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c/reconstitution·posted 2 years ago by u/elin_ferrari

unpopular opinion: most of what gets said here about concentration is guesswork

PSA Well Actually ×8 Long Haul ×3

unpopular opinion: most of what gets said here about concentration is guesswork. Change my mind, genuinely — I have no stake in being right about this.

The failure modes I have actually seen posted here, in order of frequency.

One: reconstituting at a different volume than intended and not writing it down, so the next draw is based on a remembered concentration. Two: treating units as a dose rather than a volume, which breaks the moment the concentration changes. Three: assuming a syringe is U-100 when it is not.

All three are solved by the same two habits — do the arithmetic before the water goes in, and write the result on the glass. Neither costs anything and between them they cover almost every question this board gets.

Shook the first vial because nobody told me not to. It was fine, but I have swirled every one since.

The whole calculation, once, with real numbers.

You have a 15mg vial. You add 3mL of bacteriostatic water. Concentration is mass over volume: 5mg/mL. A U-100 insulin syringe is graduated at 100 units per millilitre, so one unit is 0.01mL.

To draw 1.5mg you need 1.5 divided by 5 millilitres, which is 30 units on the barrel. Write "5mg/mL" on the vial in marker before you put it away, and you never have to do this again for that vial.

Ask me anything specific. Anything general I will probably get wrong.

1,664 up / 511 down77% upvoted34 commentsid 1jjnjf11 Nov 2023

34 comments

21 in this archive, depth 3

best — the order this archive was captured in

u/swirl_dont_shakereconstitution160 points·2 years ago

The lyophilised cake displaces a small volume, so the true concentration is very slightly lower than the arithmetic suggests. It is a fraction of a percent and it is dwarfed by fill tolerance.

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u/rosa_mensah101 points·2 years ago

Agreed on the swirl. There is no reason to shake it and a good reason not to.

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u/tl_dr_tina81 points·2 years ago

twice as much water halves the concentration and doubles the units for the same dose

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u/units_not_mgMOD160 points·2 years ago

Reminder: this board does maths, not dosing. Nobody here tells another member what amount to take.

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u/clara_weiss71 points·2 years ago

more water is not more drug, it is the same drug in a bigger volume

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u/elin_ferrariOP87 points·2 years ago·edited

Small fix — a U-100 syringe is 100 units per mL. If yours is marked differently it is not U-100 and the whole calculation changes.

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u/elodie_grimaldi27 points·2 years ago·edited

Small fix — a U-100 syringe is 100 units per mL.

This is the sentence that makes the rest unnecessary. Write it on the vial and the problem is gone.

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u/tomas_kimani87 points·2 years ago

Careful — that arithmetic is wrong. 5mg in 2mL is 2.5mg/mL, so 1mg draws to 40 units, not what you wrote.

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u/hedda_adeyemi0 points·2 years ago

What is written on the vial right now?

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u/yusuf_nakamura1 point·2 years ago

This. Showing the working is the fastest way for somebody else to spot the mistake.

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u/elin_ferrariOP-32 points·2 years ago

What concentration did you actually reconstitute at, rather than what did you intend to?

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u/georgi_adebayo1 point·2 years ago

swirl, never shake

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u/arne_restrepo84 points·2 years ago

Show the arithmetic — where did the unit figure come from?

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u/aurel_boateng52 points·2 years ago

The arithmetic in full: concentration is mass over volume, so 20mg into 1mL gives 20mg/mL. A U-100 syringe is graduated at 100 units per millilitre, so 5mg is 5 divided by 20 millilitres, which is 25 units.

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u/yusuf_achebe36 points·2 years ago

That is sterile water, not bacteriostatic. Same appearance, different product, and it matters for a multi-draw vial.

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[removed]24 points·2 years ago

[removed by moderator]

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u/elin_ferrariOP24 points·2 years ago·edited

Did the maths give you a whole number of units, or a fraction?

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u/marisol_frisk54 points·2 years ago

Wrote the date on the vial as well as the concentration after losing track of which one was opened first.

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u/priya_weiss20 points·2 years ago

bacteriostatic water has the preservative, sterile water does not

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u/vito_beaulieu24 points·2 years ago·edited

Adding more water does not change how much peptide is in the vial. It changes the concentration, which changes the volume you draw for the same amount. That is the entire relationship.

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About c/reconstitution

The arithmetic and the technique. Bacteriostatic versus sterile water, reconstitution volume as a concentration choice, converting mg/mL into insulin-syringe units, dead space, swirl-not-shake, stopper coring, and how long a reconstituted vial is actually good for. Math errors get corrected fast and politely.

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