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Titration Examples

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1. Ordered: Dopamine HCl (Intropin) 4 mcg/kg/min IV for a 110-lb patient. The literature states that the usual dose is 2 to 5 mcg/kg/min. Available: Dopamine 200 mg in 250 mL D5W.

a. Patient's weight in kg: 110 ÷ 2.2 = 50

b. SDR/min: 100 − 250 mcg/min

c. Is the order safe? Yes. 4 mcg × 50 = 200 mcg/min. 200 mcg/min is within the SDR

d. Hourly drug order in mcg: 12,000 (200 mcg × 60 min)

e. Hourly drug order in mg*: 12 (decimal moved 3 places to left)

f. TD : TV reduced ratio: 4 : 5 (200 mg : 250 mL)

g. Hourly flow rate to be set on infusion device: 200 mg = 12 mg = 15 ml/hr 250 ml X ml
*Because the available drug (250 mg) is in mg, the hourly drug order must also be entered in mg.

2. Ordered: Dobutamine HCl (Dobutrex) 5 mcg/kg/min IV for a 132-lb patient. Available: Dobutamine 250 mg in 250 mL D5W. The flow rate is currently infusing at 36 mL/hr.

a. Patient's weight in kg: 60 kg

b. Hourly drug order in mcg: 5mcg X 60 kg X 60 min = 18,000 mcg/hr

c. Hourly drug order in mg*: 18,000 mcg ÷ 1,000 mcg = 18 mg/hr

d. TD : TV reduced ratio: 1:1 (250 mg : 250 ml)

e. Hourly flow rate to be set on infusion device: 18 ml/hr

f. Is current infusion correct? No. Should be 18 ml/hr, not 36 ml/hr

g. Evaluation and decision: Unsafe. Assess patient's vital signs, report per hospital policy, and contact physician for orders.

3. Ordered: Lidocaine 4 mg/min. Available: 1 g of lidocaine in 500 mL of D5W.
a. TD : TV reduced ratio (mg : mL): 2 mg/ml
b. Hourly drug ordered: 4 mg X 60 min = 240 mg/hr
c. Hourly flow rate to be set on infusion device: 240 mg ÷ 2 mg = 120 ml/hr

4. Ordered: Isuprel (isoproterenol hydrochloride) 5 mcg/min. Available:
Isoproterenol hydrochloride 1 mg in 250 mL D5W.
a. TD : TV reduced ratio: 1mg ÷ 250 ml
b. Hourly drug ordered in mcg and in mg: 5 mcg X 60 min = 300 mcg/hr ÷ 1,000 mcg = 0.3 mg/hr
PROOF
c. TD : TV :: HD : HV ratio: 1mg : 250 ml :: 0.3 mg : Xml
d. Hourly flow rate to be set on infusion device: 0.3 mg X 250 ml = 75 ml/hr

5. Ordered: Initial infusion of norepinephrine at 50 mL/hr. Available:
Norepinephrine 1 mg in 250 mL normal saline (NS). The SDR is 8 to 12 mcg/min initially.
a. TD: TV :: HD : HV ratio: 1 mg : 250 ml :: X mcg : 50 ml
b. Hourly drug being infused in mg: 50 ml ÷ 250 ml = 0.2 mg/hr
c. Hourly drug order in mcg/hr: 0.2 mg X 1,000 mcg = 200 mcg/hr
d. Hourly drug order in mcg/min: 200 mcg ÷ 60 min = 3.3 mcg/min
e. SDR for this patient: 8 to 12 mcg/min
f. Evaluation and decision: Low; consult with provider

Answer Key
2.a. 60 (132 ÷ 2.2)
b. 300 mcg/min × 60 = 18,000 mcg/hr
c. 18 mg/hr (decimal moved 3 places to left)
d. 250 : 250 :: 1 : 1
e. 18 mL/hr (1 : 1 :: 18 : x)
f. Incorrect flow rate. Should be 18 mL/hr, not 36 mL/hr.
g. Unsafe. Assess patient's vital signs, report per hospital policy, and contact physician for orders.

3.a. 1000 mg : 500 mL :: 2 mg : 1 mL
b. 4 mg × 60 = 240 mg/hr
c. 2 : 1 :: 240 : x = 120 mL/hr

4.a. 1 mg : 250 mL
b. 5 mcg × 60 = 300 mcg/hr or 0.3 mg/hr
c. 1 : 250 mL :: 0.3 mg : x mL
d. 0.3 X 250 = 75 ml/hr

5.a. 1 mg : 250 mL :: x mcg : 50 mL
b. x = 0.2 mg/hr
c. 200 mcg/hr
d. 200 mcg ÷ 60 = 3.3 mcg/min
e. 8 to 12 mcg/min
f. Low; consult with provider

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