F L U I D S

AND

ELECTROLYTES
 Water overview
*Water comprises
about
60% -70% of the total
body
weight
*Varies with
age
weight
gender
Normal Composition in Average Man

•When a person loses more than 10% of his

total body fluids,he can DIE!!!
Functions of Water in the
Body
•-Transporting nutrients to cells and
wastes from cells
•-Transporting hormones, enzymes, blood
platelets, and red and white blood cells
•-Facilitating cellular metabolism and proper
cellular chemical functioning
•-Facilitating digestion and promoting elimination
•-Acting as a solvent for electrolytes and
non-electrolytes
•-Acting as a tissue lubricant and cushion
•-Helping maintain normal body temperature
 Two Compartments of Fluid in the Body

•Intracellular fluid (ICF) (70%)

— fluid within cells
- large amounts of K+, PO4--, Mg++
•Extracellular fluid (ECF) (30%)
— fluid outside cells
- large amounts of Na+, Ca+, Cl-, HCO3--

- Includes intravascular(15%) and

interstitial fluids(5%)
 Water Loss

ROUTES OF WATER LOSS

-SENSIBLE -INSENSIBLE
Urine Lungs
Feces Sweat
 Causes of Increased Causes of Increased
Water Loss Water Gain

•Fever •Increased sodium intake

•Diarrhea •Increased sodium
•Diaphoresis retention
•Vomiting •Excessive intake of water
•Gastric suctioning •Excess secretion of ADH
•Tachypnea
 Electrolytes
Ions
Cations — positive charge
Anions — negative charge

-An electrolyte is a substance, that when dissolved in

water, gives a solution that can conduct electricity
(Electrochemistry Dictionary)
-Simple inorganic salts
-Electrolytes dissociate when dissolved in water to form
positively and negatively charged ions
(Dissociation and electrolytes)
-All inorganic acids, bases, salts, are electrolytes
-Also known as Ionic solutes
 Importance of electrolytes
-Maintain voltages across cell membranes
-Carry electrical impulses to other cells
-Found in blood or the human body in the form of
acids, bases or salts (Sodium, calcium, potasium,
chlorine, magnesium, bicarbonate)
-Conduct an electric current that transports
energy thoughout the body
Normal Composition in Average Man
  Plasma/ Interstitial Fluid Intracellular fluid
Intravascular

Cations (mmol per      

litre)
Sodium 140 144 10
Potassium 4 4 155
Calcium 2.5 2 1
Magnesium 1 1 15
Anions (mmol per      
litre)
Chloride 102 114 5
Bicarbonate 27 30 10
Phosphate 1 1 50
Sulphate 0.5 0.5 10
Protein 2 0.1 8
Organic Anions 3 6 2
 Effects of Electrolytes

•The loss of electrolytes in the body can lead to

an unbalance of fluids in the body and the pH,
and a damage of the electric potential between
the nerve cells that transmit the nerve signals
(Encarta)
 Major Electrolytes/Chief Function
Sodium — controls and regulates volume of body
fluids
Potassium — chief regulator of cellular enzyme
activity and water content
Calcium — nerve impulse, blood clotting, muscle
contraction, B12 absorption
Magnesium — metabolism of carbohydrates and
proteins, vital actions involving enzymes
Chloride — maintains osmotic pressure in blood,
produces hydrochloric acid
Bicarbonate — body’s primary buffer system
Phosphate — involved in important chemical reactions
in body, cell division and hereditary traits
 Regulation of Body Fluid Compartments

•Osmosis
•is the movement of water from an
area of lower solute concentration to
an area of higher solute
concentration.
•Semi-permeable membrane
•membrane must be more
permeable to water
•a greater concentration of
solutes on one side of the
membrane
 •Facilitated Diffusion
•Requires a carrier molecule.
•Lipid insoluble substances cannot cross the plasma
membrane (glucose).
•ATP is not expended.
•Movement of the particles is from an area of higher
concentration to an area of lower concentration.
•Active Transport
 movement of a substance across the cell
membrane from an area of lower concentration to
an area of higher concentration.
 ATP is expended.
 The sodium-potassium pump is an example of
active transport.
Regulation of Body Fluid Compartments
 Regulation of Body Fluid Compartments
Tonicity is the ability of solutes to cause osmotic
driving forces
Filtration is the movement of water and solutes from
an area of high hydrostatic pressure to an
area of low hydrostatic pressure
Osmolality reflects the concentration of fluid that
affects the movement of water between fluid

compartments by osmosis
Osmotic pressure is the amount of hydrostatic
pressure needed to stop the flow of water by
osmosis
 Fluid Volume Deficit
•Involves either volume or distribution of water or
electrolytes

•Hypovolemia — deficiency in amount of water and

electrolytes in ECF with near normal
water/electrolyte proportions

•Dehydration — decreased volume of water and

electrolyte change

•Third-space fluid shift — distributional shift of

body fluids into potential body spaces
 Fluid Volume Excess
Hypervolemia — excessive retention of water
and sodium in ECF

Overhydration — above normal amounts of

water in extracellular spaces

Edema — excessive ECF accumulates in tissue

spaces

Interstitial-to-plasma shift — movement of fluid

from space surrounding cells to blood
 Types of IV Solutions
ISOTONIC
-solution has the same osmolality as the extracellular
fluid.
Examples: D5W ; Normal Saline
Hypertonic solutions have a higher concentration of
solute and are more concentrated than extracellular
fluids. Net movement intracellular to extracellular
Examples : 3% saline; 5% saline
Hypotonic solutions have a lower concentration of
solutes and is more dilute than extracellular fluid .Net
movement extracellular to intracellular
Examples : 1/2 Normal Saline; 1/3 Normal Saline
 Electrolyte Imbalances
SODIUM (Na+)  135-145 mEq/L
Functions
•Maintains osmolality
•Participates in active transport
•Helps regulate body fluids
•Participates in the action potential
Hyponatremia:serum sodium level falls below 130
mEq/L.Cells become swollen.
Neurological Disturbances :cerebral edema,headache,
lethargy,depression, confusion,convulsions,coma
Cardiovascular Disturbances: postural hypotension,shock
Hypernatremia: Serum sodium is more than 150
mEq/L.Cells shrink.
Complications:Osmotic Diuresis,cellular dehydration,
circulation decreases
 Electrolyte Imbalances
POTASSIUM (K+): 3.5-5.0 mEq/L
Functions
•Transmission of nerve impulses
•Resting membrane potential
•Acid-base balance
•Promotes myocardial, skeletal, and smooth muscle
contractility
Hypokalemia: <3 mEq/L
Cardiovascular: dysrhythmias, hypotension, digitalis toxicity, myocardial
damage, cardiac arrest
Neurological: lethargy, confusion, depression
Gastrointestinal : paralytic ileus
Skeletal Muscle: weakness, flaccid paralysis, weakness of respiratory
muscles, respiratory arrest
Renal System: decreased ability to concentrate urine, water loss, kidney
damage
Acid-Base Balance: metabolic alkalosis
Hyperkalemia: serum value of >6 mEq/L
Nervous System : Paraesthesia
Neuromuscular: Muscle twitching, muscle weakness, paralysis
Cardiovascular : Bradycardia, Cardiac arrest
 Electrolyte Imbalances
CALCIUM :8.5-10.5 mg/dl or 4.5-5.8 mEq/L
Functions
•Formation of bone and teeth
•Contraction of muscle
•Blood coagulation
•Blocks sodium transport into the cell
•Transmission of nervous impulses
 •Hypocalcemia •Hypercalcemia
•<0.9 mmo/L ionized Calcium >12 mg/dL total Calcium or
>1.5 mmol/L ionized Calcium

•-Nervous System •-Neurological Manifestation

• Paraesthesia • lethargy, confusion, coma
•-Muscular System •-Skeletal Manifestations
• Tetany, Laryngeal • deep bone pain; fractures
• spasms •-Renal Manifestations:stones
•-Cardiovascular System
• congestive heart failure •-Gastrointestinal Manifestations
• decreased cardiac • Constipation;anorexia
• output • Nausea and Vomiting
• cardiac dysrhythmias •-Cardiovascular Manifestations
• Shortened QT interval,
•Bradycardia
• Cardiac arrest

end
• defined as "the excessive loss of
water and electrolytes from the
body“
• Dehydration can be caused by losing
too much fluid, not drinking enough
water or fluids, or both.
• Infants and children are more
susceptible to dehydration than
adults because of their smaller body
weights and higher turnover of water
and electrolytes.
• So are the elderly and those with
illnesses
 •dehydration
occurs when losses are not replaced adequately and a deficit of water
and electrolytes develop.
•These may
occur in Vomiting or diarrhea
•Presence of an
acute illness where there is loss of appetite and vomiting:
 Pneumonia
 DHF
 Other Acute Ilnesses
•Excessive
urine output, such as with uncontrolled diabetes or diuretic use
•Excessive
sweating (sports)
•Burns
• Since diarrhea and vomiting are the
most common causes of dehydration
in children, the volume of fluid loss
may vary from 5 ml/kg (normal) to 200
ml/kg
• Concentration of electrolytes lost also
varies
• NaCl and K are the most common
electrolytes lost through stools
• In order to diagnose the type of dehydration,
you need to know the History and you must
do a thorough physical examination
• We classify type of dehydration depending
on the amount of water and electrolytes lost
• These are reflected by the signs and
symptoms the child will present
• Dehydration is classified as no
dehydration, some dehydration, or
severe dehydration based on how
much of the body's fluid is lost or not
replenished.
• When severe, dehydration is a
life-threatening emergency
 Assesment of Dehydration
• Graded according to the signs and symptoms
that reflect the amount of fluid lost.
• There are usually no signs or symptoms in the
early stages
• As dehydration increases, signs and
symptoms develop. Initially, thirst,
restlessness, irritability, decreased skin
turgor, sunken eyes and sunken fontanelles.
• As more losses occur, these
• effects become more pronounced.
Signs of hypovolemic shock (SEQUELAE)

1. diminished sensorium (lethargy)

2. Lack of urine output
3. Cool moist extremities
4. A rapid and feeble pulse
5. Decreased BP
6. Peripheral cyanosis
7. DEATH.
Look at :condition* *restless,irritable *Lethargic or
Well , alert unconscious;floppy
Eyes sunken
Tears Normal absent very sunken & dry
Mouth and tongue Present dry absent
Thirst Moist *thirsty,drinks very dry
Drinks eagerly *drinks poorly or not able
normally,not to drink *
Thirsty

Feel skin pinch Goes back quickly *goes back slowly* *Goes back very slowly

Decide The patient has no If the patient has 2 If the patient has 2 or
sign of dehydration or more signs, more signs, including at
including at least 1 least 1 *sign* , there is
*signs*, there is Severe Dehydration
Some Dehydration
Degree of Amount of Fluid Type of Fluid Feeding
Dehydration
None Vol per vol Suitable home Usual diet or
replacement or fluids (not salty or formula, continue
after each highly breastfeeding
diarrheic stool: sweetened),
50-100 ml (1/4- ORS, rice water,
1/2 cup) if < 2yrs; vegetable or
100-200 ml (1/2 chicken soup
-1 cup) if 2-10 yrs;
ad libitum for
older children
Degree of Signs Fluids Feeding
Dehydration
Mild Slightly dry ORS, 30-50 ml/kg Breastfeeding,
mucus memb., in 4-6 hrs full-strength cow
increased thirst, milk or lactose-
slightly reduced contg. formula,
urine flow undil. lactose-free
formula

Moderate Sunken eyes, ORS, 60-90 ml/kg Same as above

sunken in 4-6 hrs
fontanelle, loss of
skin turgor, dry
mucus memb.
Degree of Signs Fluids Feeding
Dehydration

Severe Signs of mod. IV or intraosseus Begin after

dehydration plus fluids (Ringer’s clinically
one or more of ff: lactate or improved and
rapid, thready NSS),30/ml/kg in ORS has begun
pulse,cyanosis, 1/2 hr (1 hr for
rapid breathing, infants) then 70
delayed capillary ml/kg in 21/2 hrs
refill time, (5 hrs for infants)
lethargy, coma
Look at :condition* *restless,irritable *Lethargic or
Well , alert unconscious;floppy
Eyes sunken
Tears Normal absent very sunken & dry
Mouth and tongue Present dry absent
Thirst Moist *thirsty,drinks very dry
Drinks eagerly *drinks poorly or not able
normally,not to drink *
Thirsty

Feel skin pinch Goes back quickly *goes back slowly* *Goes back very slowly

Decide The patient has no If the patient has 2 If the patient has 2 or
sign of dehydration or more signs, more signs, including at
including at least 1 least 1 *sign* , there is
*signs*, there is Severe Dehydration
Some Dehydration

Treat Use treatment Weigh the patient , Weigh the patient and use
Plan A if possible and use treatment Plan C
treatment Plan B URGENTLY
Three rules of home treatment:
1. give extra fluids
2. continue feeding
3. advise when to return to the doctor

(if the child develops blood in the stool, drinks poorly, becomes
sicker, or is not better in three days).
Do not give:
Very sweet tea, soft drinks, and
sweetened fruit drinks.
These are often hyperosmolar (high
sugar content).
Can cause osmotic diarrhea,
worsening dehydration and
hyponatremia.
Also to be avoided are
fluids with purgative
action and stimulants
(e.g., coffee, some medicinal teas or infusions).
Look at :condition* *restless,irritable *Lethargic or
Well , alert unconscious;floppy
Eyes sunken
Tears Normal absent very sunken & dry
Mouth and tongue Present dry absent
Thirst Moist *thirsty,drinks very dry
Drinks eagerly *drinks poorly or not able
normally,not to drink *
Thirsty

Feel skin pinch Goes back quickly *goes back slowly* *Goes back very slowly

Decide The patient has no If the patient has 2 If the patient has 2 or
sign of dehydration or more signs, more signs, including at
including at least 1 least 1 *sign* , there is
*signs*, there is Severe Dehydration
Some Dehydration

Treat Use treatment Weigh the patient , Weigh the patient and use
Plan A if possible and use treatment Plan C
treatment Plan B URGENTLY
• ORS(ml)

the mother slowly gives the recommended

amount of ORS by spoonfuls or sips
• Note: If the child is breast-fed, breast-feeding
should continue.
• After 4 hours, reassess and reclassify
dehydration, and begin feeding to provide
required amounts of potassium and glucose.
If there are no more signs of dehydration, do Plan A.
If there is still some dehydration, repeat
Plan B.
If the child now has severe dehydration, do Plan C.
Look at :condition* *restless,irritable *Lethargic or
Well , alert unconscious;floppy
Eyes sunken
Tears Normal absent very sunken & dry
Mouth and tongue Present dry absent
Thirst Moist *thirsty,drinks very dry
Drinks eagerly *drinks poorly or not able
normally,not to drink *
Thirsty

Feel skin pinch Goes back quickly *goes back slowly* *Goes back very slowly

Decide The patient has no If the patient has 2 If the patient has 2 or
sign of dehydration or more signs, more signs, including at
including at least 1 least 1 *sign* , there is
*signs*, there is Severe Dehydration
Some Dehydration

Treat Use treatment Weigh the patient , Weigh the patient and use
Plan A if possible and use treatment Plan C
treatment Plan B URGENTLY
Normal saline does not correct
acidosis or replace potassium
losses, but can be used. Plain
glucose or dextrose solutions are
not acceptable for the treatment
of severe dehydration.
If IV infusion is not possible, fluids should be given
by nasogastric tube. If none of these are possible and
the child can drink, ORS must be given by mouth.

Note: In areas where cholera

cannot be excluded for patients
less than 2 years old with severe
dehydration, antibiotics are
recommended. Start Cotrimoxazole.
 MAINTENANCE
REQUIREMENTS
• HOLIDAY-SEGAR METHOD
• BODY SURFACE AREA METHOD
 HOLIDAY-SEGAR METHOD
• Estimates caloric expenditure in
fixed weight categories
• Assumption
– 100 cal metabolized : 100 mL water
• Not suitable for neonates < 14
days
– Overestimates fluid needs
HOLIDAY-SEGAR METHOD
BODY ml/kg/day ml/kg/hr Electrolytes
WEIGHT (mEq/100ml
fluid)

First 10 kg 100 4 Na+ 3

Second 10 kg 50 2 Cl- 2

Each additional 20 1 K+ 2
kg
 EXAMPLE
• What is the maintenance fluid
rate for a an 8 year old child
weighing 25 kg using the
Holiday-Segar Method?
 100 x 10 = 1000 ml
+ 50 x 10 = 500 ml
+ 20 x 5 = 100 ml
1600 ml/day
 4 x 10 = 40 ml
+ 2 x 10 = 20 ml
+ 1x 5 = 5 ml
65 ml/hr
 EXERCISE
Using the Holiday-Segar Method,
what is the full maintenance
requirement and rate for a 10
year old patient who weighs 37
kg?
 BODY SURFACE AREA
METHOD
• Assumption: caloric expenditure
is related to BSA
• Not used in children < 10 kg
 BSA METHOD
STANDARD VALUES FOR USE IN BODY
SURFACE AREA METHOD
Componen Values
t
Water 1500 ml/m2/24 hrs

Na+ 30-50 mEq/m2/24 hrs

K+ 20-40 mEq/m2/24 hrs

 BSA Formula

Surface area (m2) = ht (cm) x

wt (kg)
3600
 EXAMPLE
Using the BSA method, what is
the maintenance requirement of
an 8 year old who weighs 25 kg
and is 132 cm tall?
 BSA Formula

0.92 m2 = 132 cm x 25 kg
3600
Water = 1500ml/0.92/day=
1630 ml
Na+ = 40 mEq/0.92/day=
43.5 mEq
K+ = 30 mEq/0.92/day= 32.6
mEq
 EXERCISE
Using the BSA Method, what is
the maintenance requirement of
a 12 year old boy who weighs
37 kg and is 142 cm tall?
 DEFICIT THERAPY
• Calculated Assessment
• Clinical Assessment
CALCULATED ASSESSMENT
Fluid deficit (L) = preillness
weight (kg) – illness weight (kg)

% Dehydration = (preillness
weight – illness
weight)/preillness weight x
100%
 CLINICAL ASSESSMENT
DEHYDRATION MILD MODERATE SEVERE

Skin turgor Normal Tenting None

Skin touch Normal Dry Clammy

Buccal mucosa Moist Dry Parched/cracked

Eyes Normal Deep set Sunken

Tears Present Reduced None
Fontanelles Flat Soft Sunken

CNS Consolable Irritable Lethargic/obtund

ed
Pulse rate Normal Sl increased Increased

Pulse quality Normal Weak Peeble

Capillary refill Normal ~ 2 secs >3 secs

Urine output Normal Decreased anuric

FLUID REPLACEMENT
Mild Moderate Severe
(in 8 (1/4 in 2 (1/3 in 2
hours) hrs then hrs then
¾ in the 2/3 in the
next 6 next 6
hours) hours)

Infant/< 15 50ml/kg 100 ml/kg 150 ml/kg

kg
Older child/ 30 ml/kg 60 ml/kg 90 ml/kg
> 15
kg
ICF & ECF COMPARTMENTS
Composition Intracellular Extracellular
(mEq/L) (mEq/L)

Na 20 133-145
K 150 3-5
Cl - 98-110
HCO3 10 20-25
PO4 110-115 5
CHON 75 10
ICF & ECF COMPARTMENTS
• In dehydration, there are
variable losses from the
extracellular and intracellular
compartments
• Percentage of deficit is based on
total duration of illness
 BASIC
MATH CONCEPTS
DECIMALS
All figures to the left of the decimal point are whole
numbers
All figures to the right of the decimal point are decimal
fractions

. 385 = .3 8 5
tenths

hundredth

thousandth
.385 = 385
1000
s

.38 = 38
s

100

.3 = 3
10
 CHANGING FRACTIONS TO DECIMALS:
• Fractions can be changed to decimals by dividing the
numerator and the denominator

» ¾ = 3÷4 = 0.75
 PERCENTAGE

• Percentage ( % ) means hundredths

• Percent ( % ) is the same as a fraction with
denomination as 100.

3% = 3
100

45
45% =
100
 CHANGING PERCENT TO A DECIMAL &
CHANGING DECIMAL TO PERCENT
• To change percent to a decimal, remove the percent sign
and divide the number by 100 or move the decimal point
two places to the left.

4% = 4/100 = .04 or 0.04

• To change a decimal to a percent, multiply by 100 or move

the decimal point two places to the right and place % sign.

0.04 X 100 = 4% or 0.04 = 4%

 RATIO
A Ratio consists of two numbers as separated by a
colon ( : )

e.g. 1:4
A ratio indicates that there is a relationship
between the two numbers.
A ratio is an indicated fraction.

e.g. ¼ = 1:4
The numbers in ratio must be expressed in the
same terms.
e.g. 3 inches : 2 feet = 3 : 24
(feet changes to
inches)
PROPORTION

It is a statement showing that the two ratios have

equivalent values
1 : 50 = 2 : 100

means
extreme
If one value is not
s known, it can be solved by using the
term X.

1 : X = 2 : 100 or
1 2
~
X 100
 THE METRIC SYSTEM

It is the international decimal system of weights and

measures
¤ In the metric system, fractions are expressed
as decimals
¤ In the decimal system, the fraction ½ is
written as 0.5

METRIC SYSTEM
Liter = vol. of fluids milli = one thousandths
Gram = weights of solids centi = one
hundredths
Meter = measure of length deci = one tenth
mcg = one thousandths
 RULE OF CONVERSION

When converting from a larger unit of measure to a

smaller unit, multiply the larger unit by (1000, 100,
10) or move the decimal to the right.
When converting a smaller unit of measure to a larger
unit, divide the smaller unit by (1000, 100, 10) or
move the decimal to the left.

e.g. 2.5 grams = ___________ mg.

 APOTHECARIES SYSTEM

Grain (gr) Dram Ounce Minims Pounds

Approximate Equivalent Value:

1 gr = 60 mg
1 ml = 15 minims (16 minims)
1 ounce = 30 ml
1 ounce = 30 Gm
1 kg = 2.2 pounds

e.g. 60 gr = _________ mg.

4 oz = _________ ml.
 HOUSEHOLD MEASURES

1 teaspoon (tsp) = 4 – 5 ml
1 Tablespoon (Tbsp) = 3 teaspoons (tsp)
1 Tablespoon = 15 ml
1 milliliter = 15 drops (gtts)

e.g. 5 ml = ______
 CONVERSION OF TEMPERATURE
Normal Temperature = 37°C = 98°F
Conversion of Centigrade (Celsius) to Fahrenheit:

°C = 5 ( °F ) – 32
Conversion of
9 Fahrenheit to Centigrade (Celsius):

°F = 9 ( °C ) + 32
5
Interpretation of Doctor’s Order for Drugs
• The nurse must understand the order perfectly before acting on it
– > The Drug
– > The Dose
– > The Route
– > The Frequency

• If any of the above are unclear or open for interpretations, it is the

Responsibility of the nurse to clarify the order with the physician.
Example:
The order reads : Inderal 2 x4
a. What is the Drug?
b. What is the Dose?
c. What is the Route?
d. What is the Frequency?
e. Do
es this order need clarification?

The order reads : Lasix 10 mg IV 1 ml O.D.

a. What is the Drug?
b. What is the Dose?
c. What is the Route?
d. What is the Frequency?
e. Does this order need clarification?
 BASIC
MATH CONCEPTS
 DECIMALS

All figures to the left of the decimal point are whole numbers
All figures to the right of the decimal point are decimal
fractions

.385 = 385

thousandth 1000
hundredth
tenths

.38 = 38
100
s

.3 = 3
s

. 385 = .3 8 5 10
 CHANGING FRACTIONS TO DECIMALS:
• Fractions can be changed to decimals by dividing the
numerator and the denominator

» ¾ = 3÷4 = 0.75
 PERCENTAGE

• Percentage ( % ) means hundredths

• Percent ( % ) is the same as a fraction with
denomination as 100.

3% = 3
100

45
45% =
100
CHANGING PERCENT TO A DECIMAL &
CHANGING DECIMAL TO PERCENT

To change percent to a decimal, remove the percent

sign and divide the number by 100 or move the decimal
point two places to the left.

4% = 4/100 = .04 or 0.04

To change a decimal to a percent, multiply by 100 or

move the decimal point two places to the right and
place % sign.

0.04 X 100 = 4% or 0.04 = 4%

 RATIO
A Ratio consists of two numbers as separated by a
colon ( : )

e.g. 1:4
A ratio indicates that there is a relationship
between the two numbers.
A ratio is an indicated fraction.

e.g. ¼ = 1:4
The numbers in ratio must be expressed in the
same terms.
e.g. 3 inches : 2 feet = 3 : 24
(feet changes to
inches)
PROPORTION

It is a statement showing that the two ratios have

equivalent values
1 : 50 = 2 : 100

means
extreme
If one value is not
s known, it can be solved by using the
term X.

1 : X = 2 : 100 or
1 2
~
X 100
THE METRIC
SYSTEM

It is the international decimal system of weights and

measures
¤ In the metric system, fractions are
expressed as decimals
¤ In the decimal system, the fraction ½ is
written as 0.5

METRIC SYSTEM
Liter = vol. of fluids milli = one
thousandths
Gram = weights of solids centi = one hundredths
Meter = measure of length deci = one tenth
mcg = one
thousandths
RULE OF CONVERSION

• When converting from a larger unit of

measure to a smaller unit, multiply
the larger unit by (1000, 100, 10) or
move the decimal to the right.
• When converting a smaller unit of
measure to a larger unit, divide the
smaller unit by (1000, 100, 10) or
move the decimal to the left.

e.g. 2.5 grams = ___________

mg.
 APOTHECARIES SYSTEM

Grain (gr) Dram Ounce Minims Pounds

Approximate Equivalent Value:

1 gr = 60 mg
1 ml = 15 minims (16 minims)
1 ounce = 30 ml
1 ounce = 30 Gm
1 kg = 2.2 pounds

e.g. 60 gr = _________ mg.

4 oz = _________ ml.
 HOUSEHOLD MEASURES

1 teaspoon (tsp) = 4 – 5 ml
1 Tablespoon (Tbsp) = 3 teaspoons (tsp)
1 Tablespoon = 15 ml
1 milliliter = 15 drops (gtts)

e.g. 5 ml = ______
 CONVERSION OF TEMPERATURE
Normal Temperature = 37°C = 98°F
Conversion of Centigrade (Celsius) to Fahrenheit:

°C = 5 ( °F ) – 32
Conversion of
9 Fahrenheit to Centigrade (Celsius):

°F = 9 ( °C ) + 32
5
Interpretation of Doctor’s Order for Drugs
• The nurse must understand the order perfectly before acting on it
– > The Drug
– > The Dose
– > The Route
– > The Frequency

• If any of the above are unclear or open for interpretations, it is the

Responsibility of the nurse to clarify the order with the physician.
Example:
The order reads : Inderal 2 x4
a. What is the Drug?
b. What is the Dose?
c. What is the Route?
d. What is the Frequency?
e. Does this order need clarification?

The order reads : Lasix 10 mg IV 1 ml O.D.

a. What is the Drug?
b. What is the Dose?
c. What is the Route?
d. What is the Frequency?
e. Does this order need clarification?
 GENERAL FORMULA FOR DRUG CALCULATION
1. D
xQ
S

2. Calculation by Ratio : Proportion

8 mg : x = 16 mg : 1 tab

(works for any computation of Dosage if you have a

given and a need to determine the unknown).

Rule :
1. Units for each ratio must be the same.
2. Units for each ratio must be placed in the same order.
 Computation of Dosages:
When the dose prescribed is in milligram (mg) and the dose
available is in Gram (Gm) or vice versa.

E.g. The order reads : 0.008 Gm of Morphine Sulfate IV

q4 hours prn for pain. Ampule available is
labeled 10 mg/ml.

1. What do you know?

0.008 Gm - 8 mg
10 mg/ml -
2. What do you need to know? Known
amount in cc for 0.008 Gm dose
3. Setting up the proportion:
a. the units for each ratio must be placed in the
same order
b. the units for each ratio must be the same
( mg to mg )
8mg : X = 10 mg : ml
4. solve for the correct dosage

8 mg : X = 10 mg : ml

10 mg X = 8 mg/ml

X = 8 mg/ml
10 mg

X = .8 ml
• When the dose is ordered in one system and the
dose on hand is in another system.

E.g. The order reads : codeine sulfate ¼ gr

P.O. q 8 hrs PRN for pain. Tablets on hand are
labeled 0.015 Gm tablets.

1. What do you know? Known

¼ gr 1 gr = 60 mg
0.015 Gm / tab1 Gm = 1000 mg
¼ = .25
2. What do you need to know?

# of tablets for ¼ gr dose

3. Setting up the proportion
a. the units for each ratio must be the same
b. the units for each ratio must be placed in
the same order.

.25 gm : X = 0.015 gm : 1 tab

15 mg : x = 15 mg : 1 tab

4. Solve for the correct dosage:

15 mg : x = 15 mg : 1 tab

15 mg x = 15 mg / tab

x = 15 mg / tab
15 mg
x = 1 tab
 Computation of Correct Insulin Dosage
• U - 40 means
• U - 80 means
• U - 100 means

• Insulin syringes are calibrated

according to the strength of insulin
with which it is to be used.

• U 40 insulin needs a U 40 syringe

• U 80 insulin needs a U 80 syringe
 If this can not be done, the dose can be converted to
milliliters
Dose Required
Dose on Hand X 1 ml = ml needed
• Serious error can occur if incorrect syringe or
incorrect b calculations are used
• It is essential that all insulin be checked by a
second RN to confirm that errors in dosage are not
made and error in the type of insulin were not
made.
Fractional Dosages
in Infants and
Children
 Children’s Doses
• Clarks’ Rule:
weight of child in pounds X A.D. = child’s dose
150

• Body Surface Area e.g. Wt = 10 kg

BSA X A.D. = child’s dose
1.7
BSA = 4(wt in kg) + 7 = BSA in m²
wt in kg + 90

= 4(10 kg) + 7 = 47
10+ 90

= .47 m²

Child’s dose = .47 m² X 500

1.7
• Youngs’ Formula:

Age of child in Years

X A.D. = Child’s
dose
Age of child + 12
CALCULATION OF FLUID VOLUME
(BASED ON BODY WEIGHT)

1. WEIGHT --- 1 – 10 kg. --- 100ml/kg.

Eg. Wt = 8 kg. --- 800cc
2. WEIGHT --- 11 – 20 kg.---
1,000+50ml/excess b.wt.
Eg. Wt = 15 kg. 1,000=250ml =
1,250ml

15 50
-10 X 5
5 250

3. WEIGHT > 20 kg.

Eg. Wt = 27 kg. 1,500 + 20
ml/excess b.wt.
1,500 + 140 ml =
1640 ml.
27 20
-20 X 7
7 140
 Calculation of IV Flow Rates

• Calculation of cc/hr is essential in most IV therapy.

Volume
# of hrs
= cc/hr

E.g. 1 L over 8 hrs = 125 cc/hr

50 cc over 20 minutes = 150 cc/hr

 Calculation of gtt/min (Long
Method)
STEPS :
1. Need to know cc/hr to calculate
2. Gtt factor = gtt / ml
gtt factors : macrodrip 10, 15, 20 gtts/ml
microdrip 60 gtt/ml

EXAMPLE : LONG METHOD

Doctors Order : Run 1L D5W over 8 hours

Microdrip - 1000 ml ÷ 8 hours = 125 cc/hr

125 cc x 60 gtt/ml = 125 gtt/ml

60 min 1

10 gtt/ml set 125cc x 10 gtt/ml = 20 – 21 gtt/min

60 min 1
15 gtt/ml set 125cc x 15 gtt/ml = 31 gtt/min
60 min 1
20 gtt/ml set 125 cc x 20 gtt/ml = 41 – 42 gtt/min
60 min 1
 SHORT METHOD

cc / hr ÷ 6 for 10 gtt / min

cc / hr ÷ 4 for 15 gtt / min

cc / hr ÷ 3 for 20 gtt / min

cc / hr = gtt / min for microdrip set

Sources
• Fluids & Electrolytes, Lippincott
Williams & Wilkins
• Fluids & Electrolytes, Walters Kluwer
• Nelson’s Texbook of Pediatrics
• WHO department of child and
adolescent development
• (Medline Plus)
http://www.nlm.nih.gov/MEDLINEPLUS/en
cy/article/000982.htm