Fluid Requierment
Fluid Requierment
Fluid Requierment
It is important that you are able to do calculations confidently, as mistakes may result in the
patient receiving the wrong dose which may lead to serious consequences for the patient.
Patient safety depends on accurate I.V. drug dosing; precise calculations are essential to this
process. Nurses shouldn't be apprehensive when I.V. drug dosages are presented in practice.
1 mL = 1cc 15 mL = 3 tsp 2 c = 1 pt
1 mL = 15 gtts 15 mL = 1 Tbs 1000 mL = 1 qt
1 mL = 15 minims 30 mL = 1 oz 32 oz = 1 qt
1 mL = 60 micro drops 1 Tbs = 3 tsp 1 L = 1 qt
4 mL = 1 dram 8 dram = 1 oz 1 L = 1000 mL
5 mL = 1 tsp 240 mL = 1 c 4 qt = 1 gal
500 mL = 1 pint
COMMON ABBREVATIONS USED IN ADMINISTRATION
Term Abbreviation
Intravenous IV
Piggy-back PB
Drop/drops gtt/gtts
Hour hr
Minutes min
Drops per minute gtts/min
Drops per millilitre gtts/ml
Milliliters per hour ml/hr
Water H2O, W
5% dextrose water D5W
10% dextrose water D10W
Normal saline (0.9%) NS
One half normal saline (0.45%) ½NS
Ringer’s Lactate solution RS
Lactated Ringer’s solution LS
Macrodrip tubing administers a larger drop and may be used for 10 gtts/mL,
15 gtts/mL or 20 gtts/mL. Microdrip tubing administers 60 gtts/mL. These are called
drop factors. The drop factor is the number of drops contained in 1 milliliter.
𝐀𝐦𝐨𝐮𝐧𝐭 𝐨𝐟 𝐟𝐥𝐮𝐢𝐝 (𝐦𝐋) /𝐓𝐨𝐭𝐚𝐥 𝐭𝐢𝐦𝐞 𝐨𝐟 𝐢𝐧𝐟𝐮𝐬𝐢 𝐨𝐧 (𝐦𝐢𝐧) x Drop factor (gtts/mL) = IV
infusion rate (gtts/min)
Example:
The physician has ordered D5W 1200 milliliters in 12 hours using 15 drops per
millilitre infusion rate. What is the IV infusion rate in drops per minute?
Given:
Amount of fluid: 1200 mL
Total time of infusion: 12 hrs
Administration set drop factor: 15 gtts/Ml
IV infusion rate: ? gtts/min
EXERCISE
The physician has ordered D10W 15 litters in 15 hours using 12 drops per milliliter
infusion rate. What is the IV infusion rate in drops per minute?
Formula:
Amount DESIRED (D)/ Amount on HAND (H) X QUANTITY (Q) = Y (Tablets Required)
Step 1: Determine your givens. Amount desired (D) = 50 mg Amount on hand (H) = 100
mg tablets Quantity = 1
Step 2: Plug in what you know into the formula and simplify. 50mg ---------x 1= 0.5 tablets
100mg
Three milligrams of Haldol IM are ordered for your patient. On your unit, Haldol
is available in 2 ml ampules that contain 5 mg/ml. What amount will you give?
Stage 1: Using the formula below, calculate the total required dosage based on given the
body weight.
Weight (kg) x dosage ordered (per kg) = Y (required dosage)
Stage 2: Apply the D/H x Q formula to calculate the actual amount of medication to
be administered.
Example 1: Medrol 4 mg/kg is ordered for a child weighing 64.8 lb. Medrol is
available as 500 mg/4mL. How many milliliters of medication must the nurse
administer?
Example 1: Salbuterol 2 mg/kg is ordered for a child weighing 28kg. Salbuterol is available
as 500 mg/2mL. How many milliliters of medication must the nurse administer?
Infusion pumps do not have a calibrated drop factor. The flow rate depends on
the volume of fluid ordered and the time of infusion.
FORMULA:
Volume (ml)
1. ------------------- = Y (Flow rate in ml/hr)
2. Time (h)
For example, the directions may read to add 1.8 mL of normal saline to a vial and
when added to the powder, the solution contains a total of 2 mL, and after reconstitution
the vial contains 250 mg/mL. The reconstituted amount is what you would use to solve
the dose amount. In this case 250 mg/mL is the dosage supply amount you would use
to solve this problem.
PEDIATRIC CALCULATION
The safe dose range is usually expressed in milligrams per kilograms (mg/kg) of body
weight. When preparing to administer a drug to a child, you must first calculate the
daily (24 hour) drug dose ordered by the physician based on kilograms of body weight,
and then verify the calculated dose with the range stated in an approved drug reference.
Each prescribed dose of medication for a child must be calculated, and you must check
the prescribed dose against the SDR to make sure that it is an acceptable safe dose for
the child.
Formula Method
Example: Your patient weighs 40 pounds and the physician has ordered Ceclor
by mouth every 8 hours.
Step 1: Convert First, convert the child’s weight into kilograms by dividing the
child’s weight in pounds by 2.2
The formula is: 2.2 lbs = 1 kg
The child’s weigh is 40 lbs, so divide: 40 lb divide by 2.2 lbs/kg = 18.18 kg
Step 2: Compute
Now determine the medication dose for the SDR using a calculator and the current
pediatric recommendations. Multiply the minimum dose by the weight of the child in
kilograms to determine the medication dose. Then, take the maximum dose times the
weight of the child in kilograms to get the safe range. Finally, compare the 24 hour
prescribed dose with the recommended SDR found in an approved drug reference.
To calculate the milliliters per hour, as when the patient receives IV fluids,
simply divide the calculated amount of fluids required in 24 hours by 24 to obtain
the amount of fluids needed per hour
Example 1:
An infant weighs 20 pounds. Calculate the hourly IV fluid rate for this infant.
Weight 20 lb = 9.1 kg
Calculation 9.1 kg 3 100 mL/kg/24 h = 910 mL/24 h
Daily fluid requirement 910 mL/24 h
IV fluid formula:
Total volume to be infused / Total time for infusion in hours = x mL/h .
Calculation 910 mL/ 24 h = 37.9 mL/h
Fluids per hour 37.9 mL/h
After the newborn period, some drugs are quickly metabolized by the liver,
which may require that the child have large doses or more frequently administered.
In children, difficulty in evaluating the desired effect and the hydration status
of the child.
There are various formulas exist – the formulas often take the child’s age,
weight, body surface and medication amount into consideration.
Surface area of child
Child dose = ---------------------------- x normal adult dose
1.7 m2
For example: ordered Ampicillin for a child weighing 12 kg. the normal adult
dose for Ampicillin is 250mg. calculate child’s dose.
Solution:
Child dose = 0.54 m2 / 1.7 m2 x 250mg
= 0.54/1.7 = 0.3
Child dose = 0.3 x 250mg = 75mg
For example, child weighed 14 kg ordered 5mg/kg.
Fried’s formula
infant dosage (<1 year) Infant’s age in months
----------------------------------------------------------- x average adult dose
150 months
Clark’s rule:
Weight of child in pounds
--------------------------------- x average adult dose
150 pounds
1.73
Parenteral dosage:
Dose ordered
----------------- x quantity in hand (ml) = volume to be given
Dose available
Insulin dosage:
What we want
--------------------- x number of division on the given syringe
What we have
Concentration:
Dose of medication (mg)
---------------------------------- x 1000
volume to be infused
young’s rule:
For example:
Adult dose of castor oil is one ounce (8 drops) or 30 ml
For a 4 year old child= 4x30/4+12= 75 ml
Clarks rule:
Calculated (according to the weight of the child, therefore it can be used for children
of all age)
For example:
Age = 6 months
Adult dose = 1/6
6/150 x 1/6 = 1/150 grain = 0.44 mg
Exercise
A client is ordered 50 milligrams of Amitriptyline. 25 milligram tablets are available.
How many tablets will you give?
50 milligrams
-----------------
25 milligrams = 2 tablets
0.0625 milligrams
-------------------------
0.25 milligrams = 0.25 tablets
35 X 1
-----
50 X 1 =35
------
50 = 0.7 ml
A client is ordered 75 milligrams of Aminophylline intravenously. 250 milligrams in
10 millilitres of liquid for IV Injection is available. How many millilitres will you
administer?
75 X 10 750
---------- = ------ = 3 ml
250X1 250
Calculate the drip rate for 100 mls of IV Fluids to be given over a half hour via a giving
set which delivers 10 drops/ml.
1000 drops
------------------
30 min = 33 drops / min
Calculate the drip rate for 500 mls of Normal Saline to be given over 4.5 hours via a
giving set which delivers 15 drops/ml.
7500 drops
--------------- =
28 drops / min 270 min
Three litres of Hartmans (Lactated Ringer's) is charted over 12 hours. The drop
factor is 15. The IV has been running for 9 hours. 800 mls remain. How many
drops per minute are needed so that the IV finishes in the required time?
= 67 drops / min
Three litres of Normal Saline is charted over 12 hours. The drop factor is 15. The IV
has been running for 9 hours and 45 minutes. 500 mls remain. How many drops per
minute are needed so that the IV finishes in the required time?