Since Med Math is not a new concept for nursing students entering their critical

care rotation, I will be focusing on the new material introduced this semester, and the
student will have to review the old material on their own. In critical care the student will
need to calculate intravenous medications that are dosed by the minute as well as by
kilograms per minute. There are three different formulas available to the students to be
able to perform these calculations, and it is the students choice which to us.

The first and most widely used is:

D/H x Q = R
D = dosage desired
H = dosage you have available
Q = quantity of available solution
R = rate
The second formula is called dimensional analysis:
Formula: Order / Have / weight / Time =
Order / Have /
/ Time
The third formula is called the X factor:
mcg/kg/min:
X = mcg/ml (concentration)
Kg x 60
mcg/min:
X = mcg/ml (concentration)
60
Dose = drip rate x X.

IV Medication Ordered Per Minute

ORDER: Lidocaine 2gm/500ml D5W to run at 2mg/min
Step 1: Calculate ml/min
Formula: D/H x Q = R
D = dosage desired = 2mg/min
H = dosage you have available = 2gm = 2 x 1000 = 2000mg
Q = quantity of available solution = 500ml
2 mg/min x 500 ml = R
2000 mg
1
2 mg / min x 500ml = R
2000 mg
4
2 ml/min = 0.5 ml/min
4
Step 2: Determine the flow rate (ml/hr)
Formula: ml/min x 60 min/hr = ml/hr
0.5 ml x 60 min = 30ml/ hr
min
hr
Step 3: Set the IV pump at 30 ml/hr to deliver 2 mg/min of Lidocaine.

IV Medication Ordered Per Minute

ORDER: Lidocaine 2gm/500ml D5W to run at 2mg/min
Step 1: ml/min using dimensional analysis
Formula: Order / Have / Time =
Order / Have / Time
2 mg / 500ml / 60 min =
1 min / 2 gm / 1 hr
Step 2: Converting
2 mg / 500 ml / 60 min =
1 min / 2 gm
/ 1 hr
2000 mg
Step 3: Cross cancel and reduce
2 mg / 1 ml / 60 min = 30 ml/hr
1 min / 4 mg / 1 hr
Set the IV pump at 30 ml/hr to deliver 2 mg/min of Lidocaine.

IV Medication Ordered Per Kilogram Per Minute

ORDER: Dopamine 400 mg/ 500 ml D5W to run at 5 mcg/kg/min
Step 1: Convert to units, such as mg to mcg or lb. to kg
1mg = 1000 mcg; 400 mg = 400 x 1000mcg = 400,000 mcg
1 kg = 2.2 lb; 110 lb = 110/ 2.2 = 50kg
Step 2: Calculate the desired dosage per minute
5 mcg/kg/min x 50 kg = 250 mcg/min
Step 3: Calculate the desired dosage in ml/min
Formula: D/H x Q = R
1
250 mcg/min x 500 ml/min = 250 = .3125 ml/min
400,000 mcg
800
800
Step 4: Calculate the flow rate of the quantity to administer in ml/hr
ml/min x 60 min/hr = .3125 ml/min x 60 min/hr = 18.75 ml/hr
Step 5: Regulate the flow rate to 18.8 ml/hr to deliver 5 mcg/kg/min of Dopamine

IV Medication Ordered Per Kilogram Per Minute

ORDER: Dopamine 400 mg/ 500 ml D5W to run at 5 mcg/kg/min
Step 1: mcg/kg/min using dimensional analysis
Formula: Order / Have / weight / Time =
Order / Have /
/ Time
5 mcg / 500 ml / 110 lb / 60 min =
1 kg/min/ 400 mg /
/ 1 hr
Step 2: Convert
5 mcg / 500 ml
/ 50 kg / 60 min =
1 kg/min/ 400,000 mcg/
/ 1 hr
Step 3: Cross cancel
5 mcg / 500 ml
/ 50 kg / 60 min = 18.8 ml/hr
1 kg/min / 400,000 mcg /
/ 1 hr
Step 4: Regulate the flow rate to 18.8 ml/hr to deliver 5 mcg/kg/min of Dopamine

IV Medication Ordered Per Kilogram Per Minute

ORDER: Dopamine 400 mg/ 500 ml D5W to run at 5 mcg/kg/min
Step 1: Calculate the X factor
Formula: X = mcg/ml (concentration)
kg x 60 min
400 mg/ 500ml
110 lbs x 60 min
Step 2: Convert
400,000 mcg/ 500ml
50 kg x 60 min
Step 3: Reduce
800 mcg/ml
= X = .266 mcg/kg/min
3000 kg/min
Step 4: X x ml/hr = dose
.X = .266 x 18.8 = 5 mcg/kg/min
This formula is good for drugs that are frequently being titrated. Once you have your X
factor just multiple your IV rate to get your dose.

Word Search
This is an exercise to assist the learner in finding the correct unit base for each word
problem.
1. You receive an order to start an infusion of insulin. The Doctor ordered 3 units/hr
and titrate per protocol. The pharmacy sends 100 units of insulin in 250 ml of
0.9% NS. How many ml/hr should be administered? _________________
2. You receive an order to start levophed to keep SBP > 90 and to start your infusion
at 5 mcg/min. The pharmacy sends 16 mg of levophed in 250 ml of 0.9% NS.
What is the correct unit dosing? ________________
3. You have Dopamine infusing at 22 ml/hr. The concentration on the bag is 800 mg
of Dopamine in 500 ml of D5W. Your patient weighs 82 kg. You want to know
how many mcg/kg/min are being infused. What is the correct unit in this case?
_______________
4. You have an order to start Versed at 0.02 mg/kg/hr. The pharmacy sends a bottle
of 100mg of Versed in 100 ml of 0.9% NS and your patient weighs 60 kg. How
many ml/hr should the pump be set at? ________________________
5. You have an order to give Lidocaine at 2 mg/min and the pharmacy sends a bottle
that contains 1 gm of Lidocaine in 250 ml of D5W. How many ml/hr should the
pump be set at? __________________
6. You come on shift and find a Heparin drip running at 22 ml/hr. The bag shows a
concentration of 25,000 units of Heparin in 500 ml of D5W. You want to know
how many units and hour are being administered to your patient. ___________

Answers
1. ml/hr
2. mcg/min
3. mcg/kg/min
4. ml/hr
5. ml/hr
6. units/hr

Practice Calculations
1. Physician orders Dopamine (800mg/ 500ml) on your 130 lbs patient at 5
mcg/kg/min. What should your pump be set at?
2. The patient becomes unstable over time and now you need to increase the
infusion to 12 mcg/kg/min. What should you set the pump at?
3. You started your shift and your 160 pound patient has a Nipride (50mg/ 250ml)
infusion running at 21 ml/hr. The physician comes in and asks you how many
mcg/kg/min is this patient currently receiving. You answer is?
4. A 120 lbs patient with ACS (Acute Coronary Syndrome) is coming up to the
Cardiac DOU on Nitroglycerine (50mg/ 250ml). How many mcg./min is the
patient receiving if the pump is set at 12 ml/hr?
5. Your patient has returned from getting a Cat Scan in Radiology and the
Radiologist has diagnosed (Pulmonary Embolism). A bolus of 2000 units of
Heparin was given. Now the Intensivist wants you to start a heparin infusion
(25,000 units/500ml) at 1500 units/hr. What do you set the pump at?
6. The physician wants to start comfort care on a terminally ill patient currently in
the ICU before he is transferred to the DOU. Morphine is ordered at 3 mg/hr. If
the morphine concentration is 100 mg in 250 ml what do you set the pump at?
7. You have to give the antibiotic Cleocin 450 mg IVPB Q6H to your patient.
Pharmacy sends you a vial that has 600 mg in 2 ml. Ho many mls will you put in
the buretrol?
8. The physician orders Digoxin 0.25 mg IV push now. The 1 ml syringe sent from
pharmacy is labeled 250 mcg. How much of the syringe do you give as the staff
RN taking care of this patient?
9. Your patient goes into rapid atrial fibrillation and the physician wants you to give
10 mg of Cardizem IV push and then start a Cardizem (150mg/150ml) infusion at
5 mg/hr. What do you set the pump at?
10. Start Lasix infusion (500mg/ 50ml) at 2 ml/hr. How much mg of lasix is the
patient getting per hour?

Answers for practice test:

1. 11.1 ml/hr
2. 26.6 ml/hr
3. .96 mcg/kg/min
4. 40 mcg/min
5. 30 ml/hr
6. 7.5 ml/hr
7. 1.5 ml
8. 1 ml
9. 5 ml/hr
10. 20 mg/hr