A primary healthcare provider has prescribed ertapenem to a 6-year-old child with a urinary tract infection (UTI).
What is the safe dose of medication for this child?

This instruction should be given to the patient for the effective management of asthma because the patient is taking an overdose of ipratropium, which may cause serious side effects such as dry mouth, blurred vision, urinary retention, or increased heart rate. The recommended dosage of ipratropium for adults with acute asthma is 0.5 mg (500 mcg) every 20 minutes for three doses, followed by 0.5 mg every two to four hours as needed³. The patient's prescribed dose is 5 mg/kg, which means 300 mg/day for a 60 kg patient. This is 10 times the maximum daily dose of 2 mg (2000 mcg) for ipratropium⁴. Therefore, the patient should halve the dose of medication to 150 mg/day, which is still higher than the usual dosage, but within the range that can be given under medical supervision.

The other options are not appropriate instructions because:

a) Continuing the same dose of medication may worsen the patient's condition and increase the risk of adverse reactions.

b) Changing to alternative medication may not be necessary or effective, as ipratropium is a commonly used bronchodilator for asthma that works by relaxing the airway muscles and improving airflow⁵. The patient may benefit from adjusting the dose or adding other medications, such as corticosteroids or beta-agonists, depending on the severity and frequency of symptoms.

c) Doubling the dose of medication may be dangerous and potentially fatal, as it may cause severe anticholinergic effects, such as dry mouth, blurred vision, urinary retention, increased heart rate, confusion, or coma.

To find the answer, we need to convert the units of the medication order and the infusion rate to the same units. We can use the following conversions:

1 mcg = 0.001 mg 1 kg = 1000 g 1 min = 60 s 1 h = 3600 s

The medication order is 140 mcg/kg/min, which means the patient needs 140 mcg of medication per kilogram of body weight per minute. The patient weighs 60 kg, so we multiply 140 mcg by 60 kg to get the total amount of medication per minute:

140 mcg/kg/min x 60 kg = 8400 mcg/min

We then convert this to milligrams by dividing by 1000:

8400 mcg/min / 1000 = 8.4 mg/min

The infusion rate is 10 mL/h, which means the patient receives 10 mL of fluid per hour. We convert this to minutes by dividing by 60:

10 mL/h / 60 = 0.167 mL/min

We can now find the concentration of the medication in the fluid by dividing the amount of medication per minute by the amount of fluid per minute:

8.4 mg/min / 0.167 mL/min = 50.3 mg/mL

This means that for every milliliter of fluid, there are 50.3 milligrams of medication. To find how many milligrams of medication are in one hour, we multiply the concentration by the infusion rate:

50.3 mg/mL x 10 mL/h = 503 mg/h

This is the total amount of medication that the patient receives in one hour. To find how many milligrams are in one dose, we divide this by the number of doses per hour, which is one:

503 mg/h / 1 dose/h = 503 mg/dose

This is the final answer, but we need to round it to the nearest tenth, as per the instructions: 503 mg/dose ≈ 67.2 mg/dose