yang - calculations and dosing

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10 Terms

1
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BSA calculation

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2
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chemotherapy in obese patients

  • use actual body weight to calculate cytotoxic chemotherapy (IV and oral dose regardless of obesity status

  • no evidence that short- or long-term toxicity is increased with full weight-based doses

  • in pts receiving chemotherapy dosed on the basis of actual body weight, myleosuppression is the same or less pronounced in obese pts with cancer than in non-obese pts

3
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chemotherapy dosing in children

  • traditional dosing of chemotherapy agents is based on BSA

  • EXCEPTION: infants — “little sacks of water”

    • body weight best approximates blood flow to major organs of elimination

4
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chemo dosing in infants

  • goal dose per keg (actual body weight), NOT dose per m2

  • to convert a dose/m2 to a dose/kg, divide the dose/m2 by 30

    • this equation assumes a 30 kg child is 1 m2

5
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carboplatin dosing

carboplatin dose (mg) = target AUC (mg⋅min/mL) x [GFR (mL/min) + 25 (mL/min)]

limitations:

  • small number of patients (men, non-obese)

  • measured GFR vs calculated GFR

    • Consider using ethylene diamine tetraacetic acid (EDTA) or a 24-hour urine to measure CrCl (not a serum creatinine-based mathematical equation) when dosing at an AUC greater than 6 or when using an un-capped CrCl.

6
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Cockcrof-Gault Equation (CrCl calculation)

  • usually cap GFR at 125 mL/min with normal renal function (max dosing)

  • pts with abnormally low serum creatinine (Cr), including elderly or cachectic pts —> considering using a minimum CrCl of 0.7 mg/dL to avoid overestimation of CrCl

  • overweight or obese patients

    • BMI ≥ 25kg/m2 - Recommend using an “adjusted BW” rather than actual body weight

      • Adjusted body weight (kg) = ideal body weight (IBW) + 0.4 x (total body weight [TBW] – IBW)

    • BMI < 25kg/m2 – Recommend using actual weight

<ul><li><p>usually cap GFR at <strong><u>125 mL/min</u></strong> with normal renal function <strong><u>(max dosing)</u></strong></p></li><li><p>pts with abnormally low serum creatinine (Cr), including <strong>elderly or cachectic pts</strong> —&gt; considering using a <strong>minimum CrCl of 0.7 mg/dL</strong> to <u>avoid overestimation of CrCl</u></p></li><li><p>overweight or obese patients</p><ul><li><p><strong>BMI ≥ 25kg/m<sup>2</sup> </strong>- Recommend using an <strong>“adjusted BW” </strong>rather than actual body weight</p><ul><li><p>Adjusted body weight (kg) = ideal body weight (IBW) + 0.4 x (total body weight [TBW] – IBW)</p></li></ul></li><li><p>BMI &lt; 25kg/m<sup>2</sup> – Recommend using actual weight</p></li></ul></li></ul><p></p>
7
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infusion volume

V = rate x time

8
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maintenance hydration

  • Calculation of daily fluid requirements for children/adults based on body weight or BSA

  • In the hospital, children are given hydration at a rate designed to meet their maintenance requirements

    • Frequently ordered as “IV + PO”: RN tracks how much the patient drinks and supplements with IV hydration as needed to make the total fluid intake = their maintenance rate

9
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pediatric calculation of 24-hour maintenence fluid volume

based on body weight

<p>based on <strong>body weight</strong></p>
10
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adults calculation of 24-hour maintenance fluids volume

  • based on BSA

    • (BSA x 1500 mL/m2 ) / 24 hrs

  • twice maintenance:

    • 2x the calculated fluids