Need some help with a Levophed math problem

[student2008]

I have been driving myself nuts with this math problem, can anyone help me?

the question is>> you are caring for a client in the ICU. the clients BP is 60/30. after notifying the MD, he orders the client to be started on a Levophed drip. ICU protocol states that the starting dose is 8 to 12 mcg/min initialy. the clients weight is 163 lbs. pharmacy sends a 500 ml bag of D5W with 4 mg of Levophed.

what is the dilution of levophed per mL of D5w? I don't know if I'm suppose the convert the 4 mg to mcg or just figure it the way it is. Which would come out being 0.008mg/ml. is this correct?

then it ask....caculate the reate of infusion per minute using 8 mcg/min. on this question I came up with 1ml/min?

what is the reate per hour for the infusion?

8mcg/ml = 1 ml/min = 1ml x 60 (hr) = 60 ml/hr

am I any where near the answer here? This is driving me crazy. Any help or suggestions would be greatly appreciated

Thanks

[Daytonite, BSN, RN]

yes, you are right.

the usual dose of levophed (norepinephrine) is 8-12 mcg/minute to achieve the desired bp. it is normally mixed as 4 mg in 1,000 ml of d5w or d5ns which gives you 4 mcg/ml. (page 936-939, 2007 intravenous medications, 23rd edition, by betty l. gahart and adrienne r. nazareno)

your problem states: the pharmacy sends a 500 ml bag of d5w with 4 mg of levophed. what is the dilution of levophed per ml of d5w?

gahart and nazareno give the dilution in mcg/ml. so, the answer would be:

4ml/500ml x 1000mcg/ml =

8 mcg/ml

then you are asked to calculate the rate of infusion per minute using 8 mcg/min. gahart and nazareno give the rates of infusion for levophed (norepinephrine) as ml/minute and ml/hour on a table on page 937 of their book.

1 ml/minute

the math:

8 mcg/minute

(dose desired)

x 1 ml/8 mcg

(dose on hand) =

1 ml/minute

60 ml/hour

the math:

1 ml/minute x 60 minutes/1 hour

(conversion factor)

=

60 ml/hour

fun, huh? that's why they use the table to compute these.

[student2008]

Thank you so much. I was hoping I was doing it right! I just wasn't sure.

[Daytonite, BSN, RN]

i get the impression that you are doing icu drugs. i have a copy of 2007 intravenous medications, 23rd edition, by betty l. gahart and adrienne r. nazareno which is what i have been using to help me with this and your other question about ardizem (diltiazem). the information in this book is more extensive than what a nursing drug reference has. i was an iv therapist.

[student2008]

yes, I'm taking critical care right now and in about 6 more weeks I will be taking mental health. This is my last semester of nursing school. It's been kind of crazy! I do thank you for all you have done to help me. I will be starting my preceptorship this week, so any advice is welcome. I will be in CCU. (yea...I'm scared to death).

Thanks again, you have help me so much and I want you to know how much I appreciate it.

[rodrn]

Here is ACEP's web-site for a vasopressor/inotrope dosing card http://secure2.acep.org/BookStore/p-10456-dose-right-card-adult-vasopressorsinotropes.aspx