Dosage Calculations

Glossary of Key Terms

 apothecary system: a very old system of measure that was specifi cally developed for use by
apothecaries or pharmacists; it uses the minim as the basic unit of liquid measure and the
grain as the basic unit of solid measure.
 Clark’s rule: a method of determining the correct drug dose for a child based on the known
adult dose (assumes that the adult dose is based on a 150-lb person); it states

 conversion: finding the equivalent values between two systems of measure

 Fried’s rule: a method of determining a pediatric drug dose for a child younger than 1 year of
age, based on the child’s age and the usual adult dose (assumes that an adult dose would be
appropriate for a 12.5-year-old child); it states

 metric system: the most widely used system of measure, based on the decimal system; all
units in the system are determined as multiples of 10
 ratio and proportion: an equation in which a ratio containing two known equivalent amounts
is on one side and a ratio containing the amount desired to convert and its unknown
equivalent is on the other side
 Young’s rule: a method for determining pediatric drug dose based on the child’s age and the
usual adult dose; it states

NOTE: To determine the correct dose of a particular drug for a patient, we consider the patient’s sex,
weight, age, and physical condition, as well as the other drugs that the patient is taking.

MEASURING SYSTEMS

A. Metric System
- Is the most widely used system of measure.
- It is based on the decimal system, so all units are determined as multiples of 10.
- This system is used worldwide and makes the sharing of knowledge and research
information easier.
- Uses the gram as the basic unit of solid measure and the liter as the basic unit of liquid
measure
B. Apothecary System
- Is a very old system of measurement that was specifically developed for use by
apothecaries or pharmacists
- Uses the minim as the basic unit of liquid measure and the grain as the basic unit of solid
measure
- This system is much harder to use than the metric system and is rarely seen in most
clinical settings.
- Occasionally, a prescriber will write an order in this system, and the dose will have to be
converted to an available form.
- An interesting feature of this system is that it uses Roman numerals placed after the unit
of measure to denote amount. For example, 15 grains would be written “gr xv.”

C. Household System
- Is the measuring system that is found in recipe books.
- This system uses the teaspoon as the basic unit of fluid measure and the pound as the
basic unit of solid measure
- Although efforts have been made in recent years to standardize these measuring
devices, wide variations have been noted in the capacity of some of them.
- Patients need to be advised that flatware teaspoons and drinking cups vary
tremendously in the volume that they contain. A flatware teaspoon could hold up to two
measuring teaspoons of quantity.

D. Avoirdupois System
- Is another older system that was very popular when pharmacists routinely had to
compound medications.
- This system uses ounces and grains, but they measure differently than those of the
apothecary and household systems.
- Is seldom used by prescribers but may be used for bulk medications that come directly
from the manufacturer.

E. Other System
- These measures may reflect chemical activity or biological equivalence.
 A unit usually reflects the biological activity of the drug in 1 mL of solution. The
unit is unique for the drug it measures; a unit of heparin is not comparable to a
unit of insulin.
 Milliequivalents (mEq) are used to measure electrolytes (e.g., potassium,
sodium, calcium, fluoride). The milliequivalent refers to the ionic activity of the
drug in question; the order is usually written for a number of milliequivalents
instead of a volume of drug.
 International units are sometimes used to measure certain vitamins or enzymes.
These are also unique to each drug and cannot be converted to another
measuring form.
CONVERSION BETWEEN SYSTEMS

The simplest way to convert measurements from one

system to another is to set up a ratio and proportion
equation. The ratio containing two known equivalent
amounts is placed on one side of an equation, and the
ratio containing the amount you wish to convert and its
unknown equivalent is placed on the other side.

For example:

Convert 6fl oz (apothecary system) to the metric system

This equation would read as follows: 1 fl oz is to 30 mL as

6 fl oz is to how many milliliters?

Equation:
Another conversion:

CALCULATING DOSE

A. Oral Drugs
 Frequently, tablets or capsules for oral administration are not available in the exact
dose that has been ordered. In these situations, the nurse who is administering the
drug must calculate the number of tablets or capsules to give for the ordered dose.
The easiest way to determine this is to set up a ratio and proportion equation

NOTE: The phrase “amount of drug” serves as the unit, so this information must be
in the numerator of each ratio.
 The same principle used to determine the number of tablets needed to arrive at a prescribed
dose can be used to determine the volume of liquid that will be required to administer the
prescribed dose. The ratio on the left of the equation shows the known equivalents, and the ratio on
the right side contains the unknown. The phrase “amount of drug” must appear in the numerator of
both ratios, and the volume to administer is the unknown (X).

B. Parenteral Drugs
The same formula can be used for this determination that was used for determining the
dose of an oral liquid drug:

C. Intravenous Solutions
- Used to deliver a prescribed amount of fluid, electrolytes, vitamins, nutrients, or drugs
directly into the bloodstream.
- Although most institutions now use electronically monitored delivery systems, it is still
important to be able to determine the amount of an IV solution that should be given,
using standard calculations.
NOTE: Most IV delivery systems come with a standard control called a microdrip, by
which each milliliter delivered contains 60 drops. Macrodrip systems, which usually
 deliver 15 drops/mL, are also available; they are usually used when a large volume must
be delivered quickly.
- Always check the packaging of the IV tubing to see how many drops/mL are delivered by
that particular device if you have any doubts or are unfamiliar with the system.

That is, the number of drops per minute, or the rate that you will set by adjusting the valve on the IV
tubing, is equal to the amount of solution that has been prescribed per hour times the number of
drops delivered per milliliter (mL), divided by 60 minutes in an hour.

D. Pediatric Consideration
For most drugs, children require doses different from those given to adults. The “standard”
drug dose that is listed on package inserts and in many references refers to the dose that has
been found to be most effective in the adult male.

Most of the time a child requires a smaller dose of a drug to achieve the comparable critical
concentration as that for an adult. On rare occasions, a child may require a higher dose of a
drug. For ethical reasons, drug research per se is not done on children.
 Unfortunately, there may be times when no recommended dose for a child is available but
that particular drug is needed. In these situations, established formulas can be used to
estimate the appropriate dose. These methods of determining a pediatric dose take into
consideration the child’s age, weight, or body surface.

Box 5.1 highlights Fried’s rule, which considers age for a child under the age of 1 year;
Young’s rule, which calculates doses for children 1 to 12 years of age; and Clark’s rule, which
accounts for weight in the dose formula. These rules are not usually used today; the
nomogram that uses body surface area is more accurate for determining doses (see Figure
5.1). If such a nomogram is not available, however, it is good to know that other methods
can be used.

1. Body Surface Area

The surface area of a child’s body may also be used to determine the approximate dose that
should be used. To do this, the child’s surface area is determined with the use of a
nomogram (Figure 5.1). The height and weight of the child are taken into consideration in
this chart. The following formula is then used:
 This method is more precise than the formula methods, but you have to have a nomogram
available to determine the surface area.

2. Milligrams/Kilograms of Body Weight

When a safe and effective pediatric dose has been established, the orders for the drug dose
are often written in milligrams/kilograms. This method of prescribing takes into
consideration the varying weights of children and the need for a higher dose of the drug
when the weight increases.

For example, if a child with postoperative nausea is to be treated with Vistaril (hydroxyzine),
the recommended dose is 1.1 mg/kg by intramuscular injection. If the child weighs 22 kg, the
dose for this child would be 1.1 mg/kg times 22 kg, or 24.2 mg, rounded down to 24 mg. If a
child weighed only 6 kg, the recommended dose would be 1.1 mg/kg times 6 kg, or 6.6 mg.

The established guidelines allow the drug to be used safely within a large range of children.
Some adult doses will also be written in this way. This is usually found in drugs with a small
margin of safety or high potential for toxic effects, such as antineoplastic drugs.