Calculations involving parenteral admixtures

By: Tsegaye N. (B. Pharm, MSc)

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 Objectives

Upon successful completion of this chapter, the student will be able

to:
Perform calculations for dry powder for reconstitution.

Perform calculations for intravenous additives.

Perform rate-of-flow calculations for intravenous fluids.

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 Introduction
 Parenteral is any medication route other than the alimentary canal
and thus, includes all routes of injection.
 Injections are sterile pharmaceutical solutions or suspensions of a
drug substance in an aqueous or nonaqueous vehicle.
 They are administered by needle into almost any part of the body,
including;
 the joints (intra-articular), joint fluid (intrasynovial),

 spinal column (intraspinal), spinal fluid (intrathecal),

 arteries (intra-arterial), and the heart (intracardiac).

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 Cont’d…

 However, most injections are administered into

a vein (intravenous, I.V., IV),

 muscle (intramuscular, I.M., IM),

skin (intradermal, I.D., ID, intracutaneous), or

under the skin (subcutaneous, sub-Q, SQ, hypodermic).

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 Cont’d…
Depending upon their use, injections are packaged
 in small volumes in ampoules or

 in prefilled disposable syringes for single-dose

use;

 in large volume plastic bags or glass containers for

administration by slow intravenous infusion.

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 Cont’d…
 In vials and pen-injectors for single- or multiple-dose use

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 Cont’d…

 Some injections are available as;

 prepared solutions or suspensions with their drug content

labeled as, for example, ‘‘10 mg/mL.’’ or
 Others contain dry powder for reconstitution to form a solution
or suspension by adding a specified volume of diluent prior to
use and are labeled as, for example, ‘‘10 mg/vial.’’

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Dry powders for reconstitution

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 Cont’d…
 They are provided as dry powder form for reconstitution with
purified water or special diluent at the time a prescription or
medication order is received.

 It is to enhance the shelf-life of these drugs that lose their potency

in a relatively short period when prepared in a liquid dosage form
i.e. suspension or emulsion.

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 Cont’d…

 In addition to therapeutic agents, the powder contains such

pharmaceutical ingredients as solubilizing or suspending agents,
stabilizers, colorants, sweeteners, and flavorants.
 The final volume of product is the sum of the volume of solvent
or diluent added and the volume occupied by the dissolved or
suspended powder mixture.

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Calculations for the Constitution of Dry Powders for
Oral Use

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 Cont’d…
2. Label instructions for an ampicillin product call for the addition of
78mL of water to make 100mL of constituted suspension such that
each 5mL contains 125 mg of ampicillin. Calculate the volume
represented by the suspended powder in the product and the total
content of ampicillin.
a. Volume of powder:100mL − 78mL = 22mL

b. each 5mL contains 125mg of ampicillin, the total amount of ampicillin in the
100mL product is:

125mg/5mL = x/100mL, x = 2500mg ampicillin.

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 Calculations for the Constitution of Dry Powders for
Parenteral Use

E.g.1 Label instructions for the reconstitution of a 500mg vial of

ceftazidime for intramuscular injection call for the addition of
1.5mL of diluent to prepare 1.8mL of injection. Calculate;

a) the volume occupied by the dry drug,

b) the concentration of ceftazidime in the injection, in mg/mL,

c) the volume of injection to provide a dose of 250 mg of ceftazidime.

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 Cont’d…

Soln

a. volume of ceftazidime = total solution volume – water volume

= 1.8mL − 1.5mL = 0.3mL

b. (ceftazidime) in mg/mL

=500 mg/1.8mL

= 277.8 mg/mL, and

c. 500mg/1.8mL = 250mg/xmL

= 250 mg × 1.8mL/500 mg

= 0.9mL 14
 Intravenous Admixtures

 An IV admixture is the preparation of a pharmaceutical mixture of

two or more drugs into a large volume of sterile IV fluid.
 IV fluid includes;

sodium chloride injection,

dextrose injection,

lactated Ringer’s injection, and others.

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 Cont’d…
E.g. How many grams each of dextrose and sodium chloride are
used to prepare a 250-mL bag of D5½NS for intravenous infusion?

NB.

D5½NS = 5% Dextrose in 0.45% Sodium Chloride

Answer;

250 mL x 0.05 (5% w/v) = 12.5 g dextrose, and

250 mL x 0.0045 (0.45% w/v) = 1.125 g sodium chloride.

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 Hyperalimentation (Total Parenteral Nutrition)

 Parenteral nutrition (PN) or intravenous hyperalimentation

(IVH) is
 the feeding of a patient by the intravenous infusion of fluids
and basic nutrients.
 intravenous feeding, especially to individuals unable to take
in food through the alimentary tract.
• PN can be partial or total parenteral nutrition.

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 Cont’d…

 Parentral nutrition consists of;

A. Macronutrients:
 Carbohydrate (e.g., dextrose)
 Protein (e.g., amino acids)
 Fat (e.g., lipid emulsions)

B. Micronutrients:
 Electrolytes
 Vitamins
 Trace elements

C. Sterile water for injection

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 Cont’d…

E.g. A hyperalimentation order for a patient includes 30mg of

amphotericin B, 50units of heparin, 25mEq of potassium acetate,
and 1.5mg of folic acid to be administered intravenously in
1000mLof D5W over an 8hour period. In filling the medication
order, the following sources are available:
 Avail containing 50mg of amphotericin B in 10ml

 A syringe containing 10 units of heparin per ml

 A 20ml vial of 40meq of potassium acetate

 An ampoule containing 5mg of folic acid per ml

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 Cont’d…
 How many mL of each additive should be used in filling the
medication order?

Soln;
 Amphotericin B: 50mg/10ml = 30mg/x = 6mL

 Heparin: 10units/1ml = 50units/xmL = 5mL

 Potassium acetate: 40mEq/20mL =25mEq/xmL = 12.5mL

 Folic acid: 5mg/1mL = 1.5mg/xmL = 0.3mL

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 Rate of Flow of IV Fluids
 On medication orders, the physician specifies the rate of flow of
intravenous fluids in
 Milliliters per minute,
 Drops per minute,
 Amount of drug (as milligrams per hour), or,
 More frequently, as the approximate duration of time of
administration of the total volume of the infusion.

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Cont..

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 Cont’d…

Examples of Rate-of-Flow Calculations

E.g. 1, A medication order calls for 1000 mL of D5W to be

administered over an 8-hour period. Using an IV administration set
that delivers 10 drops/mL, how many drops per minute should be
delivered to the patient?

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 Cont’d…
Answer,

Volume of fluid = 1000 mL = 10drops/ml x 1000ml = 10,000gtt

8 hours = 480 minutes

1000 (mL)/480 (minutes) = 2.08 mL per minute

Or,
Rate of flow (drops/minute) =[Volume infused (mL) x Dripset
(drops/mL)]/Time(’)

= [1000 mL x 10 drops/mL]/480 minutes

= 20.8 or 21 drops per minute

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 Cont’d…
E.g. 2,
Ten milliliters of 10% calcium gluconate injection and 10 mL of
multivitamin infusion are mixed with 500 mL of a 5% dextrose
injection. The infusion is to be administered over 5 hours.
If the dropper in the venoclysis set calibrates 15 drops/mL, at what
rate, in drops per minute, should the flow be adjusted to administer
the infusion over the desired time interval?

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 Cont’d…
Answer,

Total volume of infusion (mL)= 10 mL + 10 mL + 500 ml =

=520 mL

Total volume of infusion(drops) = 520mL X 15 drops/mL

= 7800 drops

=7800 drops/5 hr

26 drops per minute

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 Cont’d…
E.g. 3 An order for a patient, with a 3-liter daily IV fluid limit, calls for 3 L
of D5W with a 100-mL IVPB antibiotic to be run-in alone over a 1-hour
period and administered every 6 hours. The administration set is
calibrated to deliver 10 drops per milliliter. Calculate:

a. The flow rate of the IVPB antibiotic;

b. The total flow time for the IV antibiotic /day;

c. The total volume for the IV antibiotic /day;

d. The total flow time for the D5W;

e. The total volume for the D5W;

f. The flow rate for the D5W.

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 Cont’d…
• Soln;

(a) [100 mL * 10 drops/mL]/60 min

= 16.6 or 17 drops per minute;

(b) 1 hour * 4 times a day = 4 hours or 240 minutes;

(c) 100 mL 4 times a day = 400 mL;

(d) 24 hours - 4 hours (run time for the antibiotic) = 20 hours or 1200
minutes;

(e) 3000 mL - 400 mL (the IVPB antibiotic) = 2600 mL;

(f) [2600 mL * 10 drops/mL]/1200 min

21.6 or 22 drops per minute, answers. 28

Quiz

1. A patient received 150 mL of an infusion at a rate of 25

mL/hr.
a) What was the infusion time in hours, minutes?

b) If the infusion was begun at 8 AM, at what time was it completed?

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Thank you

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