Basic Med Math
Standard fluid boluses
The general rule is that adult patients who require a fluid bolus receive 250 mL boluses, with
reassessments between boluses. But young pediatric patients do not necessarily need all this
fluid. Pediatric patients who need fluid are usually given somewhere between 10-20 mL/kg
boluses UP TO the adult dose of 250 mL.
You probably remember that to multiply anything by 10 you just add a 0 in front of the decimal
(in the ones spot). To multiply by 20 you will double this number.
So if we want to give a 10 mL/kg bolus of 0.9% normal saline to a 20 lbs patient, how much do
we give?
First convert the weight from lbs to kg- half of 20 is 10, 10-1=9, so our patient weighs 9 kg.
Now we want to give 10 mL/kg to a 9 kg patient. 10x9=90, so we want to give our patient a 90
mL bolus.
Notice that normal saline has a concentration of 0.9%. This concentration does not
represent a volume, so it makes no difference in our calculation- just keep in mind that
it is very important clinically to give the correct concentration of a medication as well as
the correct dose.
Now we want to give a 20 mL/kg bolus of lactated ringer’s (also known as LR or as ringer’s
lactate) solution to a 31 lbs patient. Start by converting the weight to kg. Half of 31 is 15.5. 15.5-
1=14.5. To multiply by 10 we need to move the decimal point one to the right, giving us 145.
Now we want to double this number (to multiply by 20) and end up with 290. 290 mL is more
than the adult bolus dose of 250, so your 31 lbs/14.5 kg patient will receive an adult bolus of
250 mL of lactated ringer’s solution.
Giving fluids over time (AKA how many drops per minute to give)
As a standard, when we start an IV we use a 1 L (1000 mL) bag of 0.9% normal saline (NS). We
generally attach this to 10 drip (gtts) IV tubing. Our IV tubing options are generally, 10, 15, or 60
drops. 15 drip tubing is normally used in the hospital. 10 drip tubing means that every 10 drops
equal 1 cc (1 mL). These are relatively big drops of fluid and mean that we can give fluids quickly
if we need to. We call 10 and 15 gtts sets ‘macrodrip’ tubing. 60 drip tubing means that it takes
60 drops to equal 1 cc of fluid. This is typically used when we are giving fluids to people who
may not be able to handle them well (little kids or people with some health conditions) or if we
want to give medications. It creates very small drops, so we call 60 gtts tubing ‘microdrip’
tubing.
The Calculation
Volume x Drip factor
--------------------------- = drops per minute (gtts/min)
Time in minutes
Let’s say we want to give a patient 100 mL of fluid every 20 minutes. We have attached a 1 L
bag to our 10 gtts drip set. Our calculation follows:
100 cc (volume we want to give) x 10 gtts/mL (drip factor)
---------------------------------------------------------------------------
20 minutes
100x10
---------
20
1000
------
20
= 50 gtts/min
We want to give 50 drops every 60 seconds, which we could break down into 5 drops every 6
seconds or (if we divide 50/6) 8 drops every 10 seconds.
Try a few yourself:
1. You want to give 50 mL of fluid an hour (60 minutes) to a pediatric patient using a 60 gtts
set.
2. You want to give .75 L (750 mL) an hour to a patient in septic shock using a 10 gtts set.
3. You are a community care paramedic visiting a hospice patient whose nurse is out of town
for the day. Your patient is complaining of nerve pain and you’ve obtained an order for
magnesium via a banana bag. You have a banana bag hanging and are ordered to give 25 mL of
fluids over the first 30 minutes as a loading dose.
Giving a weight based dose
Weight based doses are typically seen with lidocaine and some pediatric drugs.
We do this by converting the patient’s weight into kg, multiplying the weight in kg by the
number of mg per kg. Once we’ve established the dose in mg we need to calculate the volume
(in mL) we need to draw up.
Let’s give our 132 lbs patient 1.5 mg/kg of lidocaine. If we look at the lidocaine box we see that
it is packaged in a concentration of 100 mg in 5 mL.
First convert the patient’s weight to kg- half of 132 is 66. 66-6= 60 kg
Now figure out the number of mg we want to give- we want to give 1.5 mg/kg. 1.5 (mg) x 60
(kg)= 90 mg. We want to give 90 mg of lidocaine.
Now, knowing that lidocaine comes packaged in 100 mg/5 mL, we want to draw up 90 mg.
There are two formulas to do this:
Formula 1: desired dose x volume on hand
----------------------------------------
dose on hand
Formula 2: mg in bottle (on hand) mg ordered (desired dose)
----------------------------- = -----------------------------------
mL in bottle (on hand) mL (x)
Let’s begin by using formula 1.
x mL= 90 mg x 5 mL
-----------------
100 mg
x mL= 450
-----
100
x = 4.5 mL
Let’s try using formula 2.
100 mg 90 mg
---------- = --------
5 mL x mL
Cross multiply 100 mg x X mL = 5 mL x 90 mg
100x = 450
Now divide both sides by 100 to get x by itself
100x = 450
------ -----
100 100
x = 4.5 mL
Confirm any answers you get by doing a quick brain check. You know that, based on the
patient’s weight and your weight based dose, you want to give 90 mg of lidocaine. You know
that lidocaine is packaged in a 100 mg/5 mL concentration. Your answer was go give 4.5 mL. 90
is slightly smaller than 100 (the total number of mg in the 5 mL syringe). 4.5 is slightly smaller
than 5 (the total number of mL that equals 100 mg). These correspond well, so we know that
our math is not crazy.
Try some problems on your own:
1. You have a chronic alcoholic patient. You want to give him 100 mg (not weight based) of
thiamine over 5 minutes. You have mixed your 100 mg of thiamine into a 50 mL bag with a 10
gtts set.
2. Your chronic alcoholic patient shows up at the ICU a few months later and shows signs of
Wernicke’s Encephalopathy. The doctor has ordered you to give 500 mg of thiamine IVB in a
500 mL bag using a 10 gtts set over 25 minutes.
3. You are transporting a patient to a higher level of care for DVT. He is on a streptokinase drip
at 6 mL/hour. You are using a 60 gtts set. How many drops do you give per minute? How many
drops per 10 seconds?