Drug dilution

ED HSDG

1. Adrenaline infusion Preparation 1 amp 1ml (1:1000 = 1mg/ml) Dilute 3.0mg (3mls) adrenalin with 47mls of NS in 50mls syringe. Rate : 1ml/ hr = 1mcg/min Dose : 1-10mcg/min. Titrate accordingly to desired BP Calculation: 50mls = 3mg = 3000mcg 1ml = 3000mcg/50mls = 60mcg/ml 1ml/ hr = 60mcg/ hr = 60mcg/60min = 1mcg/min 1ml/ hr = 1mcg/min

2. Adrenaline infusion ( peadiatric ) Refer Frank Shann 0.3mg/kg in 50mls Eg 10kg 10 x 0.3 = 3mg (add 3mg in D5% to make 50mls 10ml/ hr = 1mcg/kg/min IV infusion 0.05-1mcg/kg/min ( ie 0.5-10mls/ hr )

3. Atropine infusion Preparation 1mg / 1ml Dilute 10mg of atropine (10mls = 10ampulse) in 40mls NS  50mls 5mls / hr = 1mg / hr to titrate with effect

4. Magnesium sulphate For severe asthma Preparation : 2.47gm (1amp) / 5mls Dilute 2gm (4mls) in 20cc NS Give using syringe pump over 20min

5. Aminophyline infusion Preparation : 250mg/10mls Loading dose : 5mg/kg in 100mls NS over ½ hr Eg : 250-500mg in 100ml NS (or 5mg/kg) Run over 20-30min Do not give bolus to pt already on oral theophylline Infusion : 0.5 – 0.9 mg/kg/ hr Dilute 250mg in 50mls syringe with NS 1ml = 250/50 = 5mg 1ml/ hr = 5mg/ hr Eg : 70kg 0.5mg/kg/ hr = 0.5 x 70 = 35mg/ hr 35mg/ hr = 35/5 = 7mls / hr (usual dose at 6-7mls/ hr

6. Amiodarone Preparation : 150mg / 3mls Loading dose Dilute 2 amp of amiodarone (300mg / 6mls) in 100mls D5% (not compatibale with NS) Use microchamber run over 1hr Maintainance dose Dilute 6 amp of amiodarone (900mg / 18mls) in 500mls of D5% Run over 24hr ~ 20mls/ hr

7. Cocktail regime (for hyperkalemia) IV slow bolus 10mls of 10% calcium gluconate 1 st medication to be given immediately Must be given by doctor – given over 2-5min Cardiac (ECG) monitoring Can be repeated once/twice if necessary – titrate against ECG changes Avoid used in hyperK 2ndary to digoxin toxicity IV bolus 50mls of D50% (glucose not required in hyperglycemic state) IV bolue insulin 10iu IV Sodium Bicarb (IV NaHCO3) – consult EP. Given only if pt is acidotic IV / Neb salbutamol Resonium – orally or rectally every 6hr. Effect take 1-2hr HD

8. DIVC regime 6 cryoprecipitate 4 platelet 2 FFP

9. Dopamine Preparation : 1 vial = 200mg = 5mls Syringe pump : no bolus doses Method 1 (dilution dose is adjusted according to pt weight. The rate is fixed) Eg pt weight 60kg 3x BW = 3x 60kg 180mg in 50mls NS 1ml = 180/50 = 3.6mg 1ml/ hr = 3.6mg/ hr = 3.6mg/60min = 3600mcg/60min = 60mcg/min = 1mcg/kg/min Rate 1ml/ hr = 1mcg/kg/min

10. D opamine Method 2 (dilution dose is fixed, but rate is adjusted according to weight 200mg dopamine in 50mls NS = 200/50 = 4mg/1ml = 4000mcg/ml 1ml/ hr = 4000mcg/60min = 66.6mcg/min 1ml/ hr = 66.6mcg/min In 70kg person, 1ml/ hr = 66.6mcg/min = 66.6mcg/70kg/min = 1mcg/kg/min Refer table

11. Dopamine (200mg in 5mls) Wt (kg) Mcg/kg/min 45kg 50 55 60 65 70 75 80 85 90 2.5 1.6ml/ hr 1.8 2.0 2.2 2.4 2.6 2.8 3.0 3.2 3.4 5.0 3.3 3.7 4.1 4.5 4.9 5.3 5.7 6.1 6.5 6.9 7.5 5.0 5.6 6.1 6.7 7.3 7.8 8.4 9.0 9.6 10.1 10.0 6.7 7.5 8.2 9.0 9.7 10.5 11.2 12.0 12.8 13.5 12.5 8.4 9.3 10.3 11.2 12.1 13.1 14.0 15.0 16.0 16.9 15.0 10.1 11.2 12.3 13.5 14.6 15.7 16.8 18.0 19.1 20.3 17.5 11.8 13.1 14.4 15.7 17.0 18.3 19.7 20.1 22.3 23.6 20.0 13.5 15.0 16.5 18.0 19.5 21.0 22.5 24.0 25.5 27.0

12. Hydralazine For preeclampsia / eclampsia Method 1 : Dilute 50mg in 50cc NS (1mg = 1ml) Start 5ml/ hr Increase 1ml/ hr every 15-20min Max infusion rate – 10ml/ hr Method 2 : Dilute 50mg in 500ml NS 10ml = 1mg/ hr Start infusion at 15ml/ hr (1.5mg/ hr ) Increase 15ml/ hr every 15min Aim decrease diastolic BP 90-100 Caution when hydralazine if given together with Mgso4 -> BP may drop

13. Fentanyl infusion (for sedation) Preparation : 100mcg / 2mls Dilute 200mcg (2amp) of fentanyl with NS to become 20ml 200mcg = 20ml 1ml = 10mcg Dose infusion Start with 2ml/ hr (20mcg/ hr ) Titrate to desired BP

14. GTN infusion Preparation : 50mg/10ml Syringe pump 50ml Method 1 : Dilute 50mg (10ml) of nitrobid with 50ml NS Rate 0.3mls/ hr = 5mcg/min Method 2 : Dilute 30mg nitrobid (6ml) with NS to become 50ml Rate 1ml/ hr = 10mcg/min Startting dose infusion 10-20mcg/min Can increase up to 100mcg/min Monitor BP every 5min

15. Isoket (isosorbide dinitrate ) Preparation 10mg / 10mls Dilute 10mg (10ml) of isoket in 40ml NS 5ml = 1mg Dose 1-5mg/ hr Isoket (mg/ hr ) Infusion rate (ml/ hr ) 1.0 5.0 1.5 7.5 2.0 10.0 2.5 12.5 3.0 15.0 3.5 17.5 4.0 20.0 4.5 22.5 5.0 25.0

16. L abetalol Preparation: 1amp : 25mg / 5ml Bolus dose : IV 5-20mg bolus injected over 2min (max 200mg) Infusion dose : Dose 20-160mg/ hr Dilute in D5% or DS Method 1 – infusion Dilute 200mg (8amp) IV labetalol in NS to make 50cc (1ml = 4mg) Start at 5ml / hr = 20mg/ hr Dose 20 – 160mg / hr Double every ½ hr to max 160mg/ hr Method 2 – infusion Dilute 100mg (4amp) IV labetalol in 30ml NS to make 50ml solution 50ml  100mg = 1ml  2mg

17. Midazolam morphine sedation Preparation Morphine 30mg (3ml) + midazolam ( dormicum ) 30mg (6ml) Dilute with 21ml NS in 50ml syringe Rate : 1ml/ hr = 1mg of midazolam and morphine Dose Bolus dose may be required for faster effect, followed by infusion dose Infusion dose : 3mg / hr (3ml/ hr ) To titrate to desired effect Paeds dose : Mida : 3mg/kg in 50ml NS ; Morphine : 1mg/kg Morphine 30mg + midazolam 90mg dilute in 29ml NS in 50ml syringe

18. Noradrenaline infusion Preparation : 4mg/4ml (1 amp) Dilute 4mg (4ml) with 46ml NS in 50ml syringe Rate : 1ml/ hr = 1mcg/min Dose : 2-20mcg/min. titrate accordingly to desired effect Calculation 4mg (4ml) Norad in 50ml NS 50m  4mg  4000mcg 1ml  4000mcg/50ml  80mcg 1ml/ hr  80mcg/ hr  80mcg/60min  1.3mcg/min 1ml / hr = 1.3mcg/min