i shouldn't be asking this.

[smartnurse1982]

If a pt needs 0.5mg of pulmicort(the vials come in 0.5mg/2ml.) The other nurses told me to take 2 vials of 0.25mg/2ml instead because we don't have the 0.5mg. I told them they don't equal up,because 0.5mg in 4 ml solution won't give you the same concentration,and that just chart unavailable. Who is right?

[Lucky0220]

as you can see, i went to bed last night thinking about this and woke up thinking about it after getting my email to this thread!

so i pulled out the drug book from school, and yes, you should be asking. we should always be learning.

so here goes. clrn2b is correct in saying that the dose available is a lesser concentration.

so to compensate for that, you would be sure to give at least 4ml's, which is what the 2 vials add up to. so your colleagues are correct, which at first, i thought they were not.

a method to calculate this: dose ordered x volume (of dose avail)

dose available

so: .50 x 2ml = 4ml

.25

hope this helps, cause it helped me to refresh my own memory!

[Lucky0220]

in reference to my above post, it is in the process of being edited by the staff because the way it is written is incomprehensible!!

i waited too long to do it myself.

[PetiteOpRN]

pediatrics vol. 105 no. 5 may 2000, p. e67

electronic article:

undiluted albuterol aerosols in the pediatric emergency department

david j. gutglass, md*, louis hampers, md, mba*, genie roosevelt, md, mph*, doreen teoh, md*, sai r. nimmagadda, md, and steven e. krug, md*

from the divisions of * pediatric emergency medicine and allergy, children's memorial hospital, chicago, illinois.

in this research article their were no observed differences in outcomes r/t the dilution of the ordered dosage of albuterl. our practice in my ed is to dilute the ordered dose with an amp of saline in the nebulizer. we have had really good results with this and the extra couple of mls of ns does not affect the theraputic onset. also many pts with breathing problems are reassured by a longer nebulised treatment

that's very interesting, thank you. sometimes i dilute with a little more ns because the extra deep breathing and mist gets things moving.

[nursel56]

As you can see, I went to bed last night thinking about this and woke up thinking about it after getting my email to this thread!

So I pulled out the drug book from school, and YES, you should be asking. We should always be learning.

So here goes. CLRN2B is correct in saying that the dose available is a lesser concentration.

I made a mistake in my wording about the comparative concentrations -- sometimes brain to finger connection a little loose. :oI It's always good to kick this stuff around, though. I was also trying to understand why kookabura would be correct in his post that 0.5mg/2ml or 0.25mg/1ml is in reality the same concentration as 0.25mg/2ml. Maybe someone can help me out with that one.

Clearly an extra couple of milliliters of saline makes no appreciable difference and as posted by well-seasoned it may be more effective. I would be inclined to blow it off, too if I hadn't been in the trenches with Case Managers making such collosal amounts of ado over such small amounts of nothing. Really, there are times when you just pray that someone will start laughing and saying "punked!!!" so you know you are still on planet earth.

ed to add: some, not all Case Managers!

[Meriwhen, ASN, BSN, MSN, RN]

I would be inclined to blow it off, too if I hadn't been in the trenches with Case Managers making such collosal amounts of ado over such small amounts of nothing. Really, there are times when you just pray that someone will start laughing and saying "punked!!!" so you know you are still on planet earth.

ed to add: some, not all Case Managers!

That's my problem too: I've had doctors order a dose skipped, change to a different medication, or flat-out cancel a medication because I couldn't obtain exactly what they wanted in the original order. Go figure. So that's why I'd rather call to give them the heads-up.

[Lucky0220]

in reference to my above post, it is in the process of being edited by the staff because the way it is written is incomprehensible!!

i waited too long to do it myself.

--------------------------------

just in case anybody still cares, this is my corrected post:

i went to bed last night thinking about this and woke up thinking about it after getting my email to this thread!

so i pulled out the drug book from school, and yes, you should be asking. we should always be learning.

so here goes. clrn2b is correct in saying that the dose available is a lesser concentration.

so to compensate for that, you would be sure to give at least 4ml's, which is what the 2 vials add up to. so your colleagues are correct, which at first, i thought they were not.

a method to calculate this: dose ordered ÷ dose available x volume (of dose avail)

so: .50 ÷ .25 x 2ml = 4mls

hope this helps, cause it helped me to refresh my own memory!