Figure 5.

9 Dry Medication Requiring Reconstitution

 Practice Problem: Reconstituted Medication
Patient Information:
Name: Liam Vang, DOB: 04/04/19xx, Age 8, Allergies: NKDA, Weight: 60 kg

Provider Order: Cefazolin 500 mg IM every 8 hours

Medication Supplied: See Figure 5.10 for the drug label of the medication as it is supplied.
[2]

FIgure 5.10 Drug Label of Cefazolin

1. Start by reading the order and the drug label. Liam has an order to receive 500 mg of Cefazolin. The vial of
medication in powder form states there are 500 mg per vial. The powder must be reconstituted before it
can be administered. The reconstitution instructions on the label state to add 2 mL of sterile water to the
vial to reconstitute the powder into a liquid form for injection. The label states that after the powder is
reconstituted with the 2 mL of diluent, the concentration of fluid will be 225 mg/mL. See a close-up image
of reconstitution instructions in Figure 5.11.[3]
 Figure 5.11 Reconstitution Instructions
When setting up the problem, we need to identify the correct information to include in the equation. There
are several numbers we may be tempted to try to incorporate into our equation, such as 500 mg per vial,
2 mL diluent, and approximate volume of 2.2 mL. These are numbers specific to the reconstitution
process. However, keep in mind that our final goal is to calculate the number of mL of fluid to administer
after the medication is reconstituted, so this will be the goal unit. The other piece of important information
that the drug label states is that the reconstituted medication will provide a concentration of 225 mg/mL.
2. Start by identifying the goal unit for which you are solving, which is mL to administer as an injection:

3. Set up the first fraction by matching the numerator to the goal unit of mL. In this problem, we know
from the drug label that the known concentration of the reconstituted medication is 225 mg per mL, so
add 1 mL to the numerator and 225 mg to the denominator:
4. Set up the second fraction with mg in the numerator with the intent to cross off mg diagonally. Look at
the given information to determine how it relates to mg. The order tells us to give Liam 500 mg of the
medication. Plug in 500 in the numerator of the second fraction with one in the denominator so that mg
will cross off diagonally:

5. Cross off units diagonally. Multiply across the numerators and the denominators, and then divide the
final fraction for the answer in mL:

6. The final answer: 2.2 mL

Example 2

Order: 125 milligrams of amoxicillin is ordered for administration every eight hours.

Supply: For reconstitution state to add 74 milliliters of water to the contents of the bottle to yield 250
milligrams of amoxicillin per 1 teaspoon of suspension. How many milliliters will the nurse administer to
this pediatric patient? So first of all, when you're given a reconstitution problem, they like to throw a lot of
numbers at you.

And you may look at this and be like, "Ah, 125 milligrams, 74 milliliters, 250 milligrams, it's a lot." The
bottom line, though, if they are asking you for the dose, the amount to give a patient, you only really care
about the final concentration of the solution.

So we don't really care that 74 milliliters of water was added to make the concentration. The only numbers
we really care about in this order are the fact that 125 milligrams are ordered, and the final concentration
is 250 milligrams in 1 teaspoon of suspension.

So I'm going to work through this. I'm going to use dimensional analysis, which is my preference, because
it's a little more straightforward and efficient and easier in my opinion. But you can absolutely use ratio
and proportion or the formula method as well to solve this problem.

So we first write down what is ordered, which is 125 milligrams. That's usually where you start when it
comes to dimensional analysis. Then we are going to multiply it times what is available. And the final
concentration of our solution or suspension is 250 milligrams in 1 teaspoon, so 1 teaspoon over 250
milligrams. And you can see that our milligrams are going to cross off. We're going to be left with
teaspoons.

But that's not what they're asking for in this problem, right? They are asking for how many milliliters will
be administered. So that's where we need our conversion factor. And we know that 1 teaspoon equals 5
milliliters.
So we're going to multiply, again, times the conversion factor. 1 teaspoon equals 5 milliliters. And I want to
make sure my milliliters are on top, when I'm multiplying times this conversion factor, because that's what
I want to end up with, is milliliters. So you can see here that my teaspoons cross off, and I'm going to be
left with milliliters, which is perfect.

So if I take 125 divided by 250, that 0.5, times 5 and I will end up with 2.5 milliliters. And if you look at the
end of this question, it says, "If the answer is greater than 1, round to the 10th. If less than 1, round to the
100th." So we are over 1, and we are already rounded to the nearest 10th place there. So we're all set. So
2.5 milliliters will be administered to this patient. Hope that was helpful for you.