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Universal IV Infusion Rate Calculation - The Master Formula & Drug-Specific Guide

THE UNIVERSAL MASTER FORMULA

Step 1 - Find your concentration

Concentration (mg/ml) = Total drug added (mg) ÷ Total volume of solution (ml)

Step 2 - Find your infusion rate

Rate (ml/hr) = Required dose (mg/hr) ÷ Concentration (mg/ml)

Combine both into one line - the only formula you need to remember:

┌─────────────────────────────────────────────────────────────┐
│   Rate (ml/hr) = Required dose (mg/hr) × Total volume (ml)  │
│                  ────────────────────────────────────────    │
│                        Total drug added (mg)                 │
└─────────────────────────────────────────────────────────────┘

Memory trick: "Dose × Volume ÷ Drug" or D×V/D (Desired × Volume / Drug-in-bag)

UNIT CONVERSION RULES (before using the formula)

Order is in	Convert by
mg/min → mg/hr	Multiply by 60
mcg/hr → mg/hr	Divide by 1000
mcg/min → mg/hr	Multiply by 60, then divide by 1000
mcg/kg/min → mg/hr	× 60 × weight(kg) ÷ 1000
mcg/kg/hr → mg/hr	× weight(kg) ÷ 1000

The weight-based add-on: For mcg/kg/min drugs (dopamine, noradrenaline, adrenaline):

Rate (ml/hr) = Dose (mcg/kg/min) × Weight (kg) × 60 × Volume (ml)
               ────────────────────────────────────────────────────
                          Total drug (mcg)

WORKED EXAMPLES - YOUR DRUGS

1. FUROSEMIDE (Lasix) - 20 mg/2 ml ampoule = 10 mg/ml

Order: 10 mg/hr in 100 ml burette

How many ampoules?

You want a round concentration. Use 5 ampoules = 100 mg in 100 ml = 1 mg/ml (clean and easy)
Or for lower rates: 2 ampoules = 40 mg in 100 ml = 0.4 mg/ml

Rate calculation (100 mg in 100 ml):

Rate = 10 mg/hr × 100 ml ÷ 100 mg = 10 ml/hr

At 1 mg/ml concentration, the pump rate in ml/hr = dose in mg/hr. Dead simple.

Tip: The "1 mg/ml trick" makes rate = dose numerically. So 10 mg/hr = 10 ml/hr, no math needed at the bedside.

2. ADRENALINE (Epinephrine) - 1 mg/1 ml ampoule = 1 mg/ml

Standard ICU preparation: 4 mg in 50 ml (or scaled up) = 0.08 mg/ml = 80 mcg/ml

Alternatively: 6 mg in 100 ml = 60 mcg/ml

Dose range: 0.01 - 1 mcg/kg/min

Example: 70 kg patient, order 0.1 mcg/kg/min, using 6 mg in 100 ml:

Rate = 0.1 × 70 × 60 × 100 ÷ 6000 mcg = 420000 ÷ 6000 = 7 ml/hr

Ampoules needed for 6 mg in 100 ml: 6 × 1 mg ampoules (6 ampoules), top up to 100 ml NS/D5W

3. NORADRENALINE (Norepinephrine) - 4 mg/4 ml ampoule = 1 mg/ml

Standard preparation:

Standard strength: 4 mg in 100 ml D5W = 40 mcg/ml (0.04 mg/ml)
Double strength: 8 mg in 100 ml = 80 mcg/ml (use when fluid restriction needed)
LITFL/ICU standard: 4 mg in 100 ml, runs at 1-20 ml/hr

Dose range: 0.01 - 1 mcg/kg/min (titrate to MAP)

Example: 70 kg, order 0.1 mcg/kg/min, 4 mg in 100 ml:

Rate = 0.1 × 70 × 60 × 100 ÷ 4000 mcg = 420000 ÷ 4000 = 10.5 ml/hr

Ampoules needed: 1 ampoule (4 mg) in 100 ml D5W. For double strength: 2 ampoules.

4. DOPAMINE - 200 mg/5 ml ampoule = 40 mg/ml

Standard preparation: 200 mg in 50 ml (neat, no dilution) = 4 mg/ml = 4000 mcg/ml

Or: 400 mg in 250 ml NS = 1.6 mg/ml = 1600 mcg/ml

Dose ranges:

< 3 mcg/kg/min - renal/splanchnic (now debated)
5-10 mcg/kg/min - beta-1 inotropic
10 mcg/kg/min - alpha-1 vasopressor

Example: 70 kg, order 5 mcg/kg/min, 200 mg in 50 ml:

Rate = 5 × 70 × 60 × 50 ÷ 200,000 mcg = 1,050,000 ÷ 200,000 = 5.25 ml/hr

Ampoules needed: 1 ampoule (200 mg/5 ml) drawn into syringe, top to 50 ml = 4 mg/ml

5. ISOSORBIDE DINITRATE (ISDN) - typically 10 mg/10 ml ampoule = 1 mg/ml

Standard preparation: 50 mg in 50 ml NS = 1 mg/ml (neat syringe) Or: 25 mg in 250 ml NS = 0.1 mg/ml

Dose: 2-10 mg/hr (or 0.5-1.6 mcg/kg/min for weight-based)

Example: Order 5 mg/hr, 50 mg in 50 ml (1 mg/ml):

Rate = 5 mg/hr × 50 ml ÷ 50 mg = 5 ml/hr

Again, at 1 mg/ml, rate ml/hr = dose mg/hr.

Ampoules needed: 5 ampoules (10 mg each) in 50 ml total volume

6. LABETALOL - 100 mg/20 ml ampoule = 5 mg/ml

Standard preparation: 200 mg in 200 ml (40 ml drug + 160 ml NS/D5W) = 1 mg/ml

Dose: 50-200 mg/hr (titrate every 10 min)

Example: Order 100 mg/hr, 200 mg in 200 ml (1 mg/ml):

Rate = 100 mg/hr × 200 ml ÷ 200 mg = 100 ml/hr

At 1 mg/ml: rate = dose numerically (100 mg/hr = 100 ml/hr).

Ampoules needed: 2 ampoules (100 mg each = 40 ml), top to 200 ml = 1 mg/ml

QUICK REFERENCE CHEAT CARD

Drug	Standard Prep	Concentration	Typical Rate
Furosemide	5 amp (100 mg) in 100 ml	1 mg/ml	5-20 ml/hr (5-20 mg/hr)
Adrenaline	6 amp (6 mg) in 100 ml	60 mcg/ml	2-15 ml/hr
Noradrenaline	1 amp (4 mg) in 100 ml	40 mcg/ml	1-20 ml/hr
Dopamine	1 amp (200 mg) in 50 ml	4 mg/ml	2-10 ml/hr
ISDN	5 amp (50 mg) in 50 ml	1 mg/ml	2-10 ml/hr
Labetalol	2 amp (200 mg) in 200 ml	1 mg/ml	50-200 ml/hr

THE "1 mg/ml TRICK" - Bedside Shortcut

Whenever you make any drug to 1 mg/ml, the math disappears:

Rate in ml/hr = dose in mg/hr (no calculation needed)
Works for furosemide, labetalol, ISDN, morphine, midazolam, etc.
For mcg/ml drugs: if you make it 100 mcg/ml, then rate (ml/hr) × 100 = dose (mcg/hr)

DRIP RATE FOR GRAVITY/BURETTE (gtts/min)

If using a burette with a macro set (20 drops/ml) or micro set (60 drops/ml):

gtts/min = ml/hr × drop factor ÷ 60

With micro set (60 drops/ml): gtts/min = ml/hr (they are numerically equal - easy!)
With macro set (20 drops/ml): gtts/min = ml/hr ÷ 3

SAFETY PEARLS

Adrenaline & Noradrenaline - always use D5W as diluent (NS can cause degradation over time); check compatibility
Dopamine - do NOT mix with sodium bicarbonate (inactivates it)
ISDN - use glass bottles or polyethylene syringes; adsorbs to PVC
Labetalol - do NOT dilute in sodium bicarbonate; compatible with NS and D5W
Furosemide - protect from light; incompatible with acidic solutions
Always double-check concentration after preparation with a second nurse (double-check policy per WHO high-alert medication guidelines)
High-alert drugs (adrenaline, noradrenaline, dopamine) - use pre-printed standardized concentration labels per ISMP guidelines

SUMMARY OF THE ONE FORMULA

Rate (ml/hr) = Desired dose (mg/hr) × Total volume (ml) / Total drug in bag (mg)

For weight-based mcg/kg/min: multiply numerator also by weight (kg) × 60, and convert mg to mcg in denominator (× 1000)

Print this, laminate it, and stick it at the nurses' station. Everything else flows from it.

Also give answer for sandostatin (octreotide) , insulin , midazolam, dobutamine , amiodarone , lidocaine , heparin , magnesium sulphate, vasopressin

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Part 2: ICU Infusion Guide - 9 More Essential Drugs

The same master formula applies throughout:

Rate (ml/hr) = Required dose (per hr) × Total volume (ml)
               ──────────────────────────────────────────
                     Total drug in bag (same units)

For unit-based drugs (insulin, heparin, vasopressin): replace mg with units. For gram-based drugs (magnesium): keep everything in grams or convert consistently.

1. OCTREOTIDE (Sandostatin) - 100 mcg/ml or 200 mcg/ml ampoule

Formulation available: 50 mcg/ml (1 ml), 100 mcg/ml (1 ml), 500 mcg/ml (1 ml)

Standard preparation (LHSC/GlobalRPH protocol):

500 mcg in 250 ml NS or D5W = 2 mcg/ml

Doses:

Variceal bleeding: 50 mcg IV bolus, then 25-50 mcg/hr for up to 5 days
GI fistula/pancreatic: 250 mcg/hr for 48 hrs

Rate calculation for 25 mcg/hr (500 mcg in 250 ml = 2 mcg/ml):

Rate = 25 mcg/hr × 250 ml ÷ 500 mcg = 12.5 ml/hr

For 50 mcg/hr: 25 ml/hr

Ampoules needed: Use 1 × 500 mcg/ml vial (1 ml) → dilute to 250 ml NS Or use 5 × 100 mcg/ml ampoules → top up to 250 ml

Memory shortcut: 500 mcg in 250 ml → 1 ml = 2 mcg → divide required mcg/hr by 2 to get ml/hr

2. INSULIN (Actrapid/Regular) - 100 units/ml vial

Standard preparation (EMRS/ASHP standard):

50 units in 50 ml NS = 1 unit/ml (syringe pump, most common ICU prep)

Dose: Per institution's insulin infusion protocol (typically 0.05-0.1 units/kg/hr for DKA; titrate to glucose targets in ICU)

Rate calculation for 5 units/hr (50 units in 50 ml = 1 unit/ml):

Rate = 5 units/hr × 50 ml ÷ 50 units = 5 ml/hr

At 1 unit/ml: rate in ml/hr = dose in units/hr. Bedside math disappears.

Ampoules needed: Draw 0.5 ml from 100 units/ml vial (= 50 units), top to 50 ml NS

Critical: Insulin adsorbs to PVC - flush the line with 20-50 ml of the insulin solution before connecting to patient (most protocols mandate this)

3. MIDAZOLAM - 5 mg/ml ampoule (typically 3 ml = 15 mg or 10 ml = 50 mg)

Standard preparation (ASHP/EMRS):

50 mg in 50 ml NS = 1 mg/ml (neat 10 ml vial, top to 50 ml)

Doses:

ICU sedation: 0.02-0.1 mg/kg/hr (typically 2-10 mg/hr in a 70 kg patient)
Can also dose as 0.03-0.2 mg/kg/hr

Rate calculation for 5 mg/hr (50 mg in 50 ml = 1 mg/ml):

Rate = 5 mg/hr × 50 ml ÷ 50 mg = 5 ml/hr

At 1 mg/ml: rate ml/hr = dose mg/hr

Ampoules needed: 1 × 50 mg vial (10 ml at 5 mg/ml) → top to 50 ml = 1 mg/ml

4. DOBUTAMINE - 250 mg/20 ml vial = 12.5 mg/ml

Standard preparation:

Peripheral line: 250 mg in 250 ml D5W or NS = 1 mg/ml = 1000 mcg/ml
Central line (fluid restriction): 250 mg in 50 ml = 5 mg/ml = 5000 mcg/ml

Dose range: 2.5-10 mcg/kg/min (beta-1 inotrope; higher doses add vasopressor effect)

Rate calculation for 5 mcg/kg/min, 70 kg, peripheral prep (1000 mcg/ml):

Rate = 5 × 70 × 60 × 250 ml ÷ 250,000 mcg = 52,500,000 ÷ 250,000 = 21 ml/hr

Quick dose table (peripheral, 250 mg in 250 ml = 1 mg/ml):

Dose (mcg/kg/min)	50 kg	70 kg	80 kg	100 kg
2.5	7.5 ml/hr	10.5 ml/hr	12 ml/hr	15 ml/hr
5	15 ml/hr	21 ml/hr	24 ml/hr	30 ml/hr
10	30 ml/hr	42 ml/hr	48 ml/hr	60 ml/hr

Ampoules needed: 1 × 250 mg vial (20 ml) → top to 250 ml D5W

5. AMIODARONE - 150 mg/3 ml ampoule = 50 mg/ml

Standard preparation (ASHP standard concentration: 1.8 mg/ml):

Maintenance infusion: 900 mg in 500 ml D5W = 1.8 mg/ml
Loading infusion: 300 mg in 250 ml D5W = 1.2 mg/ml over 1 hour

Protocol (VT/VF/AF):

Loading: 150 mg over 10 min (rapid), then 360 mg over 6 hr (1 mg/min), then 540 mg over 18 hr (0.5 mg/min)

Maintenance rate (900 mg in 500 ml = 1.8 mg/ml) at 0.5 mg/min:

Convert 0.5 mg/min → 30 mg/hr
Rate = 30 mg/hr × 500 ml ÷ 900 mg = 16.7 ml/hr ≈ 17 ml/hr

At 1 mg/min (=60 mg/hr):

Rate = 60 × 500 ÷ 900 = 33 ml/hr

Ampoules needed:

For 900 mg in 500 ml: 6 ampoules (150 mg each) in 500 ml D5W

Critical safety notes:

Must use D5W only (precipitates in NS or LR)
Concentrations >2 mg/ml must go through a central line (peripheral causes phlebitis)
Incompatible with heparin and aminophylline in the same line

6. LIDOCAINE - 200 mg/10 ml = 20 mg/ml ampoule

Standard preparation:

1 g in 250 ml NS = 4 mg/ml (most common)
Or 2 g in 500 ml NS = 4 mg/ml

Dose: 1-4 mg/min (post-VT/VF or antiarrhythmic infusion)

Rate calculation for 2 mg/min (1 g in 250 ml = 4 mg/ml):

Convert: 2 mg/min × 60 = 120 mg/hr
Rate = 120 mg/hr × 250 ml ÷ 1000 mg = 30 ml/hr

Quick reference (1 g in 250 ml = 4 mg/ml):

Dose	mg/hr	Rate
1 mg/min	60 mg/hr	15 ml/hr
2 mg/min	120 mg/hr	30 ml/hr
3 mg/min	180 mg/hr	45 ml/hr
4 mg/min	240 mg/hr	60 ml/hr

Shortcut: At 4 mg/ml concentration, rate (ml/hr) = dose (mg/min) × 15

Ampoules needed: 5 × 200 mg ampoules (10 ml each) in 250 ml NS (total ~300 ml, withdraw 50 ml first to keep total volume at 250 ml, or use 50 ml of NS already drawn off)

7. HEPARIN - 5000 units/ml vial (or 25,000 units/5 ml)

Standard preparation (ASHP standard):

25,000 units in 250 ml NS = 100 units/ml
Or simply: 25,000 units in 500 ml NS = 50 units/ml

Dose (therapeutic anticoagulation):

Weight-based protocol: typically 18 units/kg/hr after bolus
Common maintenance: 1000-1500 units/hr (titrated by aPTT)

Rate calculation for 1200 units/hr (25,000 units in 250 ml = 100 units/ml):

Rate = 1200 units/hr × 250 ml ÷ 25,000 units = 12 ml/hr

At 100 units/ml: Rate (ml/hr) = dose (units/hr) ÷ 100

1000 units/hr → 10 ml/hr
1500 units/hr → 15 ml/hr
2000 units/hr → 20 ml/hr

Ampoules needed: Use 1 × 25,000 unit vial (5 ml) + 245 ml NS = 100 units/ml

8. MAGNESIUM SULPHATE - 50% solution = 500 mg/ml = 2 mmol/ml

Important: 50% MgSO4 MUST be diluted before IV infusion (never give undiluted IV)

Standard preparation:

4 g in 100 ml NS = 40 mg/ml = 4% (for loading)
Maintenance syringe: 20 g in 100 ml NS = 200 mg/ml (concentrated, use pump)
Commonly: 20 g drawn from 50% solution = 40 ml, top to 100 ml = 200 mg/ml = 20% (acceptable max for syringe pump per guidelines)

Doses:

Pre-eclampsia/eclampsia loading: 4-6 g over 15-20 min
Maintenance: 1-2 g/hr (max 3 g/hr)
Torsades de Pointes: 1-2 g IV over 10-20 min
Severe asthma: 1.2-2 g over 20 min

Rate calculation for 1 g/hr (20 g in 100 ml = 200 mg/ml = 0.2 g/ml):

Rate = 1 g/hr × 100 ml ÷ 20 g = 5 ml/hr
Rate for 2 g/hr = 10 ml/hr

Simpler prep for wards (4 g in 100 ml NS = 40 mg/ml):

1 g/hr: Rate = 25 ml/hr
2 g/hr: Rate = 50 ml/hr

Ampoules needed (for 20 g prep): Draw 40 ml from 50% MgSO4 vial → add 60 ml NS = 100 ml total

Toxicity monitoring (mandatory): Check respiratory rate (>12/min), urine output (>25 ml/hr), and patellar reflexes before each dose change. Antidote: Calcium gluconate 10 ml of 10% IV over 10 min.

9. VASOPRESSIN - 20 units/ml ampoule

Standard preparation:

20 units in 100 ml NS = 0.2 units/ml (ASHP standard, most common ICU)
Or 40 units in 250 ml NS = 0.16 units/ml

Doses:

Septic shock (as noradrenaline-sparing): Fixed 0.03-0.04 units/min (do NOT titrate)
Variceal bleeding (portal hypertension): 0.2-0.4 units/min

Rate calculation for 0.03 units/min (20 units in 100 ml = 0.2 units/ml):

Convert: 0.03 units/min × 60 = 1.8 units/hr
Rate = 1.8 units/hr × 100 ml ÷ 20 units = 9 ml/hr

For 0.04 units/min:

= 2.4 units/hr → Rate = 2.4 × 100 ÷ 20 = 12 ml/hr

Ampoules needed: 1 × 20 unit ampoule in 100 ml NS = 0.2 units/ml

Key note: In septic shock, vasopressin is NOT titrated by BP. Use it at fixed dose (0.03 units/min = 9 ml/hr) as an adjunct to noradrenaline.

COMPLETE MASTER CHEAT CARD - ALL 15 DRUGS

Drug	Standard Prep	Concentration	Key Dose	Rate
Furosemide	100 mg in 100 ml	1 mg/ml	5-20 mg/hr	5-20 ml/hr
Adrenaline	6 mg in 100 ml	60 mcg/ml	0.01-1 mcg/kg/min	2-15 ml/hr
Noradrenaline	4 mg in 100 ml	40 mcg/ml	0.01-1 mcg/kg/min	1-20 ml/hr
Dopamine	200 mg in 50 ml	4 mg/ml	5-15 mcg/kg/min	2-10 ml/hr
ISDN	50 mg in 50 ml	1 mg/ml	2-10 mg/hr	2-10 ml/hr
Labetalol	200 mg in 200 ml	1 mg/ml	50-200 mg/hr	50-200 ml/hr
Octreotide	500 mcg in 250 ml	2 mcg/ml	25-50 mcg/hr	12.5-25 ml/hr
Insulin	50 units in 50 ml	1 unit/ml	Per protocol	1-10 ml/hr
Midazolam	50 mg in 50 ml	1 mg/ml	2-10 mg/hr	2-10 ml/hr
Dobutamine	250 mg in 250 ml	1 mg/ml	2.5-10 mcg/kg/min	10-42 ml/hr
Amiodarone	900 mg in 500 ml	1.8 mg/ml	0.5-1 mg/min	17-33 ml/hr
Lidocaine	1 g in 250 ml	4 mg/ml	1-4 mg/min	15-60 ml/hr
Heparin	25,000 u in 250 ml	100 units/ml	1000-1500 u/hr	10-15 ml/hr
MgSO4	20 g in 100 ml	200 mg/ml	1-2 g/hr	5-10 ml/hr
Vasopressin	20 units in 100 ml	0.2 units/ml	0.03-0.04 u/min	9-12 ml/hr

THE 3-STEP BEDSIDE RULE (works for every drug above)

Step 1: Concentration = Total drug ÷ Total volume
Step 2: Convert order to same units as concentration (per hour)
Step 3: Rate (ml/hr) = Dose per hour ÷ Concentration

Unit-based bonus trick: When you make any drug to its "round concentration" (1 mg/ml, 1 unit/ml, 100 units/ml), the pump rate numerically matches the dose - no math at 3 AM.

Give me a generalized rule or formula ( easy to remember and short way or trick ) to calculate the drop rate or rate of infusion of any drugs given ((with it's formulation (mg/ml))) in given time at required rate ( mg/hr or mg / min) ..and how many ampules of that drug to are required for easy and accurate infusion rate .. for example lasix 20mg/2ml .. dilute in 100cc burrete required at rate of 10mg / hour .. or similar way adrenaline ( 1mg/1ml 1:1000) , noradrenaline (4mg/4ml) , isosorbide dinitirite (10mg/10ml), dopamine (200mg/5ml) , labetalol (50mgl/10ml) .. Also give answer for sandostatin (octreotide) (0.1mg/ml) , insulin , midazolam( 5mg/5ml), dobutamine (250ml/5ml) , amiodarone (150ml/3ml) , lidocaine (2%, 10ml), heparin (5000IU/ml), magnesium sulphate (500mg/ml), phenytoin (250mg/5ml) laviteracetam (500mg/5ml) , vasopressin (20U/ml) , terlipressin (1mg/1ml). give answer according to the formulations present in Pakistani market .. according to the latest litreture and guidelines followed in ICU and ER , and wards.

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I now have all the data needed. Let me compile the complete, Pakistan-formulation-specific answer.

Complete IV Infusion Guide - All Drugs (Pakistan Market Formulations)

THE MASTER FORMULA - ONE RULE FOR EVERYTHING

┌──────────────────────────────────────────────────────────────────────┐
│   Rate (ml/hr) =  Required dose per hour  ×  Total volume (ml)       │
│                   ────────────────────────────────────────────────   │
│                         Total drug in bag (same units)               │
└──────────────────────────────────────────────────────────────────────┘

Memory hook: "D×V/D" = Desired dose × Volume ÷ Drug in bag

Drug units	Use this unit throughout
mg/hr or mg/min	mg everywhere
units/hr	units everywhere
IU/hr	IU everywhere
g/hr	g everywhere
mcg/min → convert first	× 60 = mcg/hr ÷ 1000 = mg/hr
mcg/kg/min → convert first	× 60 × kg ÷ 1000 = mg/hr

The golden shortcut: Make concentration = 1 mg/ml (or 1 unit/ml) → rate in ml/hr = dose in mg/hr. No math at 3 AM.

UNIT CONVERSION CHEAT STRIP (stick on wall)

mcg/min  × 60  → mcg/hr  ÷ 1000 → mg/hr
mcg/kg/min × weight × 60 → mcg/hr ÷ 1000 → mg/hr
mg/min   × 60  → mg/hr
g/hr     × 1000 → mg/hr
IU/hr    stays as IU/hr

DRUG-BY-DRUG GUIDE (Pakistan Formulations)

1. FUROSEMIDE (Lasix, Frusemide)

Pakistan formulation: 20 mg/2 ml ampoule = 10 mg/ml

Standard prep: 5 ampoules (100 mg) in 100 ml NS = 1 mg/ml

Dose ordered	Rate at 1 mg/ml	Ampoules
5 mg/hr	5 ml/hr	5 amp in 100 ml
10 mg/hr	10 ml/hr	5 amp in 100 ml
20 mg/hr	20 ml/hr	5 amp in 100 ml

Calculation example: 10 mg/hr needed, 100 mg in 100 ml: Rate = 10 × 100 ÷ 100 = 10 ml/hr

Trick: At 1 mg/ml, ml/hr = mg/hr directly. Diluent: NS only (incompatible with acidic solutions). Do NOT mix with other drugs.

2. ADRENALINE (Epinephrine)

Pakistan formulation: 1 mg/1 ml ampoule (1:1000)

Standard prep: 6 mg (6 ampoules) in 100 ml D5W = 60 mcg/ml = 0.06 mg/ml

Dose range: 0.01-1 mcg/kg/min (weight-based)

Rate calculation for 70 kg patient at 0.1 mcg/kg/min:

Convert: 0.1 × 70 × 60 = 420 mcg/hr = 0.42 mg/hr
Rate = 0.42 mg/hr × 100 ml ÷ 6 mg = 7 ml/hr

Quick table (6 mg in 100 ml = 0.06 mg/ml = 60 mcg/ml):

Dose (mcg/kg/min)	50 kg	70 kg	80 kg
0.05	2.5 ml/hr	3.5 ml/hr	4 ml/hr
0.1	5 ml/hr	7 ml/hr	8 ml/hr
0.3	15 ml/hr	21 ml/hr	24 ml/hr

Ampoules: 6 × 1 mg ampoules → add to 100 ml D5W Diluent: D5W preferred. Central line for doses >0.1 mcg/kg/min.

3. NORADRENALINE (Norepinephrine)

Pakistan formulation: 4 mg/4 ml ampoule = 1 mg/ml

Standard prep: 4 mg (1 ampoule) in 100 ml D5W = 40 mcg/ml = 0.04 mg/ml Double strength (fluid restriction): 8 mg in 100 ml = 80 mcg/ml

Rate calculation for 70 kg at 0.1 mcg/kg/min (standard 4 mg in 100 ml):

Convert: 0.1 × 70 × 60 = 420 mcg/hr
Rate = 420 mcg/hr × 100 ml ÷ 4000 mcg = 10.5 ml/hr

Ampoules: 1 ampoule (4 mg) in 100 ml D5W Critical: Central line mandatory. Never in peripheral vein (causes necrosis). D5W preferred diluent.

4. DOPAMINE

Pakistan formulation: 200 mg/5 ml ampoule = 40 mg/ml

Standard prep: 200 mg (1 ampoule) in 50 ml D5W or NS = 4 mg/ml = 4000 mcg/ml

Dose ranges:

Renal dose: 2-3 mcg/kg/min (now debated)
Inotropic (β1): 5-10 mcg/kg/min
Vasopressor (α1): >10 mcg/kg/min

Rate calculation for 5 mcg/kg/min, 70 kg (200 mg in 50 ml = 4000 mcg/ml):

Convert: 5 × 70 × 60 = 21,000 mcg/hr
Rate = 21,000 × 50 ÷ 200,000 = 5.25 ml/hr ≈ 5 ml/hr

Quick table (200 mg in 50 ml):

Dose	50 kg	70 kg	80 kg	100 kg
5 mcg/kg/min	3.75 ml/hr	5.25 ml/hr	6 ml/hr	7.5 ml/hr
10 mcg/kg/min	7.5 ml/hr	10.5 ml/hr	12 ml/hr	15 ml/hr
15 mcg/kg/min	11.25 ml/hr	15.75 ml/hr	18 ml/hr	22.5 ml/hr

Ampoules: 1 ampoule, draw 5 ml, top to 50 ml in syringe. Do NOT mix with sodium bicarbonate (inactivates dopamine).

5. ISOSORBIDE DINITRATE (ISDN)

Pakistan formulation: 10 mg/10 ml ampoule = 1 mg/ml

Standard prep: 5 ampoules (50 mg) in 50 ml NS = 1 mg/ml (neat syringe) Or: 10 ampoules (100 mg) in 100 ml NS = 1 mg/ml

Dose: 2-10 mg/hr (titrate to symptom relief/BP)

At 1 mg/ml: ml/hr = mg/hr directly

Dose	Rate
2 mg/hr	2 ml/hr
5 mg/hr	5 ml/hr
10 mg/hr	10 ml/hr

Ampoules: 5 × 10 mg ampoules → 50 ml syringe (no dilution needed) Critical: Use glass bottles or polyethylene syringes - ISDN adsorbs to PVC. Protect from light.

6. LABETALOL

Pakistan formulation: 50 mg/10 ml ampoule = 5 mg/ml

Standard prep: 4 ampoules (200 mg in 40 ml) + 160 ml NS = 200 mg in 200 ml = 1 mg/ml

At 1 mg/ml: ml/hr = mg/hr directly

Dose	Rate
50 mg/hr	50 ml/hr
100 mg/hr	100 ml/hr
200 mg/hr	200 ml/hr

Ampoules: 4 × 50 mg ampoules (40 ml total) + 160 ml NS = 200 ml total = 1 mg/ml Titrate: Start 50 mg/hr, increase by 10 mg/hr every 10 minutes. Target 50-200 mg/hr.

7. OCTREOTIDE (Sandostatin)

Pakistan formulation: 0.1 mg/ml = 100 mcg/ml (1 ml ampoule = 100 mcg)

Standard prep for continuous infusion:

5 ampoules (500 mcg) in 250 ml NS or D5W = 2 mcg/ml

Doses:

Variceal bleeding: 50 mcg bolus IV, then 25-50 mcg/hr
GI fistula/pancreatitis: 250 mcg/hr

Rate calculation for 25 mcg/hr (500 mcg in 250 ml = 2 mcg/ml):

Rate = 25 mcg/hr × 250 ml ÷ 500 mcg = 12.5 ml/hr

For 50 mcg/hr: 25 ml/hr

Shortcut: At 2 mcg/ml, divide dose in mcg/hr by 2 to get ml/hr.

Ampoules: 5 × 100 mcg ampoules → 250 ml NS Bolus dose: 50 mcg (0.5 ml) diluted in 50 ml NS, given over 10 min.

8. INSULIN (Regular/Actrapid)

Pakistan formulation: 100 IU/ml vial (Actrapid HM, Humulin R)

Standard prep: 50 IU in 50 ml NS = 1 IU/ml (syringe pump)

At 1 IU/ml: ml/hr = IU/hr directly

Protocol rate	ml/hr
1 IU/hr	1 ml/hr
2 IU/hr	2 ml/hr
5 IU/hr	5 ml/hr
10 IU/hr	10 ml/hr

Preparation: Draw 0.5 ml from vial (= 50 IU) → add 49.5 ml NS = 50 ml total = 1 IU/ml

Critical: Flush the IV line with 20-30 ml of the insulin solution before connecting (insulin adsorbs to PVC tubing - first 20-30 ml is "lost" to tubing walls, causing underdosing).

Monitoring: BSL every 1 hour. Target glucose 140-180 mg/dL in most ICU patients (ADA/SCCM guidelines).

9. MIDAZOLAM

Pakistan formulation: 5 mg/5 ml ampoule = 1 mg/ml (also available as 15 mg/3 ml = 5 mg/ml)

Standard prep: 50 mg in 50 ml NS = 1 mg/ml

Use 10 × 5 mg ampoules (50 ml total, no dilution needed - already 1 mg/ml!)
Or use 50 mg/10 ml formulation if available

At 1 mg/ml: ml/hr = mg/hr directly

Dose	Rate
2 mg/hr	2 ml/hr
5 mg/hr	5 ml/hr
10 mg/hr	10 ml/hr

Typical ICU sedation: 0.02-0.1 mg/kg/hr. For 70 kg: 1.4-7 mg/hr.

Weight-based example (0.05 mg/kg/hr, 70 kg): Dose = 0.05 × 70 = 3.5 mg/hr → 3.5 ml/hr (at 1 mg/ml)

Ampoules: 10 × 5 mg/5 ml ampoules → pool into 50 ml syringe = 1 mg/ml

10. DOBUTAMINE

Pakistan formulation: 250 mg/5 ml ampoule = 50 mg/ml (note: this is a highly concentrated vial)

Standard prep:

Peripheral: 250 mg (1 ampoule, 5 ml) + 245 ml D5W or NS = 250 mg in 250 ml = 1 mg/ml
Central (fluid restriction): 250 mg in 50 ml = 5 mg/ml

Dose: 2.5-10 mcg/kg/min

Rate calculation for 5 mcg/kg/min, 70 kg (250 mg in 250 ml = 1 mg/ml = 1000 mcg/ml):

Convert: 5 × 70 × 60 = 21,000 mcg/hr
Rate = 21,000 × 250 ÷ 250,000 mcg = 21 ml/hr

Quick table (250 mg in 250 ml = 1 mg/ml):

Dose	50 kg	70 kg	80 kg	100 kg
2.5 mcg/kg/min	7.5 ml/hr	10.5 ml/hr	12 ml/hr	15 ml/hr
5 mcg/kg/min	15 ml/hr	21 ml/hr	24 ml/hr	30 ml/hr
10 mcg/kg/min	30 ml/hr	42 ml/hr	48 ml/hr	60 ml/hr

Ampoules: 1 × 250 mg vial (5 ml) → draw up and add to 245 ml D5W

11. AMIODARONE (Cordarone)

Pakistan formulation: 150 mg/3 ml ampoule = 50 mg/ml

Standard preparations:

Loading (rapid): 300 mg in 250 ml D5W = 1.2 mg/ml → over 1 hour
Maintenance: 900 mg (6 ampoules) in 500 ml D5W = 1.8 mg/ml (ASHP standard)

Protocol (AF/VT/VF):

Bolus 1: 150 mg over 10 min → run at 90 ml/hr (300 mg in 250 ml bag)
Infusion 1: 360 mg over 6 hr = 1 mg/min → 33 ml/hr (at 1.8 mg/ml)
Infusion 2: 540 mg over 18 hr = 0.5 mg/min → 17 ml/hr (at 1.8 mg/ml)

Rate calculation for 0.5 mg/min maintenance (900 mg in 500 ml = 1.8 mg/ml):

Convert: 0.5 mg/min × 60 = 30 mg/hr
Rate = 30 mg/hr × 500 ml ÷ 900 mg = 16.7 ≈ 17 ml/hr

Shortcut at 1.8 mg/ml:

1 mg/min (60 mg/hr) → 33 ml/hr
0.5 mg/min (30 mg/hr) → 17 ml/hr

Ampoules: 6 × 150 mg ampoules (18 ml) → add to 500 ml D5W

Critical safety rules:

D5W ONLY - precipitates in NS
Concentration >2 mg/ml → CENTRAL LINE only (peripheral causes thrombophlebitis)
Incompatible with heparin - never Y-site together

12. LIDOCAINE

Pakistan formulation: 2% solution, 10 ml = 20 mg/ml (= 200 mg per vial)

Standard prep: 5 vials (1 g) in 250 ml NS = 4 mg/ml

Dose: 1-4 mg/min

Rate calculation:

Dose	mg/hr	Rate (4 mg/ml prep)
1 mg/min	60 mg/hr	15 ml/hr
2 mg/min	120 mg/hr	30 ml/hr
3 mg/min	180 mg/hr	45 ml/hr
4 mg/min	240 mg/hr	60 ml/hr

Shortcut at 4 mg/ml: Rate (ml/hr) = dose (mg/min) × 15

For any dose: Rate = dose (mg/min) × 60 × 250 ÷ 1000 = dose × 15

Ampoules: Draw 50 ml from 5 × 10 ml vials (total 1 g) → add to 200 ml NS (withdraw 50 ml from bag first if using 250 ml bag) = total 250 ml = 4 mg/ml

13. HEPARIN

Pakistan formulation: 5000 IU/ml vial (usually 5 ml = 25,000 IU per vial)

Standard prep (ASHP standard): 25,000 IU in 250 ml NS = 100 IU/ml

At 100 IU/ml: Rate (ml/hr) = dose (IU/hr) ÷ 100

Dose (IU/hr)	Rate
1000 IU/hr	10 ml/hr
1200 IU/hr	12 ml/hr
1500 IU/hr	15 ml/hr
2000 IU/hr	20 ml/hr

Weight-based starting dose: 18 IU/kg/hr after 80 IU/kg bolus. For 70 kg: 1260 IU/hr → 12.6 ml/hr → round to 13 ml/hr.

Ampoules: 1 vial (25,000 IU in 5 ml) → add to 245 ml NS = 250 ml total = 100 IU/ml

Monitor: aPTT every 6 hrs after initiation. Target: 60-100 seconds (therapeutic range = 1.5-2.5× control).

14. MAGNESIUM SULPHATE (MgSO4)

Pakistan formulation: 500 mg/ml = 50% solution (= 2 mmol/ml). Usually 10 ml ampoule = 5 g per ampoule

MUST dilute before IV use (50% solution is a vesicant - never give undiluted IV)

Preparation options:

Option A - Loading (4 g over 20 min): Draw 8 ml (4 g) from 50% vial → add to 92 ml NS = 100 ml total = 40 mg/ml = 4% Run at 300 ml/hr for 20 min (= 100 ml in 20 min = 4 g given)

Option B - Maintenance syringe pump (20 g in 100 ml): Draw 40 ml (20 g) → add 60 ml NS = 100 ml = 200 mg/ml

Maintenance dose	Rate (20 g in 100 ml)
1 g/hr	5 ml/hr
1.5 g/hr	7.5 ml/hr
2 g/hr	10 ml/hr

Option C - Ward burette method (2 g in 100 ml): Draw 4 ml (2 g) → add to 96 ml NS = 100 ml = 20 mg/ml For 1 g/hr: Rate = 50 ml/hr | For 2 g/hr: Rate = 100 ml/hr

Eclampsia protocol:

Load: 4-6 g over 15-20 min
Maintenance: 1-2 g/hr for ≥24 hr after delivery

Toxicity monitoring (mandatory before each rate change):

Finding	Action
RR <12/min	STOP infusion
Loss of patellar reflexes	STOP infusion
Urine output <25 ml/hr	Reduce dose/stop
SpO2 falling	STOP, give calcium

Antidote: Calcium gluconate 10 ml of 10% IV over 10 min

15. PHENYTOIN

Pakistan formulation: 250 mg/5 ml ampoule = 50 mg/ml

NOT given as continuous infusion - given as intermittent loading doses only.

Preparation for IV loading:

Dose: 18-20 mg/kg IV (loading for status epilepticus)
Dilute in NS only (precipitates in dextrose - D5W is absolutely contraindicated)
Dilute doses <1 g in 100 ml NS, doses >1 g in 250 ml NS
Maximum rate: 50 mg/min (25 mg/min in elderly/cardiac patients)
Must be given through an in-line filter (0.22-0.5 micron)
Monitor ECG and BP throughout infusion

Rate calculation for 1 g (4 ampoules) in 100 ml NS = 10 mg/ml:

At 50 mg/min → 3000 mg/hr
Rate = 3000 × 100 ÷ 1000 = 300 ml/hr
(= 100 ml over 20 min, giving 1 g at 50 mg/min)

For 70 kg patient (loading = 1400 mg = 5.6 ampoules ≈ 6 ampoules = 1500 mg): Dilute 1500 mg in 250 ml NS = 6 mg/ml At 50 mg/min: Rate = 3000 mg/hr × 250 ml ÷ 1500 mg = 500 ml/hr for 30 min

Ampoules: Calculate dose by weight. Each ampoule = 250 mg. A 70 kg patient needs ~6 ampoules.

NEVER mix phenytoin with any other drug or dextrose solution.

16. LEVETIRACETAM (Keppra)

Pakistan formulation: 500 mg/5 ml vial = 100 mg/ml

Given as SHORT intermittent infusion (not continuous)

Standard preparation (FDA/manufacturer table):

Dose	Vials needed	Dilute in	Infusion time
500 mg	1 vial (5 ml)	100 ml NS	15 min
1000 mg	2 vials (10 ml)	100 ml NS	15 min
1500 mg	3 vials (15 ml)	100 ml NS	15 min

Rate calculation for 1000 mg in 100 ml over 15 min:

Rate = 100 ml ÷ 0.25 hr = 400 ml/hr

Dosing: 500-1500 mg IV every 12 hours (epilepsy). 60 mg/kg IV for status epilepticus (max 4500 mg).

Compatible with: NS, D5W, Lactated Ringer's. Stable 24 hr at room temperature after mixing.

17. VASOPRESSIN

Pakistan formulation: 20 IU/ml ampoule (1 ml = 20 IU)

Standard prep: 20 IU (1 ampoule) in 100 ml NS = 0.2 IU/ml

Fixed doses (do NOT titrate in septic shock):

Septic shock adjunct: 0.03-0.04 IU/min
Variceal bleeding: 0.2-0.4 IU/min

Rate calculation for 0.03 IU/min (20 IU in 100 ml = 0.2 IU/ml):

Convert: 0.03 IU/min × 60 = 1.8 IU/hr
Rate = 1.8 × 100 ÷ 20 = 9 ml/hr

Dose (IU/min)	IU/hr	Rate (at 0.2 IU/ml)
0.01	0.6	3 ml/hr
0.03	1.8	9 ml/hr
0.04	2.4	12 ml/hr
0.1	6	30 ml/hr
0.4	24	120 ml/hr

Ampoules: 1 × 20 IU ampoule in 100 ml NS Vasopressin in septic shock: Use at fixed dose 0.03 IU/min (9 ml/hr) as noradrenaline-sparing agent. Do NOT up-titrate.

18. TERLIPRESSIN

Pakistan formulation: 1 mg/1 ml ampoule (lyophilized powder or solution)

Two modes of use:

MODE 1 - IV Bolus (more common in Pakistan/South Asia)

Variceal bleeding: 2 mg IV bolus every 4-6 hr (no infusion needed)
HRS type 1: 1-2 mg IV bolus every 4-6 hr, increase to 2 mg q4h if no response

MODE 2 - Continuous Infusion (preferred for HRS, fewer side effects)

Standard prep: 12 mg (12 ampoules) in 250 ml NS = 0.048 mg/ml ≈ 0.05 mg/ml

HRS infusion doses:

Start: 2 mg/24 hr → increase to 4, 6, 8, 12 mg/24 hr if creatinine not falling by 25%

Rate calculation for 2 mg/24 hr (12 mg in 250 ml = 0.048 mg/ml):

Rate = 2 mg/24 hr ÷ 24 = 0.083 mg/hr
Rate = 0.083 × 250 ÷ 12 = 1.74 ml/hr ≈ 2 ml/hr

Simpler prep for daily dosing: dissolve required daily dose in 50 ml NS and run over 24 hr.

Daily dose	In 50 ml NS	Rate
2 mg/24 hr	2 mg in 50 ml	2.08 ml/hr
4 mg/24 hr	4 mg in 50 ml	2.08 ml/hr (run 2× bags)
6 mg/24 hr	6 mg in 50 ml	~2 ml/hr

Practical trick: For bolus dosing (most common in Pakistani ICUs) - dilute 1 mg in 10 ml NS and give IV over 1-2 min every 4-6 hours. Simple and safe.

COMPLETE MASTER REFERENCE TABLE (All 18 Drugs)

Drug	Pakistan Formulation	Standard Prep	Final Conc.	Key Dose	Rate
Furosemide	20 mg/2 ml	100 mg in 100 ml NS	1 mg/ml	5-20 mg/hr	5-20 ml/hr
Adrenaline	1 mg/1 ml	6 mg in 100 ml D5W	60 mcg/ml	0.01-1 mcg/kg/min	2-15 ml/hr
Noradrenaline	4 mg/4 ml	4 mg in 100 ml D5W	40 mcg/ml	0.01-1 mcg/kg/min	1-20 ml/hr
Dopamine	200 mg/5 ml	200 mg in 50 ml	4 mg/ml	5-15 mcg/kg/min	3-15 ml/hr
ISDN	10 mg/10 ml	50 mg in 50 ml NS	1 mg/ml	2-10 mg/hr	2-10 ml/hr
Labetalol	50 mg/10 ml	200 mg in 200 ml NS	1 mg/ml	50-200 mg/hr	50-200 ml/hr
Octreotide	100 mcg/ml	500 mcg in 250 ml NS	2 mcg/ml	25-50 mcg/hr	12.5-25 ml/hr
Insulin	100 IU/ml	50 IU in 50 ml NS	1 IU/ml	Protocol	1-10 ml/hr
Midazolam	5 mg/5 ml	50 mg in 50 ml NS	1 mg/ml	2-10 mg/hr	2-10 ml/hr
Dobutamine	250 mg/5 ml	250 mg in 250 ml D5W	1 mg/ml	2.5-10 mcg/kg/min	10-42 ml/hr
Amiodarone	150 mg/3 ml	900 mg in 500 ml D5W	1.8 mg/ml	0.5-1 mg/min	17-33 ml/hr
Lidocaine	2%/10 ml (200 mg)	1 g in 250 ml NS	4 mg/ml	1-4 mg/min	15-60 ml/hr
Heparin	5000 IU/ml	25,000 IU in 250 ml NS	100 IU/ml	1000-1500 IU/hr	10-15 ml/hr
MgSO4	500 mg/ml (50%)	20 g in 100 ml NS	200 mg/ml	1-2 g/hr	5-10 ml/hr
Phenytoin	250 mg/5 ml	1-1.5 g in 250 ml NS	4-6 mg/ml	18-20 mg/kg load	300-500 ml/hr (intermittent)
Levetiracetam	500 mg/5 ml	500-1500 mg in 100 ml	5-15 mg/ml	500-1500 mg q12h	400 ml/hr × 15 min
Vasopressin	20 IU/ml	20 IU in 100 ml NS	0.2 IU/ml	0.03-0.04 IU/min	9-12 ml/hr
Terlipressin	1 mg/1 ml	Bolus (dilute 1 mg in 10 ml)	—	1-2 mg q4-6hr	Bolus over 1-2 min

THE UNIVERSAL 3-SECOND BEDSIDE RULE

1. Find concentration:   Conc = Total drug ÷ Total volume
2. Convert dose to /hr:  × 60 if /min | × weight × 60 ÷ 1000 if mcg/kg/min
3. Rate = Dose/hr ÷ Conc

The "round number" golden standard: Make 1 mg/ml (or 1 IU/ml or 100 IU/ml for heparin) and the pump rate equals the dose. Laminate this table and post it at every bedside.

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