Dear Editor.
The infusion pump is a useful device now available in most service hospitals, however it is largely underutilised probably due to complex calculations involved. A ready reckoner in tabular form as shown below should be of help in the intensive care units and acute wards. The table lists most common emergency drugs and has been calculated for a 60 kg patient. While the infusion is in progress the infusion rate of most drugs will have to be titrated against the patient response. I would welcome comments from intensivists and others on applicability of such a table.
Infusion pump protocol for common emergency drugs
| Drug | Diluent | Available strength | Loading dose (IV) | Standard infusion dose(for 60kg) | Amountt for 50 ml syringe | Infusion rate to be entered | Indications |
|---|---|---|---|---|---|---|---|
| Amiodarone | NS/D5W | SO mg/ml, 3ml amp | 300 mg rapid in 20-30ml diluent | 1 mg/minx6hrs, then 0.5 mg/min to max dose 2gm | 150 mg (3 ml) | 20 ml/hr, then 10ml/hr | VT.SVT |
| Atropine | NS/D5W | 1 ml amp, 0.6 mg/amp | Nil | 8 mg/hr | 8 mg (13-14 amp) | 50ml/hr | OP poisoning |
| Diazepam | NS/D5W | 2ml amp, 5 mg/ml | 0.2 mg/kg at 5 mg/min | 0.12 mg/min | 10 mg (2ml) | 40 ml/hr | Status epilepticus |
| Diltiazem | NS/D5W | 5 mg/ml, 5ml amp | 0.25 mg/kg, rpt 0.35 mg/kg | 5-15 mg/hr | 25 mg (5ml) | 10-30 ml/hr | AF. Af, MAT. SVT |
| Dobutamine | NS/D5W | 5ml amp, 50mg/ml | Nil | 3-20mcg/kg/min | 250mg (5 ml) | 2.16-14.4 ml/hr | Heart failure# |
| Dopamine | NS/D5W | 5ml amp, 40mg/ml | Nil | 2-8mcg/kg/min | 200mg (5ml) | 1.8ml-7.2ml/hr | Heart failure* |
| Heparin | NS/D5W | 25000u/5ml vial | 10,000 units | 1000 unit/hr | 25000 units (5ml) | 2ml/hr | PE. AMI. UA |
| Insulin | NS | 40 U/ml vial | 10-15 units | 6 units/hr | 40 units | 7.5 ml/hr | DKA*, NKHS* |
| Lidocaine | NS/D5W | 50ml vial, 20 mg/ml | 1 mg/min | 1-4 mg/min | 200 mg, 10 ml | 15-60 ml/hr | VT |
| Midzolam | NS/D5W | 1ml amp, 5 mg/ml | 0.2 mg/kg at 5mg/min | 0.75mcg/kg/min-10 meg/kg/min | 50mg. 10ml | 2.7ml-36ml/hr | Status epilepticus |
| Nitroglycerine | NS/D5W | 5 ml amp, 5 mg/ml | Nil | 10mcg/mln | 10mg (2 ml) | 3 ml/hr | AMI*.UA*. Severe HTN* |
| Nitroprusside | D5W only | 50mg/ml, 5ml vial | Nil | 0.25-10mcg/kg/min | 50mg (1ml) | 0.9-3 ml/hr | Severe HTN* |
| Propofol | NS/D5W | 10ml, 20 mg/ml | l-2mg/kg | 2-10 mg/kg/hr | 100mg, 5ml | 1.2-6ml/hr | Status epilepticus |
VT – Ventricular tachycardia, SVT – Supraventricular tachycardia, AF – Atrial fibrillation, A fI – Atrial flutter, OP – Organophosphorous, PE – Pulmonary embolism, UA – Unstable angina, AMI – Acute myocardial infarction, MAT – Multifocal atrial tachycardia, DKA – Diabetic ketoacidosis, NKHS – Nonketotic hyperosmolar syndrome, HTN – Hypertension, NS – Normal saline, D5W – 5% dextrose
For convenience loading and bolus doses may be given separate manually
Titrate to effect