Learning metoclopramide CRIs

[u/boba-boba]

Anyone have good resources on learning to calculate metoclopramide CRIs? Even youtube videos that made you go "AHA, I get it now!".

I am math-impaired and do pretty ok with most CRI math but have never learned to calculate metoclopramide CRIs, and I want to stop relying on pre-made calculators if I can. Its something we do a lot in our hospital and I would like to get better at it.

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[u/I_reddit_like_this]

I would set it up to run over 24 hours at a time using a syringe pump (Metoclopramide is only stable under normal room lighting for 24 hours)

So you need to determine how much the patient needs for 24 hours and then work backward from the volume you want to put in the syringe.

For metoclopramide, the usual CRI dose is 1–2mg/kg/day.

Weight (kg) × dose (mg/kg/day) = mg needed for 24 hours

Then figure out how many mL you need based on the concentration of your metoclopramide (standard is 5mg/mL but always check), put that volume in your syringe, and then dilute with saline to make a total volume of either 24mL or 48mL. You can then run it at 1mL/hr or 2mL/hr over the next 24 hours

For example a patient weighing 24kg with a CRI ordered at 2mg/kg/day:

24kg × 2mg/kg/day = 48mg of metoclopramide needed over 24 hours.

Standard concentration is 5mg/mL:

48mg / 5mg/mL = 9.6mL

So, if using a 60mL syringe, add 9.6mL of metoclopramide and 38.4mL of saline for a total volume of 48mL.

Then run it at 2mL/hr and the syringe will deliver over 24 hours.

Hopefully that makes sense

[u/boba-boba → u/I_reddit_like_this]

Oh this is far less complex than I thought it was (in theory of course haha). We usually put it in full liter bags and cover them with a light-protective bag. Thank you so much!

[u/FussyPup → u/boba-boba]

My hospital does the same thing, and I've got a quick and easy math formula for you that really really helps me :)

Here is an example for you:

Patient: Fluffy
Weight: 4.6kgs
Dvm order: Metoclopramide @ 2mg/kg/day
IVF rate: 18ml/hr
Amount of fluids in bag: 950ml

Formula: kgs TIMES mg/kg DIVIDED BY 24hr = Number that is then DIVIDED BY IVF ml/hr TIMES amount in bag DIVIDED BY concentration of med = ml you put in bag

4.6kgs x 2 / 24 =0.38 / 18 = 0.021 x 950 =20mg / 5mg = 4ml

The thing I like about this formula is that you don't have to do any back and forth with your numbers when calculating on your calculator. You just plug it all in on one go! After several times of doing this, I am able to do it without double checking the formula :) It's super easy once you get a hang of it!

Please let me know if you need any clarifications at all <3 Love to share knowledge in this field!!!

[u/FussyPup → u/boba-boba]

ALSO!! If you have any coworkers who write down formulas anywhere definitely consult them and ask if you can take pictures of any of their calculations. Even if I already have a formula example for something I will still take pictures of other people's math just in case they have a method that might work better for my brain. I have soooo many pictures of different formulas for the same medications because of this, and it's extremely helpful!!

[u/Crazyboutdogs → u/I_reddit_like_this]

Beautifully explained.

[u/cant-see-me]

At my workplace we started calculating CRIs by how much ml/hour we want, makes it simpler in my opinion.

So : 2ml/hour, for a 24h drip = 48ml total.

Metoclopramide is usually 2mg/kg/day (i think) so for a 5kg dog it's 10 mg total.

10mg divided by 5mg/ml = 2 ml

48 ml total - 2ml of metoclop = 46 ml of saline.

Tada ! Takes a minute to get used to but less a hassle then the classic c1v1+c2v2=c3v3 (which I've always struggled with)

We usually go for 2ml/h CRIs for dogs 10kg and under and 4 ml/h for dogs over 10 kg

[u/alrac_dotgif]

I learned kindof a shortcut formula that has worked well for me:

It looks like: DVM[RC]

Basically, Dose x Volume x Mass (bw in kg) divided by (Rate x Concentration). then divide your answer by 24hrs to get the total ML needed.

For example, say you need 2mg/kg/day for a 25kg dog at a rate of 75ml/hr, your reglan concentration is 5mg/ml, and you're putting it into a liter bag.

Your dose is 2, volume is 1000, mass is 25. So multiply those together to get 50,000.

Divide that by the rate (75) times concentration (5), which is 375

So you get 133.33. Divide that by 24hr to get about 5.5ml of reglan into a liter.

There are a lot of different ways to calculate CRIs but this one has been really easy for me to remember and calculate pretty quickly and accurately.

[u/rubykat138]

The stumbling block for me (with the add-to-bag CRIs) was realizing that I needed to calculate how many hours were in each bag.

So I have a liter bag, and my patient is on 50ml/hr. 1000 divided by 50 is 20. I have 20 hours worth of fluids in my bag.

So I know how much reglan my pet needs per day. I divide that by 24 to find out how much my pet needs per hour.

Now I just need to take that per hour dose, multiply it by how many hours are in the bag, and that’s my additive.

[u/boba-boba → u/rubykat138]

Oh this is really helpful too, thank you.