1) A vial for preparation of 100mL of injection of the drug alteplase (ATIVASE)

Question

1) A vial for preparation of 100mL of injection of the drug alteplase (ATIVASE) contains 100 mg of drug equivalent to 58 million international units to be administered by intravenous infusion. Calculate a) the units administered to a 176-Ib patient at a dose of 0.9 mg/kg and b) the mL of injection to use.

2) A physician's hospital medication order calls for a patient to recieve 1 unit of insulin injection subcutaneously for every 10 mg/dL of blood sugar over 175 mg/dL, with blood sugar levels and injections performed twice daily in the morning and evening. The patient's blood sugar was 200 mg/dL in the morning and 320 mg?dL in the evening. How many total units of insulin injection were administered? Please i the working solution of these problems. Thanks

Explanation / Answer

Answer to question 1:

Step 1: Analyse the question and know the basics:

100 mL of injection = 100 mg of Ativase drug = 58 million International Units [IU]

Dose scheduled - drug units [in million] = 0.9 mg/kg of body weight

Patient’s weight 176 lbs.

1 kg = 2.2 lbs or 1 lbs = 0.45359 Kg

Step 2: Convert lbs to Kg:

176 lbs = ? Kg

= 176 x 0.45359 Kg = 79.83 Kg

Step 3: Calculate the drug requirements [units administered and dose of injection required/used:

Dose scheduled - drug units [in million] = 0.9 mg/kg of body weight

= 0.9 x 79.83 = 71.847 million IU = approx. 72 million IU.

100 ml of injection = 100 mg of Ativase drug = 58 million International Units [IU]

Therefore, 72 IU of drug requires

100 mg

------------         x 72 million IU            =         124.1379 mL of injection

58 million IU

Approx. = 125 mL.

Answer: To administer the drug at 0.9 mg/Kg of body weight, the dose required is 125 mL and the total drug infused is 72 million IUs.

Answer to question 2:

Step 1: Analyse the question and know the basics:

1 unit of Insulin injection subcutaneous to be administered [for every 10 mg/dL > 175 mg/dL]

Morning blood sugar level: 200 mg/dL

Evening blood sugar level: 320 mg/dL

Required is: How many total units of insulin injection were administered?

Step 2: Calculate the adjusted blood sugar level for Insulin administration:

That is 1 unit of Insulin injection for every 10 mg/dL > 175 mg/dL

Insulin requirement for the adjusted blood sugar level:

For this amount only we need to administer Insulin at the proportion of 1 unit for every 10 mg/dL

In the morning, Insulin level greater than 175 mg/dL is: 200-175 mg/dL = 25 mg/dL

In the evening, Insulin level greater than 175 mg/dL is: 320-175 mg/dL = 145 mg/dL

Step 3: Calculate the Insulin requirement:

Calculating Insulin requirement in the morning:

Adjusted blood sugar level is: 25 mg/dL

For every 10 mg/dL increase in blood glucose 1 unit is administered. Therefore

For every 25 mg/dL increase in blood glucose,

25 mg/dL

------------         x 1 unit            =          2.5 mL of Insulin is administered.

/ 10 mg/dL

Calculating Insulin requirement in the evening:

Adjusted blood sugar level is: 145 mg/dL

For every 10 mg/dL increase in blood glucose 1 unit is administered. Therefore

For every 145 mg/dL increase in blood glucose,

145 mg/dL

------------         x 1 unit            =          14.5 mL of Insulin is administered.

/ 10 mg/dL

Therefore, in the morning 2.5 mL and in the evening 14.5 mL of insulin should be administered for safe glucose control.

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