DRIP

TRICKS
 Medication Calculations
• In Critical Care, often medications are ordered as
IV continuous drips
• These medications are potent and requires
constant monitoring to assess for desired effect
and potential side effects
Medications may be ordered in:
• “mg/hr”: Lasix and Aminophylline 
• “units/hr”: Heparin and Insulin 
• “mcg/min”: Nitroglycerin 
• “mcg/kg/min”: Dopamine and Dobutamine
• “mg/min”: Lidocaine
 Units of Measure
• 1000 μg = 1 mg • 1 kg = 2.205 lbs.
• 1000 mg = 1g • 1000 mL = 1 L
• 1000 g = 1 kg • 1 mL = 1 cc = 1 cm3

To convert from one multiple to the other, move the decimal

point 3 places in the direction indicated
kg 3g 3 mg 3 μg
 Drip Formulas
mg/ml mg of medicine
mL of solution

mg/hr mg of medicine x infusion rate

mL of solution (ml/hr)

mg/min mg of medicine x infusion rate ÷ 60

mL of solution (ml/hr)

mg/kg/mi mg of medicine x infusion rate ÷ 60 ÷ pt.’s weight in kg

n mL of solution (ml/hr)
 Drip Formulas
μg/ml mg of medicine x 1000
mL of solution

μg/hr mg of medicine x 1000 x infusion rate

mL of solution (ml/hr)

μg/min mg of medicine x 1000 x infusion rate ÷ 60

mL of solution (ml/hr)

μg/kg/mi mg of medicine x 1000 x infusion rate ÷ 60 ÷ pt.’s weight in

n mL of solution kg
(ml/hr)
 Drip Formulas

Rate in volume to be given x # of gtts/ml of IV set ÷ 60

gtts/min hrs to be given

Rate in mL/hr μg/kg/min to be given x 60 x pt.’s weight in kg

drip concentration in μg/mL

Rate in mL/hr mg/kg/min to be given x 60 x pt.’s weight in kg

drip concentration in mg/mL
 Calculating Drops Per Minute
gtts/min = volume to be infused X gtts/mL of administration set
total time in minutes

Infuse 500 cc of PNSS over 3 hours. Using a 15 gtts/mL

administration set what drip rate would you use?

gtts/min = 500 mL X 15 gtts/mL = 41.66 gtts/min

180 minutes
Calculating Solution Concentration
mg in solution divided by mL in solution

To prepare your lidocaine infusion you have mixed 2

grams of lidocaine into 500 mL of D5W. How much
lidocaine is in 1 mL of this solution?

2000 mg = 4 mg/mL
500 mL
Calculating Solution Concentration
To prepare your dopamine infusion you have mixed
800 mg of dopamine into 500 mL of D5W. How much
dopamine is in 1 mL of this solution?

800 mg = 1.6 mg *1.6 mg X 1000 = 1600 μg/mL

500 mL
 Calculating mg/min OR
Calculating μg/min

gtts/min = volume on hand X drip factor X desired dose

dosage on hand

Administer 2 mg per minute of lidocaine to a patient. To

prepare the infusion you mix 2 grams of lidocaine in an IV bag
containing 500 mL of D5W. You will use a microdrop
administration set (60 gtts/mL). Calculate the infusion rate.

gtts/min = 500 mL X 60 gtts/mL X 2 mg = 30 gtts/min

2000 mg
 Calculating μg/kg/min
gtts/min = desired dose X weight (kg) X drip factor
solution concentration

Administer 5 mcg/kg/min of dopamine to a patient weighing

85 kg. To prepare the infusion you mix 800 mg of dopamine in
500 mL of D5W (1600 mcg/mL). You will use a mIcrodrop
administration set (60 gtts/mL). Calculate the infusion rate.

gtts/min = 5 mcg X 85 kg X 60 gtts/mL = 15.94 gtts/min

1600 μg
 Calculating μg/kg/min
Using the same information from the above patient
calculate the same infusion using a macrodrop
administration set (15 gtts/mL).

gtts/min = 5 mcg X 85 kg X 15 gtts/mL = 3.98 gtts/min

1600 μg
 Drip Trick #1:
C Factor x pump rate = μg/kg/min

• There’s standard drip mixture hanging, and you’re

having to titrate often. To simplify the calculation
of μg/kg/min each time you change the infusion
rate, calculate a constant (C factor or Magic
Number)
• Each time you change the infusion rate, multiple
the new rate by the C factor to determine the
μg/kg/min you are now giving
C = mg of med X 1000 ÷ 60 ÷ pt’s wgt in kg
mL of solution
 Drip Trick #1:
C Factor x pump rate = μg/kg/min

• you have Dopamine 800mg mixed in 500mL and your

patient weighs 70kg.
C = 800 X 1000 ÷ 60 ÷ 70
500
C = 0.38

C Factor x Pump Rate = μg/kg/min

0.38 x 10 mL/hr = 3.8 μg/kg/min
0.38 x 15 mL/hr = 5.7 μg/kg/min
0.38 x 25 mL/hr = 9.5 μg/kg/min
0.38 x 40 mL/hr = 15.2 μg/kg/min
 Drip Trick #2:
pump rate = μg/kg/min

• If you mix the drip according to the patient’s

weight, the infusion rate dialed into the pump (the
mL/hr) will equal the dose in μg/kg/min

the mg of med = 60 x pt wt in kg x mL of solution you want to mix in

you need 1000
 Drip Trick #2:
pump rate = μg/kg/min

For a patient weighing 70kg, you want to know how many mg

of Dopamine to mix in 500mL of solution, so that the mL/hr
infusion rate equals the μg/kg/min
mg of Dopamine = 60 x 70kg x 500mL = 2100mg
1000
So if you mix: 2100 mg of Dopamine
in 500mL

An infusion rate of 5mL/hr delivers 5 μg/kg/min

10mL/hr delivers 10 μg/kg/min
20mL/hr delivers 20 μg/kg/min
30mL/hr delivers 30 μg/kg/min
 Drip Trick #2:
pump rate = μg/kg/min

If you want a more dilute mixture, cut the mg in half

(2100mg/2 = 1050)

So that when you mix: 1050 mg of Dopamine

in 500mL

An infusion rate of 5mL/hr delivers 2.5 μg/kg/min

10mL/hr delivers 5 μg/kg/min
20mL/hr delivers 10 μg/kg/min
30mL/hr delivers 15 μg/kg/min
Common Drips
 Aminophylline
• Bronchodilator, bronchial smooth muscle
relaxant, for treatment of acute asthma or
bronchospasm associated with chronic
bronchitis or emphysema
• AE: Irritability, restlessness, tremor, insomnia,
headache, dizziness, drug-related seizures,
tachycardia, palpitations, extrasystoles,
hypotension, nausea, vomiting, anorexia,
abdominal pain, diarrhea, tachypnea,
respiratory arrest
 Aminophylline
• Prep: 25mg/mL in 10mL vial
• IVP: 5mg/kg loading dose slowly over 30 minutes
(no faster than 20mg/min)
• Drip: 500mg/500mL D5W/NS
• Concentration 1mg/mL
• Dose: 0.5 – 1.5 mg/kg/hr
 Amiodarone
• Anthiarrhythmic with effects on Na, K and Ca
channels, as well a Beta blocking properties
• AE: Hypotension in 16% of patients (related to
rate of indusion); Bradycardia occurs in 5%; New
onset Vtach/Vfib or Torsades De Pointes,
pulmonary infiltrates
 Amiodarone
• Prep: 50mg/mL in 3mL amp
• IVP: 150mg in 100mL D5W over 10 mins
• Drip: 900mg/500mL (D5W-Glass)\
• Concentration: 1.8mg/ml
* stable in plastic up to 2 hours, stable in glass up to 24 hours
• Dose: 1mg/min X 6 hours to give 360, then
0.5mg/min X 18 hours to give 540mg
• If breakthrough Vtach occurs: 150mg in
100D5W bolus then increase drip rate
 Diltiazem
• Ca channel blocker with potent negative
chronotropic and mild negative inotropic effects;
for acute Afib and Aflutter
• AE: Hypotension, flushing, 2nd or 3rd degree AV
Block, bradycardia, asystole, Vtach, Vfib, LV
failure, dyspnea, peripheral edema, chest pain,
Nausea, vomiting, dry mouth, constipation,
injection site reaction
 Diltiazem
• Prep: 5mg/ml in 25 & 50 mL vials
• IVP: 0.25 mg/kg (about 20mg) over 2 mins; if
inadequate response, wait 15 mins, then
0.35mg/kg
• Drip: 125mg/25mL Diltiazem + 100ml D5W/NS
• Concentration: 1mg/mL
• Dose: 5-15mg/hr Titrate to HR
• Do not give >15mg/hr or for >24 hours
 Dobutamine
• Synthetic sympathomimetic catecholamine with
inotropic, chronotropic & vasodilator effects. For
heart failure, especially with ↑ SVR & ↑ PVR, and
for RV infarction.
• AE: Dose related tachycardia can  Myocardial
ischemia. PVC’s, & ↑ infarct size. ↑ vent. Response
to A fib, Headache, nausea, tremor, ↑ BP (may be
precipitous), ↓ K, HA, dyspnea, palpitations,
nausea.
 Dobutamine
• Prep: 250mg in 20mL vial.
• IVP: N A
• Drip: 500mg/500mL D5W, NS, D5NS, RL
• Conc: 1000 µg/mL
• Or: 1000mg/500mL D5W, NS, D5NS, RL
• Conc: 2000 µg/mL
• OK if solution is pink, avoid alkaline solutions
• Dose: 2-10 µg/kg/min (up to 40 µg/kg/min)
• May need to ↑ dose for pt on β-blockers
 Dopamine
• Cathecolamine precursor of epinephrine &
norepinephrine with inotropic, chronotropic
and vasoactive effects.
• For bradycardia that is refractory to atropine
• For heart failure, hypotension unresponsive to
fluids, septic and anaphylactic shock. No longer
recommended for oliguric renal failure
• AE: At low dose may decrease BP, at high dose
increase HR & SVR, tachycardia, increase
MVO2, PVC’s, myocardial ischemia, atrial and
ventricular arrhythmias, renal ischemia at high
dose
 Dopamine
• Prep: 40mg/mL in 5mL; 80mg/mL in 5mL
• IVP: NA
• Drip: 800mg/500mL (D5/D5NS/NS/RL)
• Conc: 1600µg/mL
• Dosing:
• 1-3 µg/kg/min: increase renal perfusion
• 3-10 µg/kg/min: increase contractility
• >10 µg/kg/min: vasoconstriction
• >20 µg/kg/min like Levophed
 Epinephrine
• Natural & potent cathecolamine with both alpha
and beta adrenergic agonist effects; increases
BP, HR, SVR, cerebral and coronary blood flow,
myocardial O2 demand, contractility,
automaticity;
• For PEA, asystole, bradycardia, VTach, Vfib
unresponsive to defibrillation; anaphylaxis
• AE: hypertension, headache, tremors,
myocardial ischemia, increase MVO2,
tachycardia, ectopy, Vfib, renal ischemia, CVA
 Epinephrine
• Prep: 1mg/mL in 1mL amp
• IVP: for cardiac arrest 1mg q3-5 mins
• Drip: 2mg/250mL (D5/NS)
• Conc: 8 µg/mL
• Dose: start at 1 µg/min then 2.0-10 µg/min
• ET: 2-2.5 times the IV dose
 Furosemide
• Potent, rapid acting diuretic (inhibits the
reabsorption of Na, K H2O) & venodilator for
pulmonary edema associated with LV failure, also
for nephrotic syndrome, ascites and hypertension
• AE: dehydration, hypotension, hyponatremia,
hypokalemia, hypocalcemia, hypomagnesemia,
hyperosmolality, metabolic alkalosis, ototoxicity
at high doses
 Furosemide
• Prep: 10mg/mL in 2, 4, 10 mL amps & vials
• IVP: 0.5-1.0 mg/kg over 1-2 mins repeat to total of
2mg/kg
• Drip: 250mg/250mL (D5W, NS, RL)
• Conc: 1mg/mL
• Dose: 2-20mg/hr (do not exceed 1g/day total)
 Lidocaine
• An antidysryhtmic, may be used to supress
ventricular ectopy and treat Vfib/Vtach that persists
after defibrilation, epinephrine, and Amiodarone.
• Second choice behind Amiodarone and Procainamide
for hemodynamically stable V Tach
• Ineffective against atrial arrhythmias
• AE: Myocardial depression, ↓ BP. Aggravation of
arrhythmia, respiratory depression / arrest.
Bradycardia.
• Toxicity: drowsy, disoriented, paresthesias, muscle
twitching, grand mal seizure.
 Lidocaine
• Prep: For IVP: 100 mg/ 5 mL in syringe
• For drip: 1 gram in 50 mL
• IVP: 1.0-1.5 mg/kg; if no response, repeat q 5-10
mins to total 3 mg/kg (1/2 these dosages if pt
has ↓ hepatic blood flow or is over 70 y/o)
• Drip: 2 gm/500 mL D5W
• Conc: 4mg/mL
• Dose: 1-4 mg/min, titrate in increments of 1
mg/min, repeat bolus with each ↑
 Magnesium Sulfate
• Replacement therapy for Mg deficiency.
• Hypomagnesemia can precipitate refractory Vtach,
Vfib, pump inefficiency, sudden cardiac death
• May benefit polymorphic VTach (Torsades de
Pointes)
• AE: hypermagnesemia, expecially in pts with renbal
insufficiency, flushing, sweating, sensation of heat,
hypotension (keep patient supine), paralysis,
respiratory paralysis, circulatory collapse, cardiac
arrest, CNS depression (have Ca on hand)
 Magnesium Sulfate
• Prep:
• 10% = 0.10 g/mL = 0.8 mEq/mL
• 20% = 0.20 g/mL = 1.6 mEq/mL
• 50% = 0.50 g/mL = 4.0 mEq/mL
• IVP: 1-2 g in 50 -100 mL D5W over 5-60 mins
• Drip: 1-2g/100mL D5W/NS
• Conc: 0.01-0.20 g/mL or 0.08-0.16 mEq/mL
• Dose: 1-2 g/hr (or 8-16 mEq/hr)
 Nicardipine
• A calcium channel blocker with potent
vasodilatory effect on systemic, coronary, cerebral
and renal vasculature
• Used to treat hypertension and angina
• During PTCA, pretreatment with intracoronary
Nicardipene protects against ischemia
• AE: irritation at infusion site (rotate site q12 hrs),
hypotension, flushing, dizziness, tachycardia,
PVC’s, palpitations,
 Nicardipine
• Prep: 25mg/mL in 10mL amp (2.5mg/ml)
• IVP: NA
• Drip: 25mg/250mL D5W/NS
• Conc: 0.1mg/mL
• Dose: 5mg/hr (50mL/hr), increase increments of
2.5mg/hr (25ml/hr) q14 mins to max of 15mg/hr
• Reduce dose in pts with hepatic disease
 Nitroglycerin
• Dilates peripheral/coronary vasculature by
relaxing vascular smooth muscle.
• For treatment of myocardial ischemia and
infarction and to ↑ coronary blood flow in CHF.
• Also to ↓ preload and ↓ afterload in left
ventricular failure. Preferred over Nipride in pts
with CAD.
• To treat hypertension after cardiac surgery.
 Nitroglycerin
• AE: Hypovolemia, hypotension, (put head down,
feet up).
• Fainting if pt sits up, Reflex tachycardia,
Headache, flushing, 15% are resistant to its
antihypertensive effects, Develop tolerance over
1-2 d.
 Nitroglycerin
• Prep: 5 mg/mL in 1, 5, & 10 mL vials.
• IVP: May give 12.5-25 µg bolus
• Drip: 50 mg/ 250 mL D5W in glass, with
nonabsorbing tubing
• Conc: 200 µg/mL
• Dose: 5-20 µg/min, ↑ in increments of 5 µg/min q
5-10 mins (max dose is 200 µg/min). If topical or
po doses started, ↓ drip to < 20 µg/min.
 Norepinephrine (Levophed)
• Naturally ocurring catecholamine with potent α1,
α2, β1, β2 agonist activity. Vasoconstrictive effects
used for the treatment of hypotension due to low
SVR (septic shock).
• Increases contractility and MVO2.
• β1 effects are similar to the Epi, has minimal β2
effect.
 Norepinephrine (Levophed)
• AE: Hypertension, Myocardial ischemia,
Arrhythmias, bradycardia, ↓ Renal/mesenteric
blood flow, Tissue slough if it infiltrates.
 Norepinephrine (Levophed)
• Prep: 1 mg/mL in 4 mL amp.
• IVP: NA
• Drip: 8 mg/500 mL D5W, D5NS, not NS
• Conc: 16 µg/mL
• Dose: 2-12 µg/min (up to 30 µg/min)
• Start at 0.5 µg/min
• Expect great individual differences in dose
required.
 Potassium Chloride
• To prevent or treat potassium deficiency.
• ↓ K is most often due to:
• Corticosteroids
• Diuretics
• NG suction, vomiting, diarrhea, Metabolic
acidosis
 Potassium Chloride
• AE: If given peripherally, pain / irritation of IV
site and peripheral vein.
• Toxicity (K > 5.5): confusion, irritability, flaccid
paralysis, respiratory distress, ↓ BP arrhythmias,
widened QRS, prolonged PR and QT -> V fib.
 Potassium Chloride
• Prep: 2 mEq/mL in 10 & 20 mL vials
• IVP: Never
• Drip:
• Rapid replacement: 10-40 mEq/100 mL D5W
(use central line)
• Slow replacement: 20-40 mEq/1000mL
(peripheral line)
• Dose: 5-40 mEq/hr (Never > 40 mEq/hr)
 Sodium Bicarbonate
• The most widely used buffering agent, but no
longer routinely used in cardiac arrest unless pt
has:
• Preexisting metabolic acidosis
• Hyperkalemia
• Tricyclic or phenobarb overdose
• Prolonged CPR
 Sodium Bicarbonate
• AE: Iatrogenically induced alkalosis,
Hypernatremia, Hyperosmolality, Left shift of
O2 / Hgb curve can compromise release of O2 to
tissues.
 Sodium Bicarbonate
• Prep: 1 mEq/mL in 50 mL syringe
• IVP: 1.0 mEq/kg, then guided by ABG
• Drip: 300 mEq/500 mL = 5% solution
• Dose: Titrate to ABG