Download Veterinary Technician`s Guide to Practical Math for Manor College

Veterinary Technician’s
Guide to Practical Math
for
Manor College
Externship Students
Nov. 2013
Developed by
Christina M. Lunski, CVT
1
Table of Contents
Weight Conversions…………………………………………… pages 3-5
More Conversions………………………………………………pages 6-7
Reading Drug Labels………………………………………… pages 8-12
Calculating Total Fluid Needs (TFN)…………..…………… pages 13-14
Dose Calculations……………………………………………… pages 15-18
Defining CRI’s………………………………………………… pages 19-20
Step by Step Examples of CRI’s……………………………… pages 21-23
CRI Calculations……………………………………………… pages 24-25
Case Study of “Mimi”: Putting it all together………………. pages 26-29
2
Weight Conversions:
Make the following weight conversions. Remember to round to 2 decimal
places.
oz = ounce
lb = pound
kg = kilogram
Example:
17 lb 6 oz = __________ kg
Math:
Step one: Convert ounces to pounds.
6 oz x 1 lb = 0.375 lb
16 oz
Step two: Add initial pounds and ounces that were converted to pounds.
17 lb + 0.375 lb = 17.375 lb
Step three: Convert pounds to kilograms.
17.375 lb x kg = 7.897 kg = 7.9 kg
2.2 lb
Example:
5280 mcg = __________lb
5280 mcg x 1 mg = 5.28 mg x 1 g = 0.00528 g x 1 kg = 0.00000528 kg x 2.2 lb = 0.00001162 lb
1000 mcg
1000 mg
1000 g
1 kg
3
Weight Conversions:
Make the following weight conversions. Remember to round to 2 decimal
places.
1. 26 lb =
__________ kg
19. 124 lb =
_________ kg
2. 7 lb =
__________ kg
20. 97 lb 14 oz =
_________ kg
3. 2 kg =
__________ lb
21. 78 lb =
_________ kg
4. 49 lb =
__________ kg
22. 56 kg =
_________ lb
5. 33 lb =
__________ kg
23. 11 lb 4 oz =
_________ kg
6. 6 lb 15 oz =
__________ kg
24. 56 lb 3 oz =
_________ kg
7. 24 lb 12 oz = __________ kg
25. 79 lb =
8. 50 kg =
__________ lb
26. 104 kg =
_________ lb
9. 41 lb 13 oz = __________ kg
27. 132 lb =
__________ kg
10. 12 lb 4 oz =
__________ kg
28. 85 lb =
_________ kg
11. 14 kg =
__________ lb
29. 94 kg =
__________ lb
12. 97 lb =
__________ kg
30. 74 lb 7 oz =
_________ kg
13. 34 kg =
__________ lb
31. 61 kg =
__________ lb
14. 42 lb 11 oz = __________ kg
32. 83 lb =
__________ kg
__________ kg
15. 16 lb 5 oz = __________ kg
33. 75 lb =
__________ kg
16. 63 kg =
__________ lb
34. 6 kg =
__________ lb
17. 21 lb 6 oz =__________ kg
35. 41 kg =
__________ lb
18. 84 lb =
36. 32 kg =
__________ lb
__________ kg
4
37. 9 kg =
__________ lb
44. 58 lb =
__________ kg
38. 116 lb 9 oz = __________ kg
45. 63 kg =
__________ lb
39. 7 lb =
46. 81 kg =
__________ lb
__________ kg
40. 6 lb 7 oz =__________ kg
47. 43 lb 14 oz =
__________ kg
41. 37 lb 14 oz = __________ kg
48. 29 kg =
__________ lb
42. 7 kg =
__________ lb
49. 17 lb =
__________ kg
43. 16 kg = __________ lb
50. 15 kg =
__________ lb
5
More Conversions:
Make the following conversions. Remember to round units to 2 decimal
places.
ml = milliliter
L = liter
oz = ounce (fluid)
mcg = microgram
mg = milligram
g = gram
lb = pound
kg = kilogram
tsp = teaspoon
tbsp = tablespoon
1. 7 L =
__________ml
15. 12 oz =
__________lb
2. 500 mg = __________g
16. 215 mcg = __________mg
3. 3150 mg = __________g
17. 142 lb =
4. 9 g =
__________mg
18. 34 g =
__________mcg
5. 4000 ml = __________L
19. 7 lb =
__________kg
6. 7 kg = ___________g
20. 300 ml =
__________oz
7. 0.5 kg = ___________g
21. 15 g =
_________mcg
8. 1500 mg = __________g
22. 5 ml =
__________tsp
9. 0.5 g = ___________mg
23. 5.5 L =
__________ml
10. 450 ml = ___________L
24. 43 kg =
__________lb
11. 1000 mcg = _________mg
25. 30 ml =
__________oz
12. 1.9 L =
__________ml
26. 1000 ml =
__________L
13. 0.5 L =
__________ml
27. 1 kg =
__________g
14. 250 ml = __________L
__________kg
28. 3900 mcg = _________mg
6
29. 1 tsp =
__________ml
40. 1000 g =
__________mg
30. 4123 ml = __________L
41. 8 oz =
__________ml
31. 740 mg = __________mcg
42. 1 oz =
__________ml
32. 4.2 g =
__________mg
43. 500 mcg =
33. 6 kg =
__________g
44. 12 L =
__________ml
34. 20 ml = __________L
45. 42 kg =
__________lb
35. 17 kg = __________mg
46. 80 ml =
__________L
36. 7 lb 9 oz = __________kg
47. 1 mg =
_________mcg
37. 6.8 L =
48. 2.2 lb =
__________kg
38. 4321 ml = __________L
49. 1 tbsp =
__________ml
39. 39 g =
50. 6 tsp =
__________ml
__________mcg
__________g
_________ml
7
Reading Drug Labels:
Drug labels provide a variety of information such as the drug name (generic
or brand/trade name), the drug’s expiration date, the concentration of the
drug, the route of administration, and the quantity of the drug.
The following are some photographs of various drug vials. The coinciding
questions will ask you to pull information from the drug vials in order to
answer the questions. All of the vials contain their entire contents and have
not yet been opened. Only use the label’s individual information to obtain
your answers.
1. What is the generic name of this drug?
2. What is the name of the compounding pharmacy in
which this drug was produced?
3. What is the concentration of this drug in mg/ml?
4. What is the name of this injectable antibiotic?
5. Per the drug label, by which route(s) can this drug
be given?
6. How many grams are in a single vial of this drug?
7. How many milligrams are in a single vial of this
drug?
8. If you were instructed to give ½ of a gram of this
drug to a patient, how many milligrams would you
draw up in a syringe?
8
9. What is the name of this commonly used broad
spectrum antibiotic?
10. How many milligrams are contained in a single vial
of this drug?
11. Per the drug label, by which route(s) can this
antibiotic be given?
12. What two drugs make up this common
antibiotic that has the trade name unasyn?
13. How many milligrams does this vial contain?
14. How many total grams of this drug are in the
vial?
15. Per the drug label, by which route(s) can this
drug be
given?
16. Give the month and the year in which this drug
expires.
9
17. The generic name of this drug is dolasetron.
What is the brand name of this drug?
18. How many total milliliters are in this vial?
19. How many milligrams are in 5 milliliters of this
drug?
20. How many milligrams are in 1 milliliter of this
drug?
21. What is the name of this drug that is commonly
used to treat hypocalcemia??
22. What is the concentration of this drug in mg/ml?
23. What percent concentration is this drug?
24.How many total milliliters of this drug are in
this vial?
25. How many total milligrams of this drug are in
this vial?
10
26. What is the name of this injectable drug that is
commonly used as an antiarrhythmic and a local
anesthetic?
27. What percent solution is this drug?
28. How many milligrams are in 5 milliliters of this
drug?
29. How many milligrams are in 1 milliliter of this
drug?
30. If you are instructed to pull up 30 mgs of this drug,
how many milliliters will you draw up in a syringe?
31. What is the name of this commonly used
intravenous anesthetic?
32. How many milligrams of this drug are in
20 milliliters?
33. How many milligrams are in 1 milliliter of
this drug?
11
34. What is the name of this injectable solution
that is used to treat hypomagnesemia and is
commonly given via a CRI?
35. What percent concentration is this
solution?
36. How many milligrams are in 1 milliliter of
this solution?
37. How many total milliliters are in a new
single bottle of this solution?
38. By which route(s) can this drug be given?
39. Its generic name is mannitol, but
ManniJect is one of its trade names. This
osmotic diuretic has how many milligrams in 1
milliliter?
40. If you were instructed to give a patient 2
grams of this solution, how many milliliters
would you draw up in a syringe?
12
Calculating Total Fluid Needs (TFN)
For each question calculate the total fluid needs (TFN) in ml/hr and convert
into drops/second. List each component of the TFN in your answer.
Drip Rates:
10 drop/ml (blood set) = ml/hr = drop/min
6
15 drop/ml (macro drip set) = ml/hr = drop/min
4
60 drop/ml (micro drip set) = ml/hr = drop/min
1
Example:
Your patient weighs 10 kgs, is 15 % dehydrated, and has a 100 ml fluid loss from diarrhea.
Math:
Replacement fluids (RF) = 0.15 x 10 x 1000 ml/kg = 1500 ml
Ongoing Losses (OGL) = 100 ml
Maintenance Fluids (MF) = 60 ml/kg/day x 10 kg = 600 ml
Total Fluid Needs (TFN): 1500 ml + 100 ml + 600 ml = 2200 ml/24 hr
2200 ml = 91.67 ml/hr x 15 drop/ml = 1375 drop/hr = 22.92 drop /min = 0.38 drop/sec
24 hr
60 min/hr
60 sec/min
0.38 drop/sec = 1 drop/3 sec
13
1. Your patient weighs 20 kg, is 5 % dehydrated, and vomited 50 ml fluid. Calculate the
replacement fluids (RF), the ongoing losses (OGL), the maintenance fluids (MF), the
total fluid needs (TFN), and the fluid rate in drop/sec.
2. Your patient weighs 54 kg, is 7 % dehydrated, and has a 100 ml fluid loss from diarrhea.
Calculate the RF, OGL, MF, TFN, and fluid rate in drop/sec.
3. Your patient is 31 kg, is 8 % dehydrated, and has vomited 75 ml of fluid. Calculate the
RF, OGL, MF, TFN, and fluid rate in drop/sec.
14
Dose Calculations:
Dose calculations are commonly written in mgs/kg or mg/lb. Calculate the following doses
in mgs and mls. Remember to round drug doses in mg or ml to 2 decimal places.
1. A 39 kg post-operative splenectomy labrador retriever named “Joey” needs a dose of
buprenex (buprenorphine) IV for pain management. The dose is 0.01 mg/kg IV. The
concentration of buprenex is 0.5 mg/ml. How many mgs of buprenex will you give to
“Joey”? How many mls of buprenex will you give “Joey”?
2. “Lucy”, a 12 year old 16 kg beagle needs a dose of the antibiotic cefazolin IV to treat her
infected bite wound. The dose is 22 mg/kg IV. The concentration is 100 mg/ml. How
many mgs of cefazolin will you give to “Lucy”? How many mls will you give to “Lucy”?
3. A 4 kg persian named “Smokey” presents with an upper respiratory infection and
requires hospitalization. The doctor orders the antibiotic ampicillin IV for “Smokey”. The
dose is 22 mg/kg IV. The concentration is 100 mg/ml. How many mgs will “Smokey”
receive? How many mls will “Smokey” receive?
4. A 2 lb terrier puppy named “Princess” presents with hives and a swollen muzzle after
receiving her first (killed) rabies vaccine earlier in the day at her rDVM (referring
veterinarian). The doctor orders an injection of diphenhydramine (Benadryl 50mg/ml) to
be given at a dose of 2 mg/kg IM to counteract her vaccine reaction. How many mgs will
you give to “Princess”? How many mls will you give to “Princess”? Into which muscle
will you inject the diphenhydramine?
5. A 4 kg 14 year old DSH named “Kitty” is hospitalized with pyelonephritis (a bacterial
infection of the kidneys). A culture and sensitivity of her urine has already been
completed and the DST (drug-susceptibility testing) returned showing multiple drug
resistances, but it is sensitive to the broad spectrum antibiotic baytril (enrofloxacin). The
recommended dose is 5 mg/kg IV. The concentration of baytril is 22.7 mg/ml. How many
mgs will “Kitty” receive? How many mls will you give to “Kitty”? What toxicity has
been reported in feline patients receiving therapeutic doses of baytril? What primary
symptom does this cause?
15
6. “Fetch”, a 20 kg border collie is hospitalized for dehydration and diarrhea. He is to
receive the anti-diarrheal and antibiotic metronidazole (flagyl) IV. His dose is 10 mg/kg
IV. The concentration is 5 mg/ml. How many mgs will “Fletch” need? How many mls?
A fecal float is done and it shows giardia (a protozoal infection). Lucky for “Fetch”
metronidazole is also the drug of choice to treat giardia. Is giardia zoonotic?
7. A 2 kg yorkie named “Tiny” presents to the hospital postictal. You check a BG (blood
glucose). It is 32 g/dl. The doctor instructs you to give “Tiny” a dextrose bolus at a dose
of 0.5 g/kg (1000 mg/g) IV to treat his hypoglycemia. The dextrose is a 50 % solution
(500 mg/ml). How many grams will “Tiny” receive? How many mgs? How many mls?
8. “Lucky” is a 10 year old greyhound weighing 31 kgs that presents with a femur fracture.
He is very painful and needs a dose of methadone IV for pain management. The dose is
0.2 mg/kg IV. The concentration is 10 mg/ml. How many mgs of methadone will you
give “Lucky”? How many mls?
9. “Freckles” is hospitalized for pneumonia. She is a 17 kg cocker spaniel. Her treatment
orders include the bronchodilator aminophylline IV. Her dose is 7.5 mg/kg IV. The
concentration of aminophylline is 25 mg/ml. How many mgs will “Freckles” receive?
How many mls?
10. Dolasetron (anzemet) is an antiemetic. The concentration is 20 mg/ml. A nauseous 7
week old 4 kg pit bull puppy named “Spot” needs a dose at 0.6 mg/kg IV. How many
mgs will “Spot” be given? How many mls?
11. “Balto” is a 6 year old 35 kg intact husky mix. He presents through the ER after likely
being HBC (hit by car) with anisocoria and nystagmus, both signs of head trauma. The
doctor instructs you to give 1 g/kg mannitol IV to decrease intracranial pressure.
Mannitol is a 20 % solution. How many grams will “Balto” receive? How many mgs?
How many mls? Is mannitol a hypertonic fluid, an isotonic fluid, or a hypotonic fluid?
12. A 7 kg DLH named “Berry” needs the antibiotic unasyn (ampicillin and sulbactam) IV
to treat a recent bite wound that has now abscessed. The dose is 22 mg/kg IV. The
concentration is 30 mg/ml. How many mgs will “Barry” receive? How many mls?
16
13. A 10 kg spaniel mix named “Flynn” presents with acute vomiting. Abdominal
radiographs are done and there is no obstruction observed. The doctor instructs you to
give 1 mg/kg cerenia (maropitant citrate) SQ. Cerenia is an anti-emetic. The
concentration is 10 mg/ml. How many mgs will you give to “Flynn”? How many mls?
14. “Joe” is a 16 week old 9 kg boxer that presents with hives from an allergic reaction to a
bee sting. In addition to an injection of diphenhydramine (Benadryl) IM, the doctor
instructs you to give a dose of the steroid Dex SP (dexamethasone sodium phosphate)
IM. The dose is 1 mg/kg IM. The concentration is 4 mg/ml. How many mgs will “Joe”
receive? How many mls?
15. A 2 year old 52 kg Irish wolfhound named “Woody” is being treated for rodenticide
toxicity with vitamin K injections SQ. The dose is 2 mg/kg. The concentration is 10
mg/ml. How many mgs of vitamin K will you give to “Woody”? How many mls? What
are three potential clinical signs for confirmed rodenticide toxicity?
16. A post-operative 8 year old 47 kg golden retriever named “Maggie” is hooked up to a
continuous ECG. She was having intermittent VPC’s, but has now gone into V-tach with
a sustained heart rate of 240. You notify the doctor who instructs you to pull up a 2
mg/kg dose of lidocaine. The doctor instructs you to start by giving “Maggie” ½ of the
initial 2 mg/kg dose IV slowly. Lidocaine is a 2 % solution. How many mgs will you
initially draw up? How many mls? How many mgs will you administer to “Maggie”?
How many mls?
17. A 29 kg Chesapeake Bay retriever presents with cluster seizures. The doctor instructs you
to give a 0.5 mg/kg dose of the sedative valium (diazepam) IV. The concentration of
valium is 5 mg/ml. How many mgs will you give to your patient? How many mls?
18. A 5 year old 23 kg English bulldog is hospitalized and his treatment orders include a once
daily injection of protonix (pantoprazole) at a dose of 1 mg/kg IV to decrease his gastric
acid secretions and to control his gastroesophageal reflux (GERD). The concentration is 4
mg/ml. How many mgs will you give to your patient? How many mls?
17
19. An 11 kg beagle named “Butch” has gastrointestinal (GI) ulcerations and is to be treated
with 0.5 mg/kg famotidine (pepcid) IV. The concentration is 10 mg/ml. How many mgs
will you give to “Butch”? How many mls?
20. A 30 kg standard poodle named “Angel” is recovering from GDV (gastric dilatation
volvulus) surgery. Her pain management regimen includes hydromorphone (dilaudid
with a concentration of 2 mg/ml) at a dose of 0.1 mg/kg IV every four hours. How many
mgs will “Angel” receive at each dose? How many mls?
18
Defining Constant Rate Infusions (CRI’s):
A CRI is a constant rate infusion of a medication. It is the delivery of a drug
IV at a continuous rate over a predetermined amount of time. Multiple
medications have a higher efficacy rate when a constant level is able to be
achieved and maintained in serum concentrations. CRI’s are commonly used
to treat seizures, to control glucose levels, to increase GI motility, to minimize
and treat cardiac arrhythmias, to control pain, to supplement electrolytes, to
maintain blood pressure, and to also treat a multitude of other medical
ailments. All CRI’s require an indwelling intravenous catheter and a method
of delivery. Some CRI’s require sampling lines because certain drugs can be
irritating to the blood vessels. CRI’s allow for better precision in medication
delivery. There are also fewer side effects due to the slower rate/concentration
of the drug. Drugs with very short half-lives must be administered via CRI to
achieve the desired pharmacologic effects and to maintain steady serum
concentrations. Other drugs are given via CRI to decrease daily total doses
and to increase efficacy.
To calculate a CRI, you need the following information:
Weight of the patient
Dose of medication
Concentration of medication
Rate of administration
Volume of diluent
CRI doses come in different forms:
mg/kg/day (milligram/kilogram/day)
mg/kg/hr (milligram/kilogram/hour)
mcg/kg/min (microgram/kilogram/minute)
mmol/kg/hr (millimole/kilogram/hour)
mEq/kg/day (milliequivalent/kilogram/day)
19
When making up a CRI, why is it important to remove fluids equal to the amount of the
additive?
Patient: 10 kg
Lidocaine CRI: 40 mcg/kg/min at 10 ml/hr in 100 ml 0.9 % NaCl (the 100 mls is the total
volume, total volumes can range from a small number requiring a syringe pump or a larger
number requiring a fluid pump and a fluid bag)
Concentration of lidocaine: 2 % solution.
(0.04 mg)(10 kg) x 60 min x 1 hr x 100 ml (total volume) = 240000 mcgs = 240 mgs = 12 ml
1 min
1 hr
10 ml
1
1000 mg
20 mg/ml
If the 12 mls are not removed, then the total volume is 112 ml at 10 ml/hr and the bag will last
for 11.2 hours. The dose also will no longer be 40 mcg/kg/min, it will be 35.7 mcg/kg/min as
shown below.
240 mgs = 21.43 mg/hr
11.2 hr
1 hr = 60 min
21.43 mg = 0.36 mg/min
60 min
0.36 mg/min = 0.04 mg/kg/min = 35.7 mcg/kg/min
10 kg
The same applies for dextrose supplementation:
If you have a 1 L bag and want to make it a 5 % solution:
% desired x mls in bag
= 5 % x 1000 ml = 100 ml of dextrose
Concentration (50 % dextrose) available
50 %
If you do not remove the equivalent of 100 mls of diluent then the dose will be incorrect, as
shown below.
5 % desired x 1100 ml (now in bag)
Concentration (50% dextrose) available
= 100 ml
(50 %) x X % x 1100 ml = 100 ml x (50 %)
50 %
(x)(1100) = 50 ml
x%=
50
1100 ml
x = 0.045 x (100)
x = 4.5 %
20
Step by Step examples of CRI’s:
Example 1:
A lidocaine CRI is ordered for a 19 kg dog at a rate of 40 mcg/kg/min at 4 ml/h. How will you
prepare the IVF (intravenous fluids)? Lidocaine is a 2 % solution. The patient is expected to be
on the CRI for 10 hours.
Weight of patient: 19 kg
Dose of medication: 40 mcg/kg/min
Concentration of medication: 2% (20 mg/ml)
Rate of administration: 4 ml/hr
Volume of fluids: 40 ml (4 ml/h x 10 hr)
Math:
19 kg x 40 mcg/min = 760 mcg x 60 min =
kg
min
hr
456,000 mcg x 1 mg
= 456 mgs x 1 ml
1000 mcg
20 mg
= 22.8 ml of lidocaine
40 ml total volume of fluids - 22.8 ml of lidocaine = 17.2 ml of diluent
21
Example 2:
A post-op GDV German shepherd weighing 40 kg is ordered to have a reglan (metoclopramide)
CRI at 1 mg/kg/24 hr. You have a 1 L bag of P-lyte and the fluid rate is 160 ml/hr. The
concentration of reglan is 5 mg/ml. How many mgs will you add to the bag? How many mls?
Math:
First, figure out how many mgs are needed in 24 hrs. Then, how many mgs are needed in a single
hour.
40 kg x 1 mg/24 hr = 40 mg x 1 day = 1.67 mg x 1 hr = 1.67 mg/hr
1
kg
1 day 24 hr
hr
mg
Next, figure out how many hours your bag will last.
1000 ml x 1 L = 6.25 hr
1
160 ml/hr
Last, calculate your mgs and mls.
1.67 mg/hr x 6.25 hr = 10.44 mg
1
mg
10.44 mg = 2.09 ml
5 mg/ml
22
Example 3:
A post-op linear foreign body 5 kg 2 year old DSH needs a fentanyl CRI for pain management at
a rate of 3 mcg/kg/hr at 3 ml/hr. The plan is start the fentanyl CRI for her first 12 hours post-op.
You have a syringe pump and a 60 ml syringe. The total fluid volume is to equal 36 ml. The
concentration of fentanyl is 50 mcg/ml (0.05 mg/ml). How many mgs of fentanyl will you put in
the syringe? How many mls of fentanyl? How many mls of diluent?
Math:
5 kg x 3 mcg/hr = 15 mcg x 12 hr = 180 mcg x 1 mg
= 80.1 mg x 1 ml
=
1
kg
hr
mcg
1
1000 mcg
ml
0.05 mg
3.6 ml fentanyl (80.1 mgs)
Total fluid volume: 36 ml – 3.6 ml fentanyl = 32.4 ml diluent
23
CRI Calculations:
Complete the following CRI calculations. Weights in kilograms need to be rounded to 2 decimal
places. Drug doses in milliliters and milligrams need to be rounded to 2 decimal places. Always
use correct units. Use zeroes as place markers.
1. “Max” is a 29 kg collie who needs a reglan (metoclopramide) CRI to increase his GI
motility. The CRI dose is 2 mg/kg/day. The concentration of reglan is 5 mg/ml. You have
a 1 L bag of P-lyte. The fluid rate is 4 ml/kg/hr. What will your fluid rate be in ml/hr?
How many hours will 1 L of P-lyte last? How many mgs will be added to his fluids? How
many mls?
2. “Oreo” is a 49 kg great dane who needs a reglan CRI at a dose of 1 mg/kg/24hr. The
concentration of reglan is 5 mg/ml. He has a fluid rate of 150 ml/hr. There are 750 ml of
P-lyte left in his fluid bag. How many hours will the remainder of his bag last? How
many mgs of reglan will you add to his fluids? How many mls?
3. “Cody” is a 14 kg cocker spaniel who needs a lasix (furosemide) CRI for decreased urine
output and peripheral edema. The starting dose is 0.25 mg/kg/hr. The CRI should last for
10 hours and his fluid rate is 2.5 ml/hr. This CRI will be made up in a syringe pump due
to the low volume and the low rate of infusion. The concentration of lasix is 50 mg/ml.
Calculate the dose of lasix in mgs and mls. How much diluent (mls) is needed for this
CRI?
4. “Littlefoot” a 2 kg DMH needs the pressor dopamine to treat her hypotension. The dose
is 5 mcg/kg/min to start. The concentration of dopamine is 40 mg/ml. The rate is 5 ml/hr.
How many mgs of dopamine will “Littlefoot” need if the CRI is made up for 24 hours?
How many mls? How many mls of diluent will you need?
5. “Rover” a 24 kg boxer is hypoglycemic. His BG has dropped to 67 mg/dl. The doctor has
instructed you to start him on 5% dextrose supplementation (dextrose CRI). Dextrose
comes in a 50 % solution. There are 760 mls of P-lyte left in his bag. How many mgs of
dextrose will you add to his IV fluids? How many mls will you add to his IV fluids?
Don’t forget to remove the equivalent in mls from his IV fluids prior to adding dextrose
for precise dosing.
24
6. “Charlie” a 10 kg beagle needs a nitroprusside (a vasodilator) CRI at 5 mcg/kg/min at 5
ml/hr in a total volume of 50 ml. The concentration of nitroprusside is 50 mg/2 ml. How
long will the CRI last? How many mgs of nitroprusside will you add to the diluent? How
many mls?
7. “Jinx”, a 5 year old 37 kg American bulldog mix is in need of a MLK (morphine,
lidocaine, ketamine) CRI for pain management post-operatively. All three of these
medications will be added into the same 250 ml bag of fluids. The morphine CRI will be
set up at 0.12 mg/kg/hr at 20 ml/hr. The concentration of morphine is 15 mg/ml. How
many mgs will be added to the fluids? How many mls? The ketamine CRI will be set at
0.12 mg/kg/hr. The concentration of ketamine is 100 mg/ml. How many mgs will you
add to the bag? How many mls? The lidocaine CRI is 40 mcg/kg/min. The concentration
of lidocaine is a 2% solution. How many mgs will you add to the bag? How many mls?
How many hours will the bag last? What is the total volume of additives? Remember to
remove the equivalent in mls of diluent prior to adding medications.
8. “Bouncer” is a 13 year old, 9 kg DSH being treated for diabetic ketoacidosis (DKA). She
is in need of an insulin CRI at 1.1 u/kg/24 hr. The beginning rate is 10 ml/hr. How many
units of regular insulin will you add to a 240 ml bag of 0.9% NaCl (10 ml have been
removed from the bag to accommodate the rate of 10 ml/hr for 24 hr).
9. “Corey”, an 8 year old 4 kg maltese is in v-tach (ventricular tachycardia) and is not
converting to a normal sinus rhythm (NSR) on his own. The doctor has you bolus 1
mg/kg lidocaine IV slow. Lidocaine is a 2 % solution. How many mg will you bolus?
How many mls? The lidociane bolus converted the ECG into NSR, although only briefly.
The doctor orders a 40 mcg/kg/min lidociane CRI at a rate of 10 ml/hr. The CRI will be
made up in a 100 ml bag of 0.9 % NaCl. How many hours will the bag last? How many
mgs will you add to the bag? How many mls? Remember to remove the equivalent in mls
from the 100 ml bag of 0.9 % NaCl for precise dosing.
10. “Gus” is a 16 year old 8 kg DSH that presents with signs of head trauma. “Gus” needs a
dose of mannitol at 0.5 g/kg IV to decrease his intracranial pressure. Mannitol is a 20 %
solution. How many grams will “Gus” receive? How many mgs? How many mls? What
will the fluid rate be in ml/hr if the entire dose of mannitol is to be given over 20
minutes?
25
Case Study of “Mimi”:
Putting it all together…..
1. “Mimi” is a 4 year old 2 kg terrier mix that presents with a history of PLE (protein losing
enteropathy), hypocalcemia, hypoglycemia, hypoproteinemia, pleural effusion, right cranial lung
lobe consolidation, right medial lung lobe torsion, and a leukocytosis (neutrophilia with left
shift). A 20 guage intravenou catheter (IVC) is placed in each of her cephalic vessels and a 22 g
sampling line is placed in her right lateral saphenous vessel to better facilitate future serial
sampling. A 10 ml/kg P-lye bolus is ordered to begin to correct her dehydration. The bolus is to
go over 20 minutes. How many mls will “Mimi” receive? What will her fluid rate be in ml/hr?
2. “Mimi” has an ionized Calcium of 0.79 mg/dL and needs a Calcium gluconate CRI at 7.5
mg/kg/hr at a rate of 1 ml/hr. Calcium gluconate is a 10 % solution. Her CRI should last for 10
hours and you have a total fluid volume of 10 mls. Ca+ gluconate is a 10 % solution. How many
mgs will you need for the CRI? How many mls?
3. Due to “Mimi’s” low protein levels she is to receive a 20 ml dose of FFP (fresh frozen plasma)
over 4 hours. What will her rate be for her FFP transfusion in ml/hr?
4. A thoracotomy is indicated for “Mimi’s” right medial lung lobe torsion. The surgical bay is
being set up. Meanwhile, a fentanyl CRI is ordered for pain management. The doctor orders a 2
mcg/kg bolus IV prior to beginning the fentanyl CRI. The concentration of fentanyl is 0.05
mg/ml (50 mcg/ml). How many mcgs will you bolus “Mimi”? How many mgs? How many mls?
Post fentanyl bolus you need to begin “Mimi” on her fentanyl CRI at a dose of 3 mcg/kg/hr at a
rate of 3 ml/hr. The total fluid volume is 30 mls. How many mcgs of fentanyl will you need?
How many mgs? How many mls?
5. The surgical bay is ready and it is time to anesthetize “Mimi”. You pull up a total dose of 6
mg/kg of propofol. The concentration of propofol is 10 mg/ml. You are going to start by
injecting “Mimi” IV with 1/3 of her total propofol dose (a total of 2 mg/kg). How many mg is
this total? How many mls?
6. “Mimi” is then anesthetized, intubated with a 4 Fr endotracheal tube, started on isofluorane
(iso) at 2 %, prepped for surgery, and transported into the surgical bay. A dose of unasyn (an
26
antibiotic) is given at a dose of 22 mg/kg IV. The concentration of unasyn is 30 mg/ml. How
many mgs is this? How many mls?
7. A lateral intercostal thoracotomy is done at the 5th intercostal space. “Mimi” tolerates
anesthesia well and has a smooth recovery, although she still seems painful and additional pain
medication is indicated. A lidocaine bolus is first ordered at a dose of 1 mg/kg IV. The
concentration of lidocaine is a 2 % solution. How many mgs is the bolus? How many mls? A
CRI is then ordered at 25 mcg/kg/min at a rate of 2.5 ml/hr. The total fluid volume is 25 mls.
How many mgs of lidocaine do you need for the CRI? How many mls?
8. An indwelling 6 Fr foley urinary catheter is placed to monitor her urine production postoperatively and to also assist in keeping her comfortable. Her FFP transfusion is complete and
she now auscults with bilateral crackles. A dose of Lasix is ordered at 1 mg/kg IV. The
concentration of Lasix is 50 mg/ml. How many mgs is this? How many mls? The Lasix (a
diuretic) assisted with her urine production and later “Mimi” auscults clear bilaterally.
9. “Mimi’s” glucose levels then drop to 43 mg/dl and the doctor calls for a 0.5 g/kg dextrose
bolus IV and then to start 5 % dextrose supplementation in her crystalloids. How many grams
will “Mimi” be bolused of dextrose? How many mgs? How many mls? She has 410 mls of P-lyte
left in her bag. Dextrose is a 50 % solution. How many mls will you add to her bag? Do not
forget to remove the equivalent in mls from her crystalloids prior to adding the dextrose
supplementation to ensure precise dosing.
10. The night goes well for “Mimi”. Her chest tube is pulled first thing the following morning
since there has been zero production of neither fluid nor air. Her ionized calcium (iCa) is better
at 1.13 mg/dL, so you begin to wean her off of her supplementation. Her new CRI dose for
calcium gluconate is 5 mg/kg/hr at 1 ml/hr with a total fluid volume of 24 mls. Calcium
gluconate is a 10 % solution. How many mgs of calcium gluconate do you need? How many
mls?
11. As the day continues, “Mimi” continues to make progress. She has begun eating small
amounts of canned chicken when hand fed and drinking water when offered. Her protein levels
are slowly improving. Her fentanyl CRI is due to be weaned overnight to 2 mcg/kg/hr at a rate of
2 ml/hr and a total fluid volume of 24 mls. The concentration of fentanyl is 0.05 mg/ml (50
mcg/ml). How many mgs of fentanyl will you need for the CRI? How many mls?
27
12. “Mimi’s” treatment orders include a dose of dex sp (dexamethasone sodium phosphate), a
steroid for her presumed GI disease pending her biopsy results. The concentration of dex sp is 4
mg/ml. Her dose is 0.1 mg/kg IV once daily. How many mgs will you give “Mimi”? How many
mls?
13. Her iCa continues to improve and her calcium gluconate CRI is lowered to a rate of 2
mg/kg/hr. You will recheck her iCA levels in eight hours, so you only need to make up the CRI
for 8 hours. The rate will be 2 ml/hr. Calcium gluconate is a 10 % solution. How many mgs will
you need for the CRI? How many mls? How many mls of diluent?
14. Day three and we transition “Mimi” to oral calcium supplementation via TUMS. Her dose is
250 mgs PO (by mouth), but we only have 500 mg tablets. How many tablets will “Mimi”
receive?
15. “Mimi’s” blood sugars are beginning to regulate on their own and her dextrose
supplementation can be decreased to 2.5 %. She has 200 ml left in her bag of P-lyte and she has a
fluid rate of 5 ml/hr. The concentration of dextrose is a 50 % solution. How many mls of
dextrose will you add to her bag? Do not forget to remove the equivalent in mls from her
crystalloids prior to adding dextrose supplementation to ensure precise dosing.
16. Due to Mimi’s poor gastric motility, a reglan CRI has been added to her treatment orders.
The reglan CRI will be at 2 mg/kg/day. She needs a new 500 ml bag of P-lyte, since we are
simultaneously discontinuing her dextrose supplementation. She is eating reliably and
maintaining her blood glucose on her own. The concentration of reglan is 5 mg/ml. Her fluid rate
is 5 ml/hr. How many mgs of reglan will you add to “Mimi’s” bag? How many mls?
17. Her fentanyl and lidocaine CRI’s are both discontinued since she feels more comfortable and
she is transitioned to buprenex at a dose of 0.01 mg/kg IV every 4-6 hours for continued pain
management. The concentration of buprenex is 0.5 mg/ml. How many mgs will “Mimi” receive?
How many mls?
18. “Mimi” continues to improve and we transition her from injectable medications to oral
medications. You are to give her 1 mg/kg famotidine (pepcid) suspension by mouth. “Mimi”
28
weighs 2 kg. The concentration of the famotidine oral suspension is 10 mg/ml. How many mgs
will you give “Mimi”? How many mls?
19. “Mimi” needs 15 mgs metronidazole oral suspension. The concentration of the metronidazole
oral suspension is 50 mg/ml. How many mls will you give “Mimi”?
20. “Mimi’s” reglan CRI is discontinued. She is now due for oral reglan. Her dose is 0.4 mg/kg
by mouth (PO). The concentration is 5 mg/5ml (1 mg/ml). How many mgs will you give
“Mimi”? How many mls?
21. The calcium gluconate CRI is discontinued. “Mimi” continues to receive TUMS as an oral
supplement, but calcitrol has also been added into her treatment plan. Her dose of calcitrol is 15
ng/kg PO. The concentration of calcitrol is 30 ng/ml. How many nanograms will you give
“Mimi”? How many mls?
22. “Mimi” also needs the antibiotic clavamox to treat her pneumonia. The concentration of
clavamox drops is 62.5 mg/ml. She is to receive 0.5 ml PO every twelve hours. How many mgs
will she receive at each dose?
23. “Mimi” is ready to be discharged and is being sent home with oral cerenia (maropitant
citrate) to be used as needed (prn) for nausea. The dose is 2 mg/kg once daily PO for up to four
days in a row. The tablet size available is 16 mg. How many tablets will “Mimi” receive in a
single dose?
24. “Mimi” is discharged but becomes anorexic at home that same evening. A script is filled for
the appetite stimulant mirtazapine. It comes in an oral suspension. The concentration is 4 mg/ml.
The dose is 0.6 mg/kg PO. How many mgs will “Mimi” receive? How many mls?
25. The doctor wants to script out 7 doses of mirtazapine. How many mls will you send home
with “Mimi”?
29