Formulas and Drips

FORMULAS ABG (FiO2 x 713) – pCO2 0.8 II PaO2 I III Target FiO2 + pCO2 II 0.8 713 x100

FiO2: RA = 0.21 NP = Lpm x 4 + 20 FM = Lpm x 10 – 10 RB = Lpm x 10 VR = 100% AB = 80 CPAP = Lpm x 4 + 20 Delta H [H+] = 24 x pCO 2 HCO3 ΔH = [H+] [H+] – 40 pCO2 - 40

HCO3 DEFICIT [Wt (kg) x 0.4] x [Desired - Actual]

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HYPERNATREMIA

Na Deficit = 10/12 x TBW

Water Deficit = [Actual Na-140] x TBW 140

TBW = wt (kg) x 0.6

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HYPONATREMIA

Desired HCO3: Normal = 20 CRF = 15 Give only ½ of the computed deficit 1 amp = 44 meqs NaHCO3

FM: 5-6 = 40% 6-7 = 50% 7-8 = 60% TP: 6 = 40% 7 = 70% 8 = 80% 9 = 90% 10 = 100% Target FiO2: < 60 = 80 > 60 = 80 – age above 60 COPDier = 60

Example: wt = 40 kg Na Deficit = (10) (40) (0.6) = 240 meqs using PNSS 1L, 240 meqs 154 meqs/L … 1.6 L … 1600 mL/24H = 67 cc/hr

Half-correction: 1/3 D5W 2/3 PNSS

CREATININE CLEARANCE (140-Age) (wt in kg) X 0.85 (F) 1 (M) Crea (mg/dL) x 72

Expected PF = Age x 5

<0.3 Chronic RF 0.3– 0.3–0.7 Acute on top of Chronic >0.7 Acute RF, INTUBATE

TBW = wt (kg) x 0.6 (male) 0.5 (female)

Normal Impairment CRI CRF ESRD Stage

1 2 3 4 5

80-120 50-80 20-50 5-20 <5

Description

GFR (mL/min/1.73m2)

Kidney Damage w/ Normal or inc GFR Kidney Damage w/ mild dec GFR Moderate dec GFR Severe dec GFR Kidney Failure <

BUN:CREA BUN:Crea Ratio = BUN x 2.8 Crea 88.4

≥ 90 60-90 30-59 15-29 15 or dialysis

Normal Pre-renal Renal Both

247.26 > 15 < 15 15-25

24H Creatinine Clearance (mL/min) CrCl = Urine Cr (mg/dL) x Volume (mL) (mL) Plasma Cr (mg/dL) x Time (min) Conversion Factors: BUN (mg/dL) x 0.357 = __ mmol/L

Crea (mg/dL) x 88.4

= __ mmol/L

Anion Gap

Elevated AG: Ketoacidosis Lactic Acidosis RF (GFR < 20-30) Methanol & Ethylene Intoxication

Na - (Cl + HCO3) Normal = 12 ± 4 meqs

Reticulocyte Index Reticulocyte count x [Hgb x 15] 2 or Reticulocyte count x [Hct abn] x ½ [Hct N] > 2.5 Hemolysis < 2.0 Hypoproliferative Anemia or Maturation Disorder

Corrected Ca (mg/dL) (Calcium x 4) + 0.8 x (4-Albumin) 4

Diabetic Diet Ideal Body Weight (IBW) x 35 cal/kg = Total cal/day Serum Osmolality (mOsm/L) IBW = [height (in) x 2.54 – 150] – 10% (if female) [2 (Corrected Na + K)] + RBS (mmol/L) Example: Total Cal Req’t. = 2000 kcal/day 60% CHO = 2000 x 0.60 = 1200/4 = 300 g 20% CHON = 2000 x 0.20 = 400/4 = 100 g 20% Fats = 2000 x 0.20 = 400/9 = 45 g

Corrected Na = Actual Na + 1.6 [RBS (mg/dL) – 100] 100 

RBS (mmol/L) x 18 = ___ mg/dL

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Normal 280-300 mOsm/L DKA 300-320 HHS 330-380

OTF Feeding Weight (kg) x 35 kcal = ___ kcal/day x 60% CHO/4 x 20% CHON/4 x20% Fats/9

Urine Osmolality Specific Gravity

– 1

x 40,000

Mean Arterial Pressure (MAP; mmHg) Systolic BP + 2Diastolic BP 3 Body Mass Index (BMI) weight (kg) height (m)2

kcal/scoop Nutren = 35 Isocal = 83 Ensure = 42-43 Glucerna = 36-37

Normal Underweight Overweight Obese

<18.5 18.5-24.9 25-29.9 >30

D5W

D10W

Gluc 50g/L

Gluc 100g/L

IV Fluids PNSS D5LR Na 154 Cl 154

Na 130 Cl 109 K 4 Ca 3 HCO3 28

D5NM

D5NMK

D5IMB

Na 40 Cl 40 K 13

Gluc 50 Na 40 Cl 40 K 30

Na5 Cl 22 K 20 Mg 3 Acetate 23 PO4 3

DRIPS CA Drip

Actrapid Sliding Scale Clonidine Drip

Clonidine 2 amps (150 mg/amp) + Apresoline 2 amps (20 mg/amp) in 500cc PNSS or D5W x  ___ μgtts/min

Clonidine 2 amps in 500cc PNSS Systolic BP

Titrate by increments of __ μgtts to maintain BP ___ mm Hg (up to 60 μgtts/min)

Apresoline Drip Apresoline 2 amps (20 mg/amp) in PNSS 250cc

<160 160-180 180-200 >200

Dose (μgtts/min) close 20 25 30

Aminophylline Drip Aminophylline 4 a mps in 500cc D5W x ___ μgtts/min

Max: 400 mg/day

LD: 5-6 mg/kg BW MD: 0.2-0.5 mL/hr

Actrapid Drip 20 “u”  Actrapid + 100cc PNSS HGT < 160 160-199 200-249 250-299 300-349 350-399 400-499 ≥ 500

Actrapid close 3 cc/hr 8 10 15 20 25 30 & refer

< 200 200-249 250-299 300-349 350-399 400-449 450-499 > 500

close 15 20 25 30 35 40 45 & refer

Actrapid Drip for GDM 10 “u” Actrapid + 100cc PNSS HGT < 120 121-140 141-160 161-180 181-220 221-240 241-260 261-280 281-300 > 300

Actrapid close 6 cc/hr 8 10 14 16 18 20 22 refer

CBG <160 161-200 201-249 250-299 300-349 350-399 400-449 450-499 ≥500

Coverage no coverage 3 units 5 7 9 11 13 14 15 & refer

Burinex Drip Burinex 3 amps in 54cc PNSS x 10 cc/hr

Calcium Gluconate Drip Calcium Gluconate 4 amps (10mg/amp) in 500cc D5W x 24hr

Bricanyl Drip Bricanyl 5 amps in 500cc D5W x 24H Increase to 30-40 cc/hr Bricanyl 2.5 mg/tab TID

CBG ≤200 201-250 251-300 301-350 351-400 401-450 451-500 >500

Coverage no coverage 3 units 5 7 8 9 11 12 & refer

Calcium-Glucose Drip Ca gluconate 4 amps in 500cc D5W x 24hr see to it that the patient has no beta-blocker

Cordarone Drip Cordarone 4 amps + 500cc PNSS x 60 cc/hr x 1st 6 hours Subsequently 25 cc/hr Cordarone 150 mg IV now Cordarone 4 amps + 500cc D5W x 24H Cordarone 4 amps + 500cc D5W x 25 μgtts/min x 6H, then 12 cc/hr

Diazepam Drip Diazepam 10 mg/100cc D5W Diazepam 20 mg/100cc D5W Initial: 50-100 mg IV Max: 60 mg/day Diazepam 50 mg in 100cc PNSS x 6 cc/hr to titrate to control seizure, hold for BP < 90/60 mm Hg Dormicum Drip Dormicum 3 amps (1.5 mg/amp) + 500cc PNSS x 2 mg/hr

Epinephrine Drip Epinephrine 5 amps (5 mg) + 500cc D5W to run for 6 cc/hr

Glucose-Insulin-HCO3 Dr ip D5W 150cc + D50W 1 vial + NaHCO3 1 amp + Actrapid 8 units to run for 6 or 8 or 12 hrs

Dobutamine Drip Dobutamine 250 mg/amp + D5W 250cc x ___ μgtts/min (max rate: 60 μgtts/min)

Dopamine Drip Dopamine 2 amps (400 mg) + 250cc D5W (max: 10-20 mg/kg/min)

Repeat K post-drip

Rate drip: Drip mcg x kg BW 16.6

Renal Vasocons: 0-5 mg/kg/min Inotropic: 5-10 mg/kg/min Vasoconstriction: > 10 mg/kg/min

For patients w/ CHF: Dobutamine 2 amps (500 mg) + D5W 250 cc (max rate: 30 μgtts/min)

Fraxiparine Drip Fraxiparine 2 amps in 1 L D5W or D5NSS

Rate (μgtts/min): mg/kg/min x BW 13.3 or 26.6

Furosemide Drip Furosemide 3 amps + 54cc PNSS in a soluset x 10 cc/hr

88 “U”/kg BW or 0.1 cc/kg x 24H Fraxiparine 85 cc/kg or 0.1 cc/10 kg

Furosemide 80 mg in 80cc PNSS via soluset x 10 cc/hr

Glucose HGT < 60 – D50W 1 amp HGT < 40 – D50W 2 amps Target FBS 60-90, RBS 80-120

Heparin Drip D5W 250cc + Heparin 10,000 units x 10-20 μgtts/min via infusion pump Conc.: 50 U/mL Drip of 500-1000 ‘U’ ~ 10-20 μgtts/min OR In a soluset, Heparin 4cc in 36cc D5W (Heparin 1000 IU/cc) OR Heparin 5000 ‘U’ IV initially, then 4000 ‘U’ in 36cc PNSS via soluset x 1000 ‘U’/hr LD: 3000-5000 ‘U’ slow IV

Furosemide Drip (Dr. Caro) In a soluset: Furosemide 3 amps + 54cc PNSS x 10cc/hr Or D5W 250cc + Furosemide 250mg/amp x 5-30 μgtts/min Conc: 1 mg/mL Or PLR 500cc + 18 amps Furosemide x 18-20 μgtts/min

Furosemide-Albumin Drip 25% Albumin 50cc + Furosemide 20mg to run for 4hrs

LD = 80 U/kg MD = 18 U/kg APTT det’n q6h APTT 1.5-2x the baseline

In a soluset, 50cc D50W + Actrapid 8-10 units x 1hr x 3 cycles CBG monitoring qHourly while on drip Repeat K 1 hr after the last cycle

Heparin for Flushing > 500 ‘U’ Heparin in 100 mL PNSS

Hepamerz Drip < 4 amps in 500cc D5W x 12hrs BID

IVIG LD: 2 g/kg given in 5-6hrs in 3-5 days MD: 400 mg/kg or  0.4g/kg

Insulin Drip PNSS 250cc + Humulin R 50  ‘u’  Conc.: 0.2 ‘U’/mL

Albumin 50cc + PNSS 950cc + Furosemide 100mg x 24hrs

Drip of 5-50 μgtts/min ~ 110 ‘u’ Humulin

Albumin 100cc + Furosemide 40mg to run for 4-6hrs Dr. Caro: Furosemide 60mg + PNSS 54cc x 10cc/hr SD: Plasbumin 25% 100cc to run for 6 hrs

Glucose-Insulin Drip (Hyperkalemia ≥ 6)

Isoket Drip Isoket 10mg/amp (1amp) + PNSS 90cc x 10 μgtts/min (1 mg/hr)

Miacalcic Drip Miacalcic 2 amps (200 IU) + D5W 250 cc x 15H

NaHCO3 Drip NaHCO3 2 amps (50cc/amp) in D5W x 24H or  NaHCO3 3 amps in 100cc D5W x 24H

Nicardipine Drip - 5mg/10ml - Nicardipine 10mg in 90cc PNSS or D5W in a soluset to run for 10cc/hr, titrate by increments of 5 μgtts/min to maintain BP at ____ mmHg - Max of 150 cc/hr at 15mg/hr (0.5 mk/BW), give initial bolus of 2mg IVTT, titrate to BP ___

Noradrenaline (Levophed) Drip - 2mg Noradrenaline/2ml amp - D5W 250cc + Levophed 1amp x 15-60 μgtts/min - conc: 8mcg Noradrenaline/ml - drip of 2-8 mcg Noradrenaline ~ 15-60 μgtts/min Levophed 2 amps (2 mg/mL/amp) in D5W 250cc x 10 μgtts/min Levophed 4 amps in D5W 500cc x ___ μgtts/min

Lidocaine Drip -give 50 as blous, then start drip as follows: 1 g in 250cc D5W at 15cc/hr (1mg/h) increase by increments of 15

Pantoloc Drip - maintain GI acidity to stabilize clot - Pantoloc 80mg IV bolus then 5 amps in PNSS 1L x 24H for 3 days

LD: 1mg/H Conc: 4mg/cc Drip: 1-4mg/min

Mannitol (prep 20%) Dose: Amt given (cc)x0.2/kBW LD: 1-2 g/kg MD: 0.5-1 g/kg Action: 30mins Peak: 2hrs Complications: - rebound increase in ICP - IV volume expansion pulmonary edema CHF - DHN - Hypernatremia

Mannitol-Furosemide Drip: Mannitol 250cc + Furo 100mg x 10 μgtts/min OR Mannitol 36cc + Furo 240mg (24mL) x 6H

MgSO4 Drip D5W 250cc + MgSO4 2g x 20 cc/H Conc: 250mg/mL x 10 amps (2.5 g/amp)

Morphine Drip MoSO4 10 mg/amp (1 amp) + PNSS 60cc in a soluset x 10 μgtts/min

Octreotide (Sandostatin) Drip - prep: 0.5 mg/mL - 0.2 mg/mL IV bolus, give for 1 min, then start drip as ff: 4 amps + remaining 0.03 mg in 500cc PNSS x 24H Sandostatin Drip - sandostatin 0.5mg/amp 0.2mL now then drip as ff: 0.8mL in D5W 500cc x 8H - ff by 2 amps s andostatin 0.5mg/amp + D5W or D5NSS 1L x 24H Solumedrol Drip Solumedrol 2g + D5W 500cc x 20 μgtts/min Somatostatin Drip Somatostatin 250mcg IV bolus then 2amps (3mg/amp) + PNSS 1L x 24H for 5 days w/o interruption

Streptokinase Drip Streptokinase 1.5M units + D5W 90cc x 100cc/H (1H running rate) via soluset

MoSO4 1 amp (16mg/amp) + PNSS 50cc x 6 μgtts/min (2mg/H)

Give prior: Benadryl 50mg ivtt Solucortef 250mg ivtt

PRN: 1-3mg MoSO4 SQ

APTT monitoring q6H

Nimotop Drip Nimotop ½ vial + D5W 500cc x 24H

Nootropil Drip Nootropil 12g in 60cc x 24H

Terbutaline (Bicanyl) Drip D5W 250cc + Bricanyl 5amps x 10-30 μgtts/min

Thiamine Drip: 50-100mg IV (for 40-50 y.o.)

Toradol Drip Toradol 30mg + PNSS 80cc via soluset x 8H Toradol 100mg + PNSS 80cc x 10cc/H Tramadol Drip Tramadol 100mg + PNSS 80cc x 10 μgtts/min Trental Drip Trental 4amps in PNSS 500cc x 24H Zantac Drip Zantac 5amps in D5W 500cc x 16H Zithromax Drip Zithromax 500mg in 90cc IVF via soluset to run for 5H