I am making a pun at my own expense. Not More on Drug Calculations , but Moron Drug Calculations . And I am the moron. In my last post, Current Drug Shortages , I was pointing out ridiculing concerns about the use of 1:1,000 epinephrine IV, since it should never be given through an IV to a live patient, except as a drip. This is true. It is not considered wrong by the FDA (Food and Drug Administration), but that is something the FDA should change. The problem is with my calculation of the drip rate. I wrote, not just once, that putting 1 mg of epinephrine in 250 ml NS (Normal Saline) would produce a concentration of 4 mg/ml. I hope that everybody reading this has noticed the mistake I made. You don’t need to be a math whiz to be able to figure out that when you dilute 1 mg/ml by adding 250 ml, you do not get a more concentrated solution. Dilution produces a less concentrated solution. If the same mistake were being made by a student in an ACLS (Advanced Cardiac Life Support) class, and this mistake has been made plenty of times, I would ask the student some questions, because many of these mistakes cannot be made with the supplies that are in a crash cart or EMS drug bag. For example, plenty of students have stated that they would give one gram of epinephrine. I have never seen a crash cart or EMS drug bag with even 100 mg of epinephrine. You have to do some restocking to get that much. In the hospital, that means somebody running to the pharmacy to get 1,000 mg. If they state 1:10,000, that means 10 liters, and it is unlikely that the pharmacy carries epinephrine in 1:10,000 concentration in liter containers. 1,000 preloaded syringes of 1:10,000 epinephrine may be more than is available in the pharmacy. Anyway, once I state, A coworker points out that we do not have enough epinephrine to give 1 gram of 1:10,000 epinephrine, the student usually realizes the mistake and corrects the mistake without any further need for hint or for explanation. I have seen several instructors immediately state that the student killed the patient

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