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How do I get 12 units out of a vial reconstituted to 8 mg/mL without guessing?

Asked 13 Aug 2024Modified 20 months agoViewed 25k times
15

Concretely: 12 units · 8 mg/mL.

I have done this once and I suspect I got away with it rather than got it right.

For context: I keep records of every batch, every lot number and every result, so an answer that requires me to track something is fine.

What does a defensible version of this look like in practice?

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askedfelix_araya6.8k1613 Aug 2024
2Worth stating whether you have a content assay, because the calculation assumes label claim. – e_dziedzic 5 months ago
Same question, and I got two answers that differ by a factor of ten, so I am watching this. – Dr_Jonas_Halvorsen 3 months ago
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5 Answers

Accepted answer first, then by votes
8

Accepted answer

12 units is 0.12 mL, which at 8 mg/mL is 0.96 mg. Work it in that order and there is nothing to guess at: units to volume on the U-100 scale, volume to dose through the concentration. Draw with the barrel vertical, expel the air before you read, and read the leading edge of the plunger stopper rather than the shoulder — the difference between the two is about a unit on a 0.3 mL barrel.

The relevant precision limit is that you cannot reliably read half a graduation, so the barrel decides the smallest change you can make.

Barrel sizes and graduations: 0.3 mL barrels are marked in single units to 30, 0.5 mL barrels in single units to 50, and 1 mL barrels usually in two-unit increments to 100. The smallest barrel that holds the dose gives the finest reading.

Concentration and unit conversion at a glance

VialDiluentConcentration0.25 mg0.5 mg1 mg2.5 mg
5 mg1 mL5 mg/mL5 u10 u20 u50 u
5 mg2 mL2.5 mg/mL10 u20 u40 u100 u
10 mg1 mL10 mg/mL2.5 u5 u10 u25 u
10 mg2 mL5 mg/mL5 u10 u20 u50 u
10 mg3 mL3.33 mg/mL7.5 u15 u30 u75 u

Units are U-100 insulin units, where 1 unit = 0.01 mL. Divide dose by concentration for millilitres, then multiply by 100.

U-40 syringes still exist, mostly in veterinary supply. A U-40 barrel marked "20 units" holds 0.5 mL, not 0.2 mL. Using one with U-100 arithmetic overdoses by a factor of two and a half.

Published dead-space comparisons put low-dead-space fixed-needle designs under 2 microlitres and conventional detachable-needle designs at 35 microlitres or more.

Nothing here is medical advice.

Check the syringe is U-100 and not U-40 before doing any arithmetic with it.

edited 2 Oct 2024 by orla_ferriter — added the citation requested in comments

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answered · acceptedorla_ferriter89k14819 Sept 2024
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11

Concretely, this is arithmetic and instrumentation, and both halves are simple once stated.

Read the leading edge of the rubber plunger stopper against the graduation, not the tip of the conical shoulder. The difference is roughly one unit on a 0.3 mL barrel, which is a four per cent error on a 25-unit dose.

Needle length for subcutaneous administration is conventionally 4 to 8 mm; the 4 mm length is sufficient for essentially all adults and reduces the chance of an intramuscular injection.

Half-graduation estimation is not measurement. If the dose needs it, change the concentration instead.

One unit is 0.01 mL on U-100. That is the whole scale.

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answeredu100_marks52k3711 Oct 2024
3Small correction: the units in the third paragraph should be micrograms, not milligrams. – j_wierzbicki 7 months ago
4I have added the label-the-vial suggestion to my own notes. Obvious in hindsight. – seamus_brady 8 months ago
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6

Answering this needs to know whether the syringe is U-100 or U-40, since a U-40 syringe used with the U-100 conversion produces a two-and-a-half-fold error.

A 2 mm air bubble in a 0.3 mL barrel is about 4 microlitres, which against a 10-unit (100 microlitre) draw is a four per cent error. Flick it to the hub and expel it before reading.

The underlying point is that syringes are single-use. Reusing one blunts the tip against the stopper, degrades the silicone coating and makes the graduation reading no more accurate than it was the first time.

U-100 is a concentration standard meaning 100 units of insulin per millilitre; the syringe graduation is a volume scale expressed in those units.

If your arithmetic and someone else's differ by a factor of ten, one of you has misplaced a decimal rather than misunderstood the biology.

Smallest barrel that holds the dose. Resolution is free and you should take it.

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answeredorla_ferriter89k14823 Oct 2024
Adding that a fixed-needle syringe loses about a tenth of what a luer one does. – leonid_marchuk 4 days ago
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2

The short version: U-100 only, smallest barrel that fits the dose, read the leading edge of the plunger stopper.

The conversion in full: volume in mL = dose in mg ÷ concentration in mg/mL; units = volume × 100. At 5 mg/mL, a 0.25 mg dose is 0.05 mL, which is 5 units. At the same concentration a 1 mg dose is 0.2 mL, which is 20 units.

Fixed needle, not detachable, unless you have a specific reason.

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answeredtandem_gradient61k24830 Sept 2024
6Does this change at lower concentrations, or does adsorption start to dominate? – kelvin_lam 5 months ago
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1

Start with the barrel size, because a 0.3 mL barrel graduated in single units and a 1 mL barrel graduated in twos are different instruments for this purpose.

Fixed-needle insulin syringes retain roughly 3 to 5 microlitres after the plunger bottoms out. Detachable-needle luer syringes retain 35 to 100 microlitres depending on hub design — an order of magnitude more.

The caveat is that this describes an instrument, not a treatment, and research-use compounds are not approved for human use.

Read the leading edge of the stopper, every time.

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answeredtabular_nums71k4825 Nov 2024

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Ask PeptideStack is a static archive. Posting is closed, but the norms are worth stating: answer the question that was asked, show your working, cite the trial or the certificate, and say plainly where the evidence runs out.

Not medical advice. Research-use-only compounds are not approved for human use.