3/16/2023

ER MATH

OBJECTIVES
- To Discuss and Update different Formulas used in the Emergency Room
- To have uniformity on all orders written in the chart

COURSE Basic Concepts

Electrolyte Deficits
Vasopressor Computations
Pulmonology
GI
Endocrinology
Nephrology
Anesthesia
Pain medications
Pedia
Neonatology
Trauma
Parkland Formula

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CASE:
BASIC CONCEPTS
CORRECTED SODIUM 23 yr old male with Type 1 DM came in with
drowsiness. He tested positive Ketone hence DKA
is considered. RBS 450mg/dl; Na: 152

CORRECTED SODIUM :
FORMULA = Actual Na + [0.016 x ( RBS-100)]
= Actual Na(mEq/L) + 0.016 x [RBS(mg/dl ) = 152mEqs/L + [0.016 x ( 450mg/dl - 100
- 100)]
)]
= 157.6mEqs/L (True Sodium)
Serum Sodium falls in proportion to ECF
dilution, declining 1.6mEq/L per 100mg/dll
increase in RBS
In marked hyperglycemia, ECF osmolality
increases
-IM Platinum, 2018, p94

BASIC CONCEPTS
ANION GAP
ANION GAP (AG):
= Na - (Cl + HCO3)
*Na; Cl; HCO3 : mmol/L or mEq/L

NORMAL AG: 8-12

High AG: > 12

-IM Platinum, 2018,p54; 92

BASIC CONCEPTS
SODIUM DEFICIT Hyponatremia is almost always caused by impaired renal
water excretion; hence, assessment & correction of volume
status is important in correcting the deficit
Definition: Na < 135 mmol/L Identify by history and PE if the hyponatremia is
hypovolemic, euvolemic or hypervolemic. Correct
hemodynamic instability first before correcting hyponatremia
DETERMINE RATE OF CORRECTION:
ACUTE(<48hrs) & severely symptomatic (seizures) = 4-
6mmol/L within the first 2-4 hours, with frequent sodium
monitoring
CHRONIC/assymptomatic = not more than 8-10mmol/L in
any 24 hr period
-IM Platinum, 2018, p98

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BASIC CONCEPTS
SODIUM DEFICIT
CHANGE IN SERUM Na:
= (Infusate Na + Infusate K) -Actual Serum Na
TBW +1

AMOUNT OF FLUID
= Change in Serum Sodium desired
Estimated effect of 1L infusate

DRIP RATE = Amount of fluid / target # of hrs

CHANGE IN SERUM Na:

= (Infusate Na + Infusate K) -Actual Serum Na
TBW +1

BASIC CONCEPTS AMOUNT OF FLUID

SODIUM DEFICIT = Change in Serum Sodium desired
Estimated effect of 1L infusate

DRIP RATE = Amount of fluid / target # of hrs

CASE: 30M; 60kg with Serum sodium of 120mEq/L; Serum K :

3.2mmol/L

CHANGE in Serum Na
= (154 + 20) - 120]
36 +1
= 1.46mmol/L
*Rate desired in this case : 7mmol/L in 24 hrs
AMOUNT of FLUID = 7mmol / 1.46mmol/L = 4800ml
DETERMINE RATE OF CORRECTION: DRIP RATE: 4800ml/24h = 200ml/hr
ACUTE(<48hrs) & severely symptomatic (seizures) = 4-6mmol/L
within the first 2-4 hours, with frequent sodium monitoring
ORDER:
CHRONIC/assymptomatic = not more than 8-10mmol/L in any
24 hr period Start IVF with PNSS 1 L + 20mEqs KCl at 200ml/hr
-IM Platinum, 2018, p98

BASIC CONCEPTS
SODIUM DEFICIT
Definition: Na < 135 mmol/L

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CASE:

BASIC CONCEPTS Serum Na = 105 in a 50kg patient, what is the deficit

and how will you correct using Plain NSS?
SODIUM DEFICIT
Sodium Deficit
Target Sodium: 125 -135 mEq/L (average : 130mEq/L)
Na deficit = 0.6 x wt(kg) x (Desired Na - Actual Na)
= 0.6 x 50kg x ( 130 - 105 )
= 750mEq/L needed to be replaced
= 750 mEq/L / 154 (using PNSS)
= 4.87 % OR 487ml
= 487ml / 24 hours
= 20.29 or 20ml per hour
ORDER:
Hook to patient Plain NSS at the rate of 57ml per hour

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CASE:
Serum Na = 105 in a 50kg patient, what is the deficit and
BASIC CONCEPTS how will you correct using 3% Saline?
SODIUM DEFICIT
Sodium Deficit
Target Sodium: 125 -135 mEq/L (average : 130mEq/L)
Na deficit = 0.6 x wt(kg) x (Desired Na - Actual Na)
= 0.6 x 50kg x ( 130 - 105 )
= 750mEq/L needed to be replaced
= 750 mEq/L / 513 (using 3% saline)
= 1.462 % OR 146ml
= 146ml / 24 hours
= 6.08 or 6ml per hour
ORDER:
Hook to patient 3% Saline at the rate of 17 ml per hour

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FORMULA
BASIC CONCEPTS
= [( 3.5 - actual K) X BW(kg) x 0.4
POTASSIUM DEFICIT *Target K for cardiac patients is usually 4; otherwise, a target of 3.5
is used
-Tintinalli, 9th Ed
Definition: K < 3.6 mmol/L

EQUIVALENT mEQs CASE: 60kg patient; Serum K = 2.5, what is the deficit and how will you
correct?
15cc 10% oral KCl sol’n : 20mEqs/L
30cc 10% oral KCl sol’n : 40mEqs/L
KCl tab 600mg: 8 mEqs K Potassium Deficit
KCl tab 750mg: 10mEqs K
= 24mEqs
1 average size banana : 11 - 12 meQs K
-IM Platinum, 2018 Oral K Correction is preferred therapy
We can address deficit using 10% oral KCl solution (30cc =
CORRECTION 40mEqs)
IV route - limited to those unable to utilize enteral route or those w/
severe complications (i.eparalysis, arrhythmia)
Give 30cc of 10% oral KCL for total of 9 doses every 6 hours
Use saline solo’s; dextrosed- induced increase in insulin can acutely
trigger hypokalemia

If hypokalemia is severe, IV KCl may be given via central vain (femoral

veins are preferrable) with cardiac monitioring ar rates of 10-
20mmol/hr

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BASE DEFICIT in mEQ

BASIC CONCEPTS = [ 24- serum HCO3(mEq/L)] x 0.4 x kg
(weight)
SODIUM BICARBONATE
DEFICIT CASE: Calculate Base Deficit in a 75kg male with
pH= 6.96; pCO2 =30mmHg & HCO3 = 6mEq/L

BASE DEFICIT
Sodium Bicarbonate is usually given to patients with
acute and severe metabolic acidosis or pH < 7.1 to = (24 - 6 ) x 0.4 x 75
raise plasma HCO3 levels to approx 15mEqs/L
Usual initial target (desired HCO3 concentration is = 540mEq
10-12 meQs/L, which should bring blood pH to 7.20
To obtain deficit in grams, divide mEq by 12
IM Platinum, 2018

ORDER:
Loading 150mEq IV slow IV push the 350mEqs IV in
1L PNSS drip to run for 24 hours
May give half of dose as IV bolus over 3-4 hours;
remaining as drip after reassessment within 24
hours
IM Platinum, 2018

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BASIC CONCEPTS
DOPAMINEDRIP

200mg in 250ml

Cardiovascular Effects: Therapeutic (Tx) dose: 2-20mcg/kg/min

↑HR, BP, CO, SVR
Rate: (Tx dose / Stock dose) x weight
Contraindications:
Hypersensitivity to sulfites
Pheochromocytoma
Uncorrected tachyarrhythmias
Ventricular Fibrillation
Tintinalli, 9th ed, p134

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CASE: 60kg patient

PREPARATION: 200mg / 250ml Dopamine
BASIC CONCEPTS
=> 0.8 mg / mL Dopamine
DOPAMINEDRIP Desired therapeutic (Tx) dose : 5 mcg/kg/min
= 5 mcg/kg/min x (60min/hour) / (1000mcg/mg)
= 0.3 mg/ kg/ hour
Cardiovascular Effects: Rate = 0.3 mg/kg/hour / 0.8 mg/mL x 60 kg
↑HR, BP, CO, SVR
Rate = 22.5 mL/hr
Contraindications:
Hypersensitivity to sulfites ORDER:
Pheochromocytoma
Uncorrected tachyarrhythmias DESIRED THERAPEUTIC DOSE: 5mcg/kg/min
Ventricular Fibrillation
Tintinalli, 9th ed, p134
Start Dopamine Drip 200mg in 250 ml PNSS to start
at 22.5ml/ hr then titrated in increments/decrements
of 2mcg/kg/min to maintain SBP greater than or
equal to 90mmHg

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BASIC CONCEPTS
DOBUTAMINE DRIP
250mg in 250ml
Therapeutic (Tx) dose: 2-20mcg/kg/min
Cardiovascular Effects:
↑BP, CO Rate: (Tx dose / Stock dose) x weight
=/↑ HR
= MAP
↓SVR

Contraindications:
Hypertrophic cardiomyopathy w/ outflow tract
obstruction
Tintinalli, 9th ed, p134

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CASE: 60kg patient

PREPARATION = 250mg / 250ml
BASIC CONCEPTS => 1mg / ml Dobutamine
DOBUTAMINE DRIP Desired therapeutic (Tx) dose = 5 mcg/kg/min
= 5 mcg/kg/min x (60min/hour) / 1000mcg/min
= 0.3 mg/kg/hr

Cardiovascular Effects: Rate = (0.3mg/kg/hour) / (1mg/ml) x 60kg

↑BP, CO Rate = 18 ml/hr
=/↑ HR
= MAP
ORDER:
↓SVR
DESIRED THERAPEUTIC DOSE: 5mcg/kg/min
Contraindications:
Hypertrophic cardiomyopathy w/ outflow tract Start Dobutamine Drip 250mg in 250 ml PNSS to start
obstruction at 18ml/ hr then titrated in increments/decrements of
Tintinalli, 9th ed, p134 2mcg/kg/min to maintain SBP greater than or equal to
90mmHg

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BASIC CONCEPTS
NOREPHINEPHRINE DRIP

4 mg in 250ml (Example mixture- may vary)

Therapeutic (Tx) dose: 2-30mcg/kg/min
Cardiovascular Effects:
Rate: (Tx dose / Stock dose) x weight
↑ HR, MAP, BP, CO

Contraindications:
Hypotension from hypovolemia except as an
emergency measure to maintain coronary and
cerebral perfusion until volume can be replaced
Tintinalli, 9th ed, p134

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CASE: 60kg Patient;

Norepi PREPARATION = 16mg / 250ml
BASIC CONCEPTS
NOREPHINEPHRINE DRIP => 0.064 mg / ml Norepi
Desired therapeutic (Tx) dose = 0.01 mcg/kg/min
= 0.01 mcg/kg/min x (60min/hour) / 1000mcg/min
= 0.0006 mg/kg/hr
Cardiovascular Effects: Rate = (0.006mg/kg/hour) / (0.064mg/ml)
↑ HR, MAP, BP, CO
Rate = 0.009375 ml/kg/hr x 60kg
Running Rate: 0.6 ml/hr
Contraindications:
Hypotension from hypovolemia except as an ORDER:
emergency measure to maintain coronary and
cerebral perfusion until volume can be replaced DESIRED THERAPEUTIC DOSE: 0.01 mcg/kg/min
Tintinalli, 9th ed, p134 Start Norepinephrine Drip 16 mg in 250 ml PNSS to start at
0.6 ml/ hr then titrated in increments/decrements of 2ml/hr
to maintain SBP greater than or equal to 90mmHg

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CASE: 60kg Patient;

PREPARATION = 16mg / 250ml
BASIC CONCEPTS = [Desired Tx dose (mcg/kg/min) x kg (wt) x
60mins/hr]
SHORTCUT
COMPUTATION FOR ALL [Stock dose(mg/ml) x 1000mcg/min]
DRIPS = (0.1 x 60kg x 60) / [(16/2500 x 1000)
(DOPAMINE, DOBUTAMINE, NOREPINEPHRINE)
= 0.6 ml per hour

When endorsing a case, better to state the dose of drug.

To compute for specific dose being delivered, use the ff formula:

DOSE OF DRUG (mcg/kg/min)

= [ Present drip (ml/hr) x Drug conc
(mcg/ml)]
[Body wt (kg) x 60mins/hr]

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BASIC CONCEPTS
NITROGLYCERIN DRIP PREPARATION: One 10ml ampule contains 10mg
Nitroglycerin
ORDER:
10mg NTG + 90ml D5W in a soluset
This will give a concentration of 0.1mg/ml (or 100mcg/ml)
USE: NTG
Organic nitrate w/c causes systemic DOSE:
ventilation, decreasing preload & after load
& reducing myocardial oxygen demand; Initial dose: 5mcg/min (for HTN urgency)
improves coronary collateral circulation
Titrate by 5mcg/min q 5mins until pain relief or BP is
controlled
-IM Platinum, 2018 p 87

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Determine Drug Concentration

10mg NTG divided by 100ml = 0.1mg/ml
BASIC CONCEPTS CONVERT UNITS:
NITROGLYCERIN DRIP Since desired dose is in mcg/min and computed concentration is
in mg/ml, convert units to simplify equation
0.1 mg/ml = 100mcg/ml
COMPUTE DRIP RATE:
= Desired Dose (mcg/min) x 60mins/hr
CASE Drug concentration(mcg/ml)
= 5mcg/min x 60mins/hr
You plan to give a patient diagnosed with
Hypertensive urgency 10mg NTG plus 100 mcg/ml
enough D5W (90ml) to make 100ml = 3ml/hr
soluset. Your desired initial dose is
ORDER:
5mcg/min
Start Nitroglycerin drip: 10mg NTG + 90 ml D5W in a soluset at
3ml/hr
Titrate by 3ml/hr until with clinical response/ BP goal achieved
-IM Platinum p87

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PREPARATION: One 10ml ampule contains 10mg NIcardipine

ORDER:
BASIC CONCEPTS
NICARDIPINE DRIP 10mg Nicardipine + enough IVF to make 100ml in a soluset
This will give a concentration of 0.1mg/ml Nicardipine
DOSE:
ACTION: Dihydropyridine Calcium
Channel Blocker > Relax smooth muscles Initial dose: 5mg/hr (for HTN urgency)
> Lowers BP Titrate by 2.5mg/hr q 15mins until target BP is reached
USE: Hypertension Maximum dose : 15mg/hr
Contraindicated: Aortic Stenosis -Platinum IM, 2018, p89

*Use with caution in patients with MI,

concurrent use of fentanyl(hypotension),
CHF, hypertrophic cardiomyopathy, portal
hypertension, renal insufficiency
Side Effects: headache, flushing,
dizziness, nausea, reflex tachycardia
Tintinalli, 9th ed, p130; 1128
ORDER
10mg in 90ml PNSS to run at 5ml/hr. Tirate at increment/decrements of
5ml/hr to maintain SBP (Computed MAP)
*may set running rate at 2ml/hr
TARGET: 20% less of MAP or 80% MAP

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Determine Drug Concentration

10mg Nicardipine divided by 100ml = 0.1mg/ml
BASIC CONCEPTS
NICARDIPINE DRIP CONVERT UNITS:
Not needed since drug concentrate and desired
dose have the same units(mg)
COMPUTE DRIP RATE:
= Desired Dose (mg/hr)
CASE:
Drug concentration(mg/ml)
65 year old came in with headache and = 5 mg/hr
BP of 230/120mmHg. You plan to start
10mg Nicardipine plus enough PNSS 0.1 mg/ml
(90ml) to make 100ml soluset. Desired
initial dose is 5mg/hr.
= 50 ml/hr
ORDER:
Start Nicardipine drip: 10mg + 90 ml PNSS in a
soluset to run at 50ml/hr
-IM Platinum p89

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BASIC CONCEPTS
ISOSORBIDE DINITRATE
DRIP ORDER:
10mg in 90ml Plain NSS to run 5ml/hr to abolish
chest pain. Titrate to increment and decrement of
ACTION: Relaxes vascular smooth muscle in 5 ml/hr. Hold for SBP less than 100mmHg
arteries, arterioles and veins through metabolic
conversion of organic nitrates to nitric oxide
USE: AMI patients not treated w/ thrombolytics,
reduces infarct size, improves regional function, &
decreases rate of cardiovascular complications
Contraindicated: Hypotension; use cautiously in
inferior wall ischemia
Tintinalli, 9th ed, p348

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BOLUS : 150-300mg in 100ml D5W to run for 10

BASIC CONCEPTS mins
AMIODARONE DRIP CONTINUOUS INFUSION: 1mg/min for 6 hours
then 0.5mg/min infusion
SAMPLE PREPARATION:
DRIP: 150-600mg + 250ml D5W for 16-24 hrs
ACTION: Antagonizes K, Na, Ca, beta TITRATION : Approximately 1g Amiodarone is given
adrenergic, alpha adrenergic ion channels within 24 hrs
-IM Platinum, 2018,p91
USE: Acute management and chronic
suppression of supreventrivcular
tachycardia and ventricular arrhythmias
ALTERNATIVE
Tintinalli, 9th ed, p126
600mg in 500ml D5W to run at 1mg/ml for the next 6
hours then run at 0.5mg/ml for the next 18 hours

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BASIC CONCEPTS Mannitol : 0.5 - 1.0 g/kg IV

MANNITOL DRIP Preparation: 20% Mannitol (20g in 100ml solution)

MANNITOL LOADING COMPUTATION

= Weight (kg) x (100/20)
= Weight (kg) x 5
*Maintenance is half of the loading dose

Example:
60kg Patient
Give Mannitol 20% 300ml intravenous bolus now then 150ml
intravenous every 4-8 hours

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NEUROLOGY Mannitol Dose: 0.25 - 1g/kg

MANNITOL DRIP Preparation: 20% Mannitol (20g in 100ml solution)

Example:
60kg Patient
Desired Dose : 0.5g Mannitol / weight (kg) = 30g
Compute: 20g /100ml = 30g / X
X = ml / hr (Amount to administered)
X = (30 x 100) / 20
X = 150 ml

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Actual FiO2 FORMULA on NC

PULMONOLOGY = (4% x liter per minute) + 20%
ACTUAL FIO2
CASE: 5lpm
% FiO2 FiO2 =40%
NC : (lpm x 4) + 20
Intubated : 100 % Determination of FiO2 with nasal cannula or Simple face mask
MVM : 30- 50 % or 0.5 Fraction of inspired Oxygen is concentration of oxygen (expressed
in percent) that a person inhales
Room Air : 21% or 0.21
Ambient or room air is made up of 21% oxygen , hence FiO2 of
Inline nebulization: >60% room air is 21%
When you give supplemental Oxygen, you are raising the patient’s
FiO2 to level over 21% (ranges 22-100%)
For every 1LPM, there is an estimated increase of 4% in FiO2
-IM Platinum, 2018, p58

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Desired FiO2
(Desired PaO2 x Actual FiO2)
PULMONOLOGY
Actual PaO2
DESIRED FIO2 Desired PaO2 : Obtained using formula
Desired PaO2 Actual PaO2 : Obtained from ABG
AGE < 60y/o Increasing FiO2 can increase PaO2 & SpO2 to desired levels
= 104 - (0.43 x age)
AGE > 60y/o and above Example Case:
= 80 - (Age - 60) ABG at Fio2 70% MV shows PaO2 of 78, 83year old patient
-IM Platinum, 2018, p59

Desired PaO2
% FiO2 = 80- ( 83 - 60 )
NC : (lpm x 4) + 20 = 57

Intubated : 100 %
MVM : 30- 50 % or 0.5 Desired FiO2
= (57 x 0.70) / 78
Room Air : 21% or 0.21
= 0.51 or 51%
Inline nebulization: >60%
-IM Platinum, 2018, p.59

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PULMONOLOGY
PF RATIO
PFR
PaO2 : arterial O2 partial pressure;
obtained from ABG = ( PaO2) / (FiO2)
FiO2 : Fraction of Inspired Oxygen at
time the ABG was withdrawn Severity of ARDS
MILD : 200 - 300 mmHg
MODERATE : 100 - 199 mmHg
SEVERE : < 100mmHg
-IM Platinum, 2018, p 60

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PULMONOLOGY
BIPAP SETTINGS
EPAP (E): 5
IPAP (I): 10

Ratio E : I
1 : 2-2.5

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PULMONOLOGY
EXERCISE COMPUTATION NOTES
”= 60 /0.8”
CASE: PFR Severe ARDs
40M (70kg) “= 75”
“= 104 - (0.43 x 40)”
FiO2 : 80% Desired PaO2 “= 104 -17.2”
ABG “= 86.8mmHg”
pH : 7.35 Desired FiO2
pCO2 : 38mmHg “= (0.8 x 87) / 60” approximates 100%

PaO2 : 60mmHg Desired FiO2 “= 1.16 or hence, FiO2 setting

116%” should be maintained at
HCO3 : 22mEq/L 100%

*Determine PFR, Desired PaO2, Desired Fi02

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GASTROENTEROLOGY DRIPS OMEPRAZOLE

OMEPRAZOLE BOLUS : 80mcg IV then

OCTREOTIDE CONTINUOUS INFUSION: 8mg/hr

SAMPLE PREPARATION:
DRIP: 40mg + 90ml PNSS for 5 hrs RTC
TITRATION : Maintain drip for 72 hrs
-IM Platinum, 2018,p91

OCTREOTIDE (Splanchnic Vasoconstrictor)

BOLUS : 50mcg IV then
CONTINUOUS INFUSION: 25-50mcg/hr (up to 5 days)
SAMPLE PREPARATION:
DRIP: 600mcg + 250ml D5W at 25mcg/hr
*In emergency, may be given as IV bolus (undiluted) over 3-5 mins
-IM Platinum, 2018,p91

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ENDOCRINOLOGY
INSULIN DRIP
HYPERKALEMIA
Insulin causes K shift (Extracellular K goes
intracellularly)
Glucose- Insulin (GI) Solution: 50ml of 50% dextrose
in water (D50-50) + 10 units regular insulin in 2-5
mins
Sample Order : Mix 1 amp D50-50 with 10 units
Regular Insulin (GI Solution) IV stat, then every 6
hours x 4 doses
IM Platinum, 2018, p89

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HYPERGLYCEMIA
FORMULATION of INSULIN DRIP (depends on physician)
EXAMPLES:
ENDOCRINOLOGY
DRIP 1: 20 units of HR in 100ml PNSS : conc of 0.2 unit/L
INSULIN DRIP DRIP 2: 50 units of HR in 100ml PNSS : conc of 0.5 unit/L
DRIP 3: 100 units of HR in 100ml PNSS : conc of 1 unit/ml
IM Platinum, 2018, p89

EXAMPLES:
EXAMPLE 1: if we decide to give 2 units of insulin per hr via insulin
drip
DRIP 1: give 10ml/hr
DRIP 2: give 4ml/hr
DRIP 3: give 2ml/hr
IM Platinum, 2018, p89

EXAMPLES:
EXAMPLE 2: Start Insulin drip at 0.1 unit/kg/hr & titrate to desired
blood glucose
If patient weighs 50kg, start insulin drip ar 5units/hr.
If we decide to use DRIP 3 from above example: Insuline drip 100
units HR + 100ml PNSS at rate of 5ml/hr (to deliver 5 units/hr)
IM Platinum, 2018, p89

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ENDOCRINOLOGY
DIABETIC DIET
FORMULA
= {[(Ht in cm) - 100] x 25}
(50-20-30) divided into 3 meals, 2 snacks and 1 fruit
exchange per day with no sources of simple sugar
and less than 7 % saturated fat.

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NEPHROLOGY
CrCl(male):
CREATININE (140 - age x wt)
CLEARANCE (Plasma crea x 72)

CrCl(Female): CrCl(male) x 0.85

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ANESTHESIA LOADING DOSE: 1mcg /kg over 10 mins

DEXMEDETOMIDINE DRIP Continuous infusion: 0.5 - 1 mg/hr (usually
started at 1mg/hr)
SAMPLE PREPARATION:
ACTION:Agents for procedural sedation
in adults. Potentially useful when DRIP : 2.5mg + 90ml NSS or D5W
cooperation is required or in patient
experiencing respiratory depression with TITRATION : Titrate in 0.1mcg/kg/hr increment to
opioids desired level of sedation (max dose: 1.5mcg/kg/hr)
SIDE EFFECTS : Hypotension; longer
readiness in discharge
- IM Platinum, 2019, p90
Tintinalli, 9th ed, p252

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PAIN MEDICINE KETOROLAC

KETOROLAC 90mg in 250ml D5W or PNSS for 24 hours
TRAMADOL
TRAMADOL
150mg-300mg in 250ml D5W or PNSS for 24 hrs

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PEDIATRICS
1 x ETT (Age/4) + 4 (uncuffed tubes)
NEONATOLOGY 2 x ETT NG / OG / Foley Size
3 x ETT Depth of ETT insertion
Chest tube size (max, eg.
4 x ETT
Hemothorax)

5 year old child came in at the ED.

5 year old
1 x ETT 5-0 ETT
2 x ETT 10f NG / OG / Foley Size
3 x ETT 15 cm ETT insertion depth
20Fr Chest tube size (max, eg.
4 x ETT
Hemothorax)

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Weight
First 10 Kg 100ml/kg/day
PEDIATRICS
11 - 20kg 50ml/kg/day
HOLLIDAY SEGAR
Succeeding Kg
METHOD Above 20kg
20ml/kg/day

Calculate maintenance fluid of a 25kg, 5 year old child?

Weight
Shortcut: First 10 Kg 100 x 10 1000ml
11 - 20kg 50 x 10 500ml
If patient is above 20kg, automatic
Succeeding Kg
1500ml fluid requirement Above 20kg
5 x 20 100ml

TOTAL 1600ml

= 1600ml to be given in 24 hours

= 1600/ 24hrs
ORDER:
Hook to D5NSS 500ml to run 67 ml per hour

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CASE: Calculate maintenance fluid of a 25kg, 5 year old

febrile child?
PEDIATRICS
Weight
HOLLIDAY SEGAR First 10 Kg 100 x 10 1000ml
METHOD 11 - 20kg 50 x 10 500ml
Succeeding Kg
5 x 20 100ml
Above 20kg
TOTAL 1600ml
Weight Mild Dehydration
< 2yrs old and/or < 20
+ 50 ml/kg
kg
> 2 yrs old and/or >20
If with mild dehydration + 30 ml/kg
kg
, = ( 25kg x 30ml/kg ) + 1600ml (maintenance fluid)
= 2350ml / 24hrs
ORDER:
Hook to D5NSS 500ml to run 98 ml per hour

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TRAUMA - ADULT
PARKLAND FORMULA

Calculate fluid requirement in a 50kg patient with 70%

TBSA burn

= 4 x 70 x 50 = 1400ml
= 14000 / 2 = 7000ml
FLUID REQUIREMENT
= 7000 / 8 = 875ml /hr for first 8 hours
= 7000 / 16 = 438ml/hr for the next 16 hours

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TRAUMA - ADULT
PARKLAND FORMULA

Calculate fluid requirement in a 50kg patient with 70%

TBSA burn who was burn 8am and arrived at ER at 10
If there is significant delay like 7 hours
am.
or more than 8 hours, fluids are given
as fast as possible with CVP monitoring. 4 x 70 x 50 = 14000ml
14000 / 2 = 7000ml
FLUID REQUIREMENT
7000 / 6 = 1,167 ml /hr for first 6 hours w/
congestion precaution
7000 / 16 = 438ml/hr for the next 16 hours

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First 24 hours (for 2nd & 3rd degree burns greater than or
equal to 15% TBSA burned)
TRAUMA - PEDIA 4ml LR x wt (kg) x % TBSA PLUS Maintenance Fluid
(D5LR)
PARKLAND FORMULA Give half over the first 8 hours (starting from time of
burn)
Next hand over the next 16 hours

Maintenance Fluid ( D5LR )

< 40kg
First 10 Kg 100ml/kg
11 - 20kg 50ml/kg
>20kg 20ml/kg

>40kg : Maintenance fluids are NOT included in the

estimate of fluid requirements

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CASE: 5 yr old male ( 25kg wt )with 30% TBSA burn

TRAUMA - PEDIA
PARKLAND FORMULA COMPUTATION
4ml LR x 25kg x 30 = 3000ml
3000ml + 1600 = 4600ml
4600 / 2 =2300
2300 / 8 hrs = 288 ml/hr for first 8 hours
= 144ml/ hr for the next 16 hours

COMPUTATION
4ml LR x 25kg x 30 = 3000ml
3000ml / 2 = 1500ml
= 1,500ml + 1,600ml (maintenance fluid by wt)
3,100 / 8 hrs = 388 ml/hr for first 8 hours
= 194ml/ hr for the next 16 hours

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KRISTIAN A. VILLESENDA, MD, FPCEM

ANY QUESTIONS?!?!

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 3/16/2023

KRISTIAN A. VILLESENDA, MD, DPBEM

THANK YOU!

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- FENTANYL INFUSION
Add 500mcg Fentanyl (10ml or 5 ampules) to 40ml pNSS to make a solution of
500mcg Fentanyl in 50ml (Fentanyl 10mcg/ml). Run at 0.2mcg/hr =
10mcg/hr

- DEXMEDETOMIDINE INFUSION
Add 2ml of Precedex (200mcg) to 48ml pNSS to make a Precedex Solution
200mcg in 50ml pNSS (or 4mcg/ml).
Start Precedex infusion at 0.5mcg/kg/hr or 25mcg/hr

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