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

genuine question about reconstitution that I am slightly embarrassed to ask

Math Cold Box ×5 Long Haul ×3

genuine question about reconstitution that I am slightly embarrassed to ask — that is what I am asking, and I have already read the wiki twice.

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.

The arithmetic in full: concentration is mass over volume, so 5mg into 1mL gives 5mg/mL. A U-100 syringe is graduated at 100 units per millilitre, so 1.5mg is 1.5 divided by 5 millilitres, which is 30 units.

Bacteriostatic water contains benzyl alcohol as a preservative, which is what makes repeated entry into the same vial reasonable. Plain sterile water has no preservative.

If somebody has the same thing measured a different way, post it next to mine and we will see whether they agree.

1,647 up / 624 down73% upvoted42 commentsid 1k3mqt11 Oct 2023

42 comments

29 in this archive, depth 6

best — the order this archive was captured in

u/freya_onwuka89 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/ahmed_rasmussen43 points·2 years ago

How many mg in the vial and how many mL are you adding?

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u/lyophile_lou13 points·2 years ago

dead space in the needle hub is real and it is small

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u/aleksi_lehtinenOP7 points·2 years ago

I keep a laminated card in the drawer with the arithmetic on it. Looks ridiculous. Has never once let me draw the wrong volume.

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[deleted]5 points·2 years ago

[deleted]

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u/swirl_dont_shakereconstitution40 points·2 years ago

Started reconstituting everything to a round concentration and the six-in-the-morning error rate went to zero.

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u/erez_perrin47 points·2 years ago

Started reconstituting everything to a round concentration and the six-in-the-morning error rate went to zero.

Adding one thing — put the date on the label too. Concentration plus date and you can never mix two vials up.

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u/aleksi_lehtinenOP20 points·2 years ago

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

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u/ilias_cabrera6 points·2 years ago

write the concentration on the vial in marker, that is the whole post

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u/clara_weiss13 points·2 years ago

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/yusuf_achebe20 points·2 years ago

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

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u/julia_erdogan16 points·2 years ago

Correction: that gives 50 units, not what you have written. 10mg into 1mL is 10mg/mL and the division follows from there.

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u/ilias_cabrera10 points·2 years ago

Spent 5 weeks confused about this until somebody drew the table for me. 10mg, 2mL, 5mg/mL, 0.25mg is 5 units. That is the whole thing.

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u/yusuf_nakamura14 points·2 years ago

Research-use-only material is not approved for human use, so treat everything in this thread as arithmetic about solutions rather than instructions for a person.

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u/hedda_adeyemi4 points·2 years ago

Cosigning the round-number approach. Reconstituting to something awkward is how you end up drawing 27.5 units at six in the morning.

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u/runa_cabrera1 point·2 years ago

Cosigning the round-number approach.

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

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u/aleksi_lehtinenOP1 point·2 years ago

Bacteriostatic or plain sterile water?

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u/iman_falk9 points·2 years ago

5mg into 3mL is 1.67mg/mL, and 0.25mg of that is 15 units

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u/sock_puppet_spotter7 points·2 years ago

Aim the stream down the wall of the vial rather than into the cake. Reconstitution is a solubility problem, not a mixing problem, and mechanical shear does nothing helpful.

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u/bac_water_banditreconstitution5 points·2 years ago·edited

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

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u/reflux_report10 points·2 years ago

Asked SWB what volume they reconstitute to for their own stability testing and they answered in one line. Useful thing to know.

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u/vial_math_veraMOD4 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/viktor_kirchner2 points·2 years ago

Reminder: this board does maths, not dosing.

Disagreeing with this line only: adding more water is not a safety margin, it is a different divisor.

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u/rosa_mensah2 points·2 years ago

reconstituting at a round concentration makes every later dose easy

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u/anya_antonsen1 point·2 years ago

Agreed — units are volume. Once that lands, the rest of the arithmetic is one division.

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u/adaeze_cabrera1 point·2 years ago

That only works if the fill weight is exactly the label weight, and it usually is not exactly anything.

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u/aleksi_lehtinen7 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/katrin_marchetti5 points·2 years ago

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

Right, and the arithmetic behind it: 5mg in 2mL is 2.5mg/mL, so 1mg is 40 units.

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u/signe_grimaldi1 point·2 years ago

Is that a U-100 syringe? The barrel markings change the answer completely.

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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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