg/minute
 Some literature state that maximum dose is 40mcg/kg/min
 But ACC/AHA recommend maximum dose of 20mcg/kg/min
Stability  24 hr.

Dose (mcg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
5 1.8 2.4 3.0 3.6 4.2 4.8 5.4 6.0
6 2.2 2.9 3.6 4.3 5.0 5.8 6.5 7.2
7 2.5 3.4 4.2 5.0 5.9 6.7 7.6 8.4
8 2.9 3.8 4.8 5.8 6.7 7.7 8.6 9.6
9 3.2 4.3 5.4 6.5 7.6 8.6 9.7 10.8
10 3.6 4.8 6.0 7.2 8.4 9.6 10.8 12.0
11 4.0 5.3 6.6 7.9 9.2 10.6 11.9 13.2
12 4.3 5.8 7.2 8.6 10.1 11.5 13.0 14.4
13 4.7 6.2 7.8 9.4 10.9 12.5 14.0 15.6
14 5.0 6.7 8.4 10.1 11.8 13.4 15.1 16.8
15 5.4 7.2 9.0 10.8 12.6 14.4 16.2 18.0
16 5.8 7.7 9.6 11.5 13.4 15.4 17.3 19.2
17 6.1 8.2 10.2 12.2 14.3 16.3 18.4 20.4
18 6.5 8.6 10.8 13.0 15.1 17.3 19.4 21.6
19 6.8 9.1 11.4 13.7 16.0 18.2 20.5 22.8
20 7.2 9.6 12.0 14.4 16.8 19.2 21.6 24.0

4. Dopamine
Strength 200 mg / 5 ml
Compatibility D5W, NS
Dilution 200 mg (1 amp) *50 ml
Concentration
4000 mcg/ ml

Dose
Dopa dose 1-3mcg/kg/min (evidence does not support this practice)
Beta dose 4- 10mcg/kg/min
Alpha dose >10mcg/kg/min (above 20 mcg/kg/min not recommended)
Stability  24 hr.

Dose (mcg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
1 0.5 0.6 0.8 0.9 1.1 1.2 1.4 1.5
2 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3.0
3 1.4 1.8 2.3 2.7 3.2 3.6 4.1 4.5
4 1.8 2.4 3.0 3.6 4.2 4.8 5.4 6.0
5 2.3 3.0 3.8 4.5 5.3 6.0 6.8 7.5
7.5 3.4 4.5 5.6 6.8 7.9 9.0 10.1 11.3
10 4.5 6.0 7.5 9.0 10.5 12.0 13.5 15.0
12.5 5.6 7.5 9.4 11.3 13.1 15.0 16.9 18.8
15 6.8 9.0 11.3 13.5 15.8 18.0 20.3 22.5
17.5 7.9 10.5 13.1 15.8 18.4 21.0 23.6 26.3
20 9.0 12.0 15.0 18.0 21.0 24.0 27.0 30.0

5. Nitrogylcerine
Strength 50 mg / 10 ml
Compatibility D5W
Dilution 10 mg (2 ml) *50 ml
Concentration 200 mcg/ ml
Dose
5- 200 mcg/minute
(increase by 5 mcg/minute every 5 min)
Stability  24 hr.

Dose
(mcg/min)
Infusion Rates
(ml/ hr)
Dose
(mcg/min)
Infusion Rates
(ml/ hr)
5 1.5 100 30
10 3 110 33
15 4.5 120 36
20 6 130 39
30 9 140 42
40 12 150 45
50 15 160 48
60 18 170 51
70 21 180 54
80 24 190 57
90 27 200 60

6. Nitroprusside
Strength 50 mg / 2 ml
Compatibility D5W
Dilution 50 mg( 1 amp) *250 ml
Concentration 200 mcg/ ml
Dose
0.2 - 10 mcg/kg/minute
Doses >5 mcg/kg/minute are not recommended

Stability
 24 hr.
 Prepare it away from light
 wrapped immediately with aluminum foil

Dose (mcg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
0.1 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3
0.2 1.8 2.4 3 3.6 4.2 4.8 5.4 6
0.3 2.7 3.6 4.5 5.4 6.3 7.2 8.1 9
0.4 3.6 4.8 6 7.2 8.4 9.6 10.8 12
0.5 4.5 6 7.5 9 10.5 12 13.5 15
1 9 12 15 18 21 24 27 30
2 18 24 30 36 42 48 54 60
3 27 36 45 54 63 72 81 90
4 36 48 60 72 84 96 108 120
5 45 60 75 90 105 120 135 150
6 54 72 90 108 126 144 162 180
7 63 84 105 126 147 168 189 210
8 72 96 120 144 168 192 216 240
9 81 108 135 162 189 216 243 270
10 90 120 150 180 210 240 270 300

7. Heparin
Strength 5000 IU /amp
Compatibility NS
Dilution 25000 IU ( 5 amp) *50 ml
Concentration 500 IU / ml
Dose 80 units/kg then 18 units/kg/hour
Stability
 24 hr.
 Prepare it away from light
 wrapped immediately with aluminum foil

Dose (IU) WT(kg) 30 40 50 60 70 80 90 100
Loading (80
units/kg)
2400
IU
3200
IU
4000
IU
4800
IU
5600
IU
6400
IU
7200
IU
8000
IU
Maintenance
(18 units/kg/hour)
Infusion Rates ml/ hr
0.768 1.024 1.28 1.536 1.792 2.048 2.304 2.56

8. Fentanyl
Strength 50 mcg/ml amp=2ml
Compatibility D5W, NS.
Dilution 500 mcg (5 amp) *50 ml
Concentration 10 mcg / ml
Dose 0.5 to 10 mcg/kg/hr IV
Stability  24 hr

Dose (mcg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
0.5 1.5 2 2.5 3 3.5 4 4.5 5
0.75 2.25 3 3.75 4.5 5.25 6 6.75 7.5
1 3 4 5 6 7 8 9 10
1.25 3.75 5 6.25 7.5 8.75 10 11.25 12.5
1.5 4.5 6 7.5 9 10.5 12 13.5 15
1.75 5.25 7 8.75 10.5 12.25 14 15.75 17.5
2 6 8 10 12 14 16 18 20
2.25 6.75 9 11.25 13.5 15.75 18 20.25 22.5
2.5 7.5 10 12.5 15 17.5 20 22.5 25
3 9 12 15 18 21 24 27 30
3.5 10.5 14 17.5 21 24.5 28 31.5 35
4 12 16 20 24 28 32 36 40
4.5 13.5 18 22.5 27 31.5 36 40.5 45
5 15 20 25 30 35 40 45 50

9. Midazolam
Strength 5 mg/ml amp=3ml
Compatibility D5W, NS. Incompatible with LR.
Dilution 45 mg (3 amp) *45 ml
Concentration 1 mg / ml
Dose
Initial dose (0.01 – 0.05 mg/kg) OR 0.5 to 4 mg
Maintenance infusion: 0.02 to 0.1 mg/kg/hour
Stability  24 hr

Dose (mg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
0.02 0.6 0.8 1 1.2 1.4 1.6 1.8 2
0.03 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3
0.04 1.2 1.6 2 2.4 2.8 3.2 3.6 4
0.05 1.5 2 2.5 3 3.5 4 4.5 5
0.06 1.8 2.4 3 3.6 4.2 4.8 5.4 6
0.07 2.1 2.8 3.5 4.2 4.9 5.6 6.3 7
0.08 2.4 3.2 4 4.8 5.6 6.4 7.2 8
0.09 2.7 3.6 4.5 5.4 6.3 7.2 8.1 9
0.1 3 4 5 6 7 8 9 10

10. Propofol
Strength 10 mg/ml (1%) amp=20ml
Compatibility Does not need to be diluted
Dilution 500 mg (2.5 amp) Total 50 ml
Concentration 10 mg / ml
Dose
 Initial dose (0.3 mg/kg)
 Maintenance infusion: 0.3 to 3 mg/kg/hour
Stability
 If transferred to a syringe or other container prior to
administration, use within 6 hours.
 If diluted in 5% dextrose stable for 8 hours at room
temperature

Dose (mg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
0.3 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3
0.4 1.2 1.6 2 2.4 2.8 3.2 3.6 4
0.5 1.5 2 2.5 3 3.5 4 4.5 5
0.75 2.25 3 3.75 4.5 5.25 6 6.75 7.5
1 3 4 5 6 7 8 9 10
1.25 3.75 5 6.25 7.5 8.75 10 11.25 12.5
1.5 4.5 6 7.5 9 10.5 12 13.5 15
1.75 5.25 7 8.75 10.5 12.25 14 15.75 17.5
2 6 8 10 12 14 16 18 20
2.25 6.75 9 11.25 13.5 15.75 18 20.25 22.5
2.5 7.5 10 12.5 15 17.5 20 22.5 25
2.75 8.25 11 13.75 16.5 19.25 22 24.75 27.5
3 9 12 15 18 21 24 27 30

11. Insulin Infusion Protocol
1. Standard infusion: 50 Units Regular insulin/50 mL NS via an infusion device
2. For most patients, the goal BG should be between 90-140 mg/dL.
3. Initiating the Infusion:
 Algorithm 1: Start here for most patients.
 Algorithm 2: Start here if the patient has a glucose > 600 mg/dL, is in diabetic ketoacidosis, or
is s/p CABG, s/p solid organ transplant, receiving glucocorticoids, or patient with diabetes
receiving over 80 units/day of insulin as an outpatient, has a BMI more then 35, or is pregnant.
 Algorithms 3-8: Do not start patients in these algorithms.
4. Patient Monitoring:
 Hourly monitoring is indicated for most critically ill patients.
 For stable patients, check BG every hour until it is within goal range (90 – 140 mg/dL) for 4
hours, then decrease BG checks to every 2 hours.
6. Moving down from Algorithm to Algorithm When glucose decreases >60 mg/dl in 1 hour
Blood Glucose Adjustment
BG < 60 mg/dL Treatment of Hypoglycemia
BG 61-90 mg/dL Turn off the infusion and recheck BG every 1 hour
until> 90 mg/dL and then restart infusion in next
Lower algorithm
BG between 90 and 140 mg/dL (goal) Adjust the rate within the SAME algorithm
BG between 141 and 180 mg/dL and decreased by
30 mg/dL or more
Adjust the rate within the SAME algorithm
BG between 141 and 180 mg/dL and did not
decrease by at least 30 mg/dL
Adjust the rate to the next HIGHER algorithm
BG > 180 mg/dL and decreased by 60 mg/dL or
more
Adjust the rate within the SAME algorithm
BG > 180 mg/dL and did not decrease by at least 60
mg/dL
Adjust the rate to the next HIGHER algorithm

Blood Glucose
(mg/dl)
Scale 1
(ml/hr)
Scale 2
(ml/hr)
Scale 3
(ml/hr)
Scale 4
(ml/hr)
Scale 5
(ml/hr)
Scale 6
(ml/hr)
Scale 7
(ml/hr)
Scale 8
(ml/hr)
≥400 3 4 5 6 7 8 10 11
320-399 2.5 3.5 4 5 6 6 8 9
250-319 2 3 3 4 5 5 6 7
210-249 1.5 2.5 2.5 3 4 4 4 5
180-209 1 2 2 2 3 3 3 4
140-179 1 1.5 1.5 1.5 2 2 2.5 3
110-139 0.5 1 1 1 1.5 1.5 2 2
90-109 0.5 0.5 0.5 1 1 1 1.5 1.5
<90 Stop IV insulin infusion and inform doctor

12. Rocuronium Bromide (Esmeron)
Strength 10 mg/ml amp=5ml
Compatibility D5W, NS.
Dilution 250 mg (5 amp) *50 ml
Concentration 5 mg / ml
Dose
Initial dose (0.6 mg/kg)
Maintenance infusion: 0.3 to 0.6 mg/kg/hour
Stability  24 hr

Dose (mg) WT(kg)
30 40 50 60 70 80 90 100
Infusion Rates ml/ hr
0.3 1.8 2.4 3 3.6 4.2 4.8 5.4 6
0.35 2.1 2.8 3.5 4.2 4.9 5.6 6.3 7
0.4 2.4 3.2 4 4.8 5.6 6.4 7.2 8
0.45 2.7 3.6 4.5 5.4 6.3 7.2 8.1 9
0.5 3 4 5 6 7 8 9 10
0.55 3.3 4.4 5.5 6.6 7.7 8.8 9.9 11
0.6 3.6 4.8 6 7.2 8.4 9.6 10.8 12