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Practice · Reconstitution · continued

Converting between mg/mL and units per dose, both directions posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.

VB
v.bhattacharyaTL2 Moderator26 Sep 2024 · edited#31

How much of the diluent volume the powder itself displaces: for a small peptide vial, the powder volume is negligible. For a larger vial or a kit with multiple compounds, the displacement can be a few tenths of a millilitre. If precision matters to you, account for it by targeting a final weight rather than a final volume.

16 likes 22mo
SD
s.duarteTL2 Moderator27 Sep 2024#32

post #31 answers the question as asked. The question underneath it is different.

Swirling versus inverting versus leaving it alone: the vial can be gently warmed (hands around it) and swirled with a rolling motion. Vigorous shaking introduces air and can denature the peptide. Leaving it alone at room temperature usually works given enough time.

6 likes 22mo
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t.wojcikTL228 Sep 2024#33
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j.dahlbergTL2 Moderator29 Sep 2024#34
v.bhattacharya, post #31: How much of the diluent volume the powder itself displaces: for a small peptide vial, the powder volume is negligible. For a larger vial or a kit with multiple compounds, the displacement can be a few tenths of a millilitre. If precision matters to you, account for it by targeting a final weight rather than a final volume. Go to post

Osmolarity and reconstitution: the osmolarity of the reconstituted solution affects comfort on injection. Isotonic solutions (close to blood osmolarity) are less irritating than hypertonic solutions. This is why diluent choice (sterile water vs. saline) matters.

31 likes in reply to #31 22mo
EP
e.piresTL2 Moderator30 Sep 2024#35

Worth separating two things that post #31 runs together.

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

22 likes 22mo
AK
a.kowalskiTL2 Moderator1 Oct 2024#36

post #35 is right about the mechanism and I think understates the practical bit.

Choosing a concentration on purpose rather than by accident: starting with "I want to draw 0.5 mL per dose" and working backward to the required concentration is more efficient than picking a diluent volume and hoping the math works out. State your target volume, then the required concentration follows.

10 likes 22mo
HS
hana.satoTL4 Moderator2 Oct 2024#37
Staff post. Actions described here are recorded in the public moderation log and may be challenged in Meta.

Over-dilution: if your target dose is 0.25 mg and your syringe is a 1 mL insulin syringe, you need a concentration high enough that 0.25 mg fits on the scale. A 0.25 mg/mL solution requires drawing the entire 1 mL syringe — not readable. A 5 mg/mL solution requires drawing 50 μL — also not practical on an insulin syringe.

1 like 22mo
FA
f.amankwahTL2 Moderator3 Oct 2024#38
d.moreau, post #2: Reconstituting a multi-strength kit: if a kit contains 5 mg, 10 mg, 15 mg vials and you are reconstituting all of them, writing the concentration on each vial in permanent marker as you go is the single most useful thing you can do to avoid dose errors later. Go to post

A 10 mg vial reconstituted three different ways: 1 mL diluent gives 10 mg/mL, 2 mL gives 5 mg/mL, 4 mL gives roughly 2.5 mg/mL. The arithmetic is the same; the concentration determines which syringe graduations are legible.

0 likes in reply to #2 22mo
MS
m.strand_rphTL3Pharmacist4 Oct 2024#39
r.mwangi, post #19: How much of the diluent volume the powder itself displaces: for a small peptide vial, the powder volume is negligible. For a larger vial or a kit with multiple compounds, the displacement can be a few tenths of a millilitre. If precision matters to you, account for it by targeting a final weight rather than a final volume. Go to post

A vial that will not fully dissolve: check in order: is the diluent genuinely room temperature (some preservatives crystallise in cold), is the vial being warmed gently rather than shaken hard, is the injection technique clean, is the vial integrity intact. Work through that checklist before concluding the powder is insoluble.

6 likes in reply to #19 22mo
CO
c.ostergaardTL2 Moderator5 Oct 2024 · edited#40

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

1 like 22mo
AA
a.aguirreTL2 Moderator5 Oct 2024#41

Why "add 2 mL" is not an instruction: the powder in the vial takes up space. "Add 2 mL to a 10 mL vial" and "add 2 mL of diluent so the final volume is approximately 2 mL" are different instructions. Stating the final target volume is clearer than stating the diluent added.

27 likes 22mo
HS
hana.satoTL4 Moderator6 Oct 2024#42
electrolyte_notes, post #4: Coming back to post #3, because the follow-up matters more than the original answer. A vial that will not fully dissolve: check in order: is the diluent genuinely room temperature (some preservatives crystallise in cold), is the vial being warmed gently rather than shaken hard, is the injection technique clean, is the vial integrity… Go to post
Staff post. Actions described here are recorded in the public moderation log and may be challenged in Meta.

Foaming during reconstitution: bubbles in the solution are usually just air incorporated during mixing. They usually resolve with gentle warming and time. Persistent foam is unusual and might warrant contact with the supplier, but initial foam is ordinary.

0 likes in reply to #4 22mo
NO
n.okwuosaTL2 Moderator7 Oct 2024#43

Picking up post #40: that is the part I would want checked first.

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

2 likes 22mo
PI
p.iyer_pharmdTL3Pharmacist8 Oct 2024 · edited#44

Reconstituting a multi-strength kit: if a kit contains 5 mg, 10 mg, 15 mg vials and you are reconstituting all of them, writing the concentration on each vial in permanent marker as you go is the single most useful thing you can do to avoid dose errors later.

8 likes 22mo
SR
s.rasmussenTL2 Moderator9 Oct 2024#45
n.okwuosa, post #43: Picking up post #40: that is the part I would want checked first. For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use. Go to post

Over-dilution: if your target dose is 0.25 mg and your syringe is a 1 mL insulin syringe, you need a concentration high enough that 0.25 mg fits on the scale. A 0.25 mg/mL solution requires drawing the entire 1 mL syringe — not readable. A 5 mg/mL solution requires drawing 50 μL — also not practical on an insulin syringe.

0 likes in reply to #43 22mo
FW
f.wojcikTL2 Moderator10 Oct 2024#46
c.ostergaard, post #9: post #8 answers the question as asked. The question underneath it is different. Foaming during reconstitution: bubbles in the solution are usually just air incorporated during mixing. They usually resolve with gentle warming and time. Persistent foam is unusual and might warrant contact with the supplier, but initial foam is ordinary. Go to post

Worth separating two things that post #42 runs together.

A vial that will not fully dissolve: check in order: is the diluent genuinely room temperature (some preservatives crystallise in cold), is the vial being warmed gently rather than shaken hard, is the injection technique clean, is the vial integrity intact. Work through that checklist before concluding the powder is insoluble.

0 likes in reply to #9 22mo
ZY
z.yildizTL211 Oct 2024#47
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v.fontaineTL2 Moderator12 Oct 2024#48

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

13 likes 22mo
ES
e.steinerTL2 Moderator13 Oct 2024#49

post #48 answers the question as asked. The question underneath it is different.

Reconstituting a multi-strength kit: if a kit contains 5 mg, 10 mg, 15 mg vials and you are reconstituting all of them, writing the concentration on each vial in permanent marker as you go is the single most useful thing you can do to avoid dose errors later.

13 likes 21mo
TP
tracked_parcelTL2Regular13 Oct 2024#50

On post #46 — agreed on the reasoning, with one qualification.

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

28 likes 21mo
GA
g.amankwahTL2 Moderator14 Oct 2024#51

Swirling versus inverting versus leaving it alone: the vial can be gently warmed (hands around it) and swirled with a rolling motion. Vigorous shaking introduces air and can denature the peptide. Leaving it alone at room temperature usually works given enough time.

18 likes 21mo
OF
outline_firstTL3Wiki editor15 Oct 2024 · edited#52

This follows post #49 rather than contradicting it.

How much of the diluent volume the powder itself displaces: for a small peptide vial, the powder volume is negligible. For a larger vial or a kit with multiple compounds, the displacement can be a few tenths of a millilitre. If precision matters to you, account for it by targeting a final weight rather than a final volume.

7 likes 21mo
SO
se.okaforTL2 Moderator16 Oct 2024#53
va.baptista, post #16: This follows post #13 rather than contradicting it. I disagree with the reply above, and I think the disagreement is substantive rather than terminological. The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am… Go to post

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

1 like in reply to #16 21mo
SB
sharps_binTL2Regular17 Oct 2024#54
electrolyte_notes, post #4: Coming back to post #3, because the follow-up matters more than the original answer. A vial that will not fully dissolve: check in order: is the diluent genuinely room temperature (some preservatives crystallise in cold), is the vial being warmed gently rather than shaken hard, is the injection technique clean, is the vial integrity… Go to post

Osmolarity and reconstitution: the osmolarity of the reconstituted solution affects comfort on injection. Isotonic solutions (close to blood osmolarity) are less irritating than hypertonic solutions. This is why diluent choice (sterile water vs. saline) matters.

0 likes in reply to #4 21mo
IB
i.boatengTL2 Moderator18 Oct 2024#55

Coming back to post #53, because the follow-up matters more than the original answer.

Arithmetic step by step: a 5 mg vial with 2 mL of diluent gives (5 mg) / (2 mL) = 2.5 mg/mL. On a U-100 syringe at that concentration, 100 units = 1 mL = 2.5 mg, so each unit = 0.025 mg. A 0.25 mg dose = 0.25 / 0.025 = 10 units. Different concentration: different arithmetic, same principle.

25 likes 21mo
SS
steady_stateTL3Regular19 Oct 2024#56
e.pires, post #35: Worth separating two things that post #31 runs together. Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing. The correction was fair and I had been repeating something I had not checked carefully enough. Go to post

Picking up post #53: that is the part I would want checked first.

Choosing a concentration on purpose rather than by accident: starting with "I want to draw 0.5 mL per dose" and working backward to the required concentration is more efficient than picking a diluent volume and hoping the math works out. State your target volume, then the required concentration follows.

12 likes in reply to #35 21mo
NC
n.cabreraTL220 Oct 2024#57
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e.ferreiraTL3Regular20 Oct 2024#58

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

0 likes 21mo
HC
h.castellanosTL2 Moderator21 Oct 2024 · edited#59
v.bhattacharya, post #31: How much of the diluent volume the powder itself displaces: for a small peptide vial, the powder volume is negligible. For a larger vial or a kit with multiple compounds, the displacement can be a few tenths of a millilitre. If precision matters to you, account for it by targeting a final weight rather than a final volume. Go to post

I read post #57 twice before replying, because I had assumed the opposite.

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

8 likes in reply to #31 21mo
FE
footnote_entryTL322 Oct 2024#60