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MedCalc1050,777,‘ÌŠiŽw”(BMI)@Body mass index 1100,2144,ƒAƒjƒIƒ“ ƒMƒƒƒbƒv(ŒŒŸ÷)@Anion gap 1150,1600,A-a O2•ªˆ³Šr·@A-a O2 gradient 1200,2080,Ca•â³’l(ƒAƒ‹ƒuƒ~ƒ“)@Corrected Ca 1250,2080,Ca•â³’l(’`”’)@Corrected Ca 1300,2057,CCr (Cockcroft) 1350,2056,CCr (‘ª’è) 1400,128,Child-Pugh •ª—Þ 1450,67,S”o—Ê(Fick)@Cardiac output 1500,16,–Þ“x”ä@Likelihood ratios 1550,2144,…•ªŒ‡–R@Water deficit 1600,2144,Na”rŸ•—¦(FENa)@Fractional excretion Na 1650,104,Na•â³’l(“œ)@Corrected sodium 1700,104,Na•â³’l(Ž‰Ž¿)@Corrected sodium 1750,96,Na•â³’l(’`”’)@Corrected sodium 1800,66,Q-Tc 1850,265,‘Ì•\–ÊÏ@Body surface area 1900,16,ŒŸ¸ŒãŠm—¦(sens/spec)@Post-test probability 1950,16,ŒŸ¸ŒãŠm—¦(LR)@Post-test probability 2000,2056,’`”’”ro@Protein excretion 2050,2080,”A׊ǂjŒù”z@Transtubular K gradient 2100,128,“SŒ‡–R@Iron deficit 2150,10,LDL ƒRƒŒƒXƒeƒ[ƒ‹ 2200,2048,Kt/V (URR) 2250,1345,O2ƒ^ƒ“ƒNŽc—ÊŽžŠÔ@O2 tank remaining time 2300,67,S”o—Ê (echo)@Cardiac output 2350,1,–ƒ–ò“™‰¿Š·ŽZ@Opiate equivalence 2400,128,ŠÌ‰Š”»•ÊŠÖ” Hepatitis discriminant function 2450,704,PELD ƒXƒRƒA 2500,2144,Delta gap 3600,2144,Z“§ˆ³Šr·(ŒŒŸ÷)@Osmotic gap 3700,321,Glasgow coma scale 3800,323,•½‹Ï“®–¬ˆ³@Mean arterial pressure 3900,2048,Henderson-Hasselbalch 4000,512,”DPŒvŽZ@Pregnancy calculator 4100,16,Ž¡—ÕK—v”(NNT)@Number needed to treat 4200,1088,ƒs[ƒNƒtƒ[—\‘ª(¬l)Predicted peak flow 4400,2144,ƒAƒjƒIƒ“ ƒMƒƒƒbƒv(”A)@Anion gap 4500,257,“_“H‘¬“x@IV drip rate 4600,1088,Ž_‘fŽw”@Oxygen index 4700,2,S‘Ÿ•Ù–ÊÏ(Gorlin) @Cardiac valve area 4800,256,’PˆÊ•ÏŠ·(standard)@Units conversion 4900,2560,CCr (Schwartz) 5000,512,”N—îŒvŽZ@Age calculator 5100,257,—A‰tŠÇ—@Infusion management 5200,2560,”A׊ǃŠƒ“Ž_Ä‹zŽû@Tubular phosphate reabsorption 5300,66,S””(EKG)@Heart rate 5400,296,’PˆÊ•ÏŠ·(‰»Šw)@Units conversion 5500,512,ˆÛŽ—A‰t(¬Ž™)@Maintenance IV fluids 5600,448,Šî‘bƒGƒlƒ‹ƒM[Á”ï—Ê(BEE)@Basal energy expenditure 5700,96,Na•Ï‰»iŒŒŸ÷j@Change in plasma Na 5800,66,ŒŒŠÇ’ïR@Vascular resistances 5900,2048,Ž…‹…‘Ìàh‰ß‘¬“x(Levey)@GFR 6500,2560,”A’†Ca”rŸ•Urinary excretion of Ca 6600,128,Z“§ˆ³Šr·(•Ö)@Osmotic gap 6700,0,D’†‹…â‘Δ@Absolute neutrophil count 6800,1,Aldrete –ƒŒŒãƒXƒRƒA 6900,512,ƒAƒvƒK[ ƒXƒRƒA@Apgar score 7000,64,”MŽž—A‰t—Ê(Parkland)@Fluid repl. for burns 7100,8,—‘z‘Ìd@Ideal body weight 7200,0,–ÔóÔŒŒ‹…Žw”@Reticulocyte index 7300,576,¬Ž™ŠOƒXƒRƒA@Pediatric trauma score 7400,192,Ranson's score 7700,1,‹–—eŽ¸ŒŒ—Ê@Allowable blood loss 7800,2048,ŒŒŸ÷—Ê@Plasma volume 7900,0,ƒtƒFƒjƒgƒCƒ“•â³’l(ƒAƒ‹ƒuƒ~ƒ“) @Corrected phenytoin 8000,257,–ò—p—Ê@Dose calculator 8100,0,ÔŒŒ‹…Žw”@Red blood cell indices 8200,512,¬’·‘¬“x@Growth velocity 8400,2056,ƒ~ƒNƒƒAƒ‹ƒuƒ~ƒ“”AÇ@Microalbuminuria 8600,10,Š¥ó“®–¬«SŽ¾Š³ƒŠƒXƒN 8700,0,ƒXƒeƒƒCƒh“™‰¿Š·ŽZ@Steroid equivalence 8800,192,MELD ƒXƒRƒA 8900,1088,PIF (PaO2/FiO2) 9000,64,C³ŠOƒXƒRƒA@Revised trauma score 9100,66,Ž_‘f‰^”ÀŽw•W@Oxygen transport parameters 9200,256,ŠúŠÔŒvŽZ@Interval calculator 9300,2048,—\‘ªpCO2(Winters)@Expected pCO2 9400,2560,”A—Ê@Urine output 9500,1088,ŒÄ‹z‹@”\@Spirometric values 9700,66,ˆ³Šr·@Pressure gradient (Bernoulli) 9800,16,Two-way table (diagnostic test) 9900,512,–Ú•Wg’·@Target height Initializing...result savedAdd a new drugrecordrecordsSelect a drug...Enter a date [wk] Choose a timePress "Details..." button to enter more information about the drug.Solution to use (D5%, NaCl, pure) and drugs that should not be mixed with this one.Low and high range, start and maintenance dose ...Additional notes about the drug, such as possible adverse reactions.Drug informationSolution:Therapeutic range:Miscellaneous:No drug information: To enter additional information please press 'details' button in the drug edit dialog. No result has yet been saved...To save a result use the 'Save...' button on the formula of your choice.Clinical use: A high body mass index is associated with increased risk of death from all causes at all ages among both men and women. Adult values: <18.5 = Underweight 18.5-24.9 = Normal weight 25-29.9 = Overweight 30-39.9 = Obesity >=40 = Extreme obesity Pediatric values: Overweight (95%ile BMI): Age - M / F 5 - 18.3 / 18.5 6 - 19.0 / 19.3 7 - 20.0 / 20.4 8 - 21.5 / 21.7 9 - 23.1 / 23.0 10 - 24.6 / 24.5 11 - 25.7 / 26.1 12 - 26.5 / 27.5 13 - 27.1 / 28.6 14 - 27.8 / 29.3 15 - 28.7 / 29.6 16 - 29.8 / 29.9 17 - 30.1 / 31.3 Formula: BMI = weight/height² Units: BMI [kg/m²], weight [kg], height [m] References: Calle EE. NEJM 1999 ; 341 : 1097 - 1105 Rosner et al. J Pediatr 1998 ; 132 : 211 Clinical use: Help classify metabolic acidosis. Normal AG = 8-16 [mmol/L]. High AG is caused by increase in "unmeasured anions": ketoacidosis, uremic acidosis, drug ingestion (salicylates, methanol, ethylene glycol), lactic acidosis Formula: AG = Na - (Cl + HCO3) Units: AG,Na,Cl,HCO3 [mmol/L] References: Emmet M, Narins RG. Medicine 1977 ; 56 : 38 - 54 Roberts WL, Johnson RD. Arch Pathol Lab Med. 1997 ; 121 : 568 - 572 Clinical use: Measure of efficiency of blood oxygenation. Affected by ventilation / perfusion or diffusion abnormalities. Unaffected by hypo- or hyperventilation. Formula: Grad = FiO2 * (pAtm- pH2O) - paO2 - pCO2 / RQ pAtm = 760*exp(-alt/7000) Units: FiO2=fractional inspired oxygen pAtm=atm. pressure [mmHg] alt = altitude [m] pH2O = 47 [mmHg] at 37 °[C] RQ = respiratory quotient paO2 = arterial press. of O2 pCO2 = arterial press. of CO2 both in [mmHg] References: Mellemgaard K. Acta Physiol Scand 1966 ; 67 : 10 Clinical use: Ionized calcium levels vary with albuminemia. Normal : 2.1-2.5 [mmol/L] or 8.5-10.5 [mg/dL] Formula: Ca corr = Cam + 0.8 * (4-Alb) Units: Ca [mg/dL], Alb [g/dL] References: Payne RB, Little AJ, BMJ 1973 ; IV : 643 - 646 Clinical use: Ionized calcium levels vary with proteinemia. Normal : 2.1-2.5 [mmol/L] or 8.5-10.5 [mg/dL] Formula: Ca corr = Ca / (0.55 + Prot / 160) Units: Ca [mmol/L], Prot [g/L] Clinical use: Valid if age between 20-100 [y] Normal: 95(F) or 120(M) ± 20 [mL/min] Formula: Cl(M) = 1.23 * Weight * (140 - Age) / Creat Cl(F) = 1.03 * Weight * (140 - Age) / Creat Units: Creat [µmol/L], Weight [kg], Age [y] References: Cockcroft D, Gault MH. Nephron. 1976 ; 16 : 31 - 41 Clinical use: Clearance can be normalized for 1.73m2 in order to compare it to reference values, see below. Formula: Cl = (Ucreat * Uvol) / (time * Pcreat) Cl (normalized for 1.73m²) = Cl * 1.73/BSA Units: Ucreat = urine creatinine [mmol/L] Pcreat = plasma creatinine [mmol/L] time = duration of urine sampling [min] Uvol = volume of urine [mL] BSA = body surface area [m²] Reference values: 5-7 j: 50.6 ± 5.8 [mL/min/1.73m²] 1-2 m: 64.6 ± 5.8 [mL/min/1.73m²] 5-8 m: 87.7 ± 11.9 [mL/min/1.73m²] 9-12 m: 86.9 ± 8.4 [mL/min/1.73m²] >12 mois: H: 124 ± 26 [mL/min/1.73m²] F: 109 ± 13.5 [mL/min/1.73m²] Adultes: H: 105 ± 14 [mL/min/1.73m²] F: 95 ± 18 [ml/min/1.73m²] Clinical use: This classification evaluates the severity of liver disease. The grades correlate with one- and two-year patient survival. Grade A: 100% and 85% Grade B: 80% and 60% Grace C: 45% and 35% References: Desmet VJ, Gerber, M, et al. Hepatology. 1994; 19 : 1513 - 1520. Formula: Q = VO2 / (13.4 * Hb * (SaO2 - SvO2)) Units: VO2 [mL/min], Hb [g/dL], SaO2, SvO2 % References: Berkow R, Fletcher AJ, et al. The Merck Manual, 16th edition. 1992. pages 400-403. Formula: Positive test result: LR = sens / (1 - spec) Negative test result: LR = (1 - sens) / spec Units: LR = Likelihood ratio sens = sensitivity spec = specificity References: Pauker SG. NEJM 1992;327:1009-13 Clinical use: The correction of hypernatremia requires calculation of the water deficit. No more than half the estimated deficit should be replaced during the first 24 hours. Use oral route or 5% dextrose iv. Formula: Def(M) = 0.5 * Weight *((Na_m / Na_s)-1) Def(F) = 0.4 * Weight *((Na_m / Na_s)-1) Units: Na_m, Na_v [mmol/L], Weight [kg] References: Rose BD. Clinical physiology of acid-base and electrolyte disorders, 4th ed, Mc Graw-Hill, 1994, pp. 720-723 Clinical use: FENa < 1% seen in pre-renal azotemia Formula: FENa = (Una * Pcreat) / (Pna * Ucreat) Units: Ucreat,Pcreat,Una,Pna [mmol/L] References: Corwin HL, Schreiber MJ, Fang LST. Arch Intern Med. 1984 ; 144 ; 981 - 982 Clinical use: Hyperglycemia causes pseudohyponatremia. Formula: Na corr = Na + (Gluc - 5) / 3.5 Units: Na, Gluc [mmol/L] References: Katz MA. NEJM 1973 ; 289 : 843 Clinical use: Hyperlipidemia causes pseudohyponatremia. Formula: Na corr = Na + 0.2 * TG Units: Na [mmol/L], TG [g/L] Clinical use: Hyperproteinemia causes pseudohyponatremia. ( if prot>80 [g/L ]) Formula: Na corr = Na + 0.025 * prot Units: Na [mmol/L], prot [g/L] References: Marino PL. The ICU Book, Williams&Wilkins, 2nd ed.1997 Clinical use: Long QT syndrome : QTc > 0.44 Formula: QTc = QT / sqrt(RR) Units: QT, RR [s] References: Bazett HC. Heart 1920 ; 7 : 353 - 370 Choice of the best formula: Dubois -> classic, still used Haycock -> infant, child and adult Mosteller -> best for adults Formula: 1. BSA = 0.007184 * height^0.725 * weight^0.425 2. BSA = 0.024265 * height^0.3964 * weight^0.5378 3. BSA = sqrt (weight * height / 3600) Units: BSA [m²], weight [kg], height [cm] References: 1. Dubois D et al. Arch Intern Med 1916; 17: 863 2. Haycock GB, J Pediatr. 1978; 93: 62 3. Mosteller RD. NEJM 1987; 317: 1098 Clinical use: Help determine a probability of disease given the characteristics of the test and a pretest probability. Formula: Positive test result: Postt = pret * sens / ( pret * sens + (1-pret) * (1-spec)) Negative test result: Postt = pret * (1-sens) / (pret * (1-sens) + (1-pret) * spec) Units: Postt = post-test probability pret = pretest probability sens = sensitivity spec = specificity References: Bayes T. Philos Trans 1763 ; 53 : 370 Formula: Odds posttest = Odds pretest * L.R. Units: L.R. = likelihood ratio Odds = probability / ( 1 - probability ) Prob = odds / (odds + 1) Formula: Prot = (Uprot / Ucreat ) * 8.8 * BSA / 1.73 Units: Uprot [g/L], Ucreat [mmol/L] BSA = body surface area [m²] References: Ginsberg JM et al. NEJM 1983 ; 309 : 1543 Clinical use: Normal: 8-9 [mmol/l]. Values <7 (<5 ) with hyperkaliemia are (highly) suggestive of hypoaldosteronism. Formula: Grad = (Uk / (Uosm/ Posm)) / Pk Units: Uk, Pk [mmol/L], Uosm, Posm [mosm/kg] Assumptions: Uosm>Posm Una>25 [mmol/L] References: Ethier JH. Am J Kidney Dis 1990 ; 15 : 309 - 315 Clinical use: "Rule of thumb" equation for estimating the total amount of iron to give a patient to replenish iron stores in iron deficit anemia. Formula: Def = (14 - Hb) * 250 Units: Def [mg], Hb [g/dL] Clinical use: Only correct if Trig < 4. Formula: VLDL=Trig/2.2 (mmol/L) VLDL=Trig/5 (mg/dL or g/L) LDL=Tot_chol - VLDL - HDL References: "Friedwald formula" Clinical use: Calculation of the Kt/V is the most common method used to assess the adequacy of hemodialysis. Adequate if URR>60% and Kt/V>1.2-1.4 Formula: R=PostHD_BUN/PreHD_BUN URR=1-R Kt/V=-log(R-0.03) + ((4-3.5*R) * (UF/Weight)) Units: Weight [kg], BUN [mmol/L] UF = ultrafiltrate vol. [L] References: Daugirdas JT. J Am Soc Nephrol 1993 ; 22 : 267 - 270 Clinical use: Estimation of how long an oxygen tank is going to last at a given flow rate. Formula: Time =Vol * Press / Flow Units: Time [min], Vol [L], Pres [bar], Flow [L/min] Clinical use: Estimation of cardiac output with echocardiographic values. Formula: Q = 3.14 * HR * Diam² * TVI/ 4 Units: Diam = left ventricular outflow tract diameter [cm] TVI = Time-Velocity Integral [cm] HR = Heart rate [bpm] Q = Cardiac output [mL/min] References: Tschernich H. Acta Anaesthesiol Scand Suppl. 1997;111:276-8. Quiñones MA. J Am Soc Echocardiogr 2002;15:167-84. Equi-analgesic doses (mg): Codeine (iv) 120 Codeine (po) 200 Fentanyl 0.1 Hydromorphone (iv) 1.5 Hydromorphone (po) 7.5 Meperidine (iv) 75 Meperidine (po) 300 Methadone (iv) 10 Methadone (po) 20 Morphine (iv/im/sc) 10 Morphine (po) 30 Oxycodone (iv) 25 Clinical use: In severe alcoholic hepatitis, demonstrated by a score > 32, prednisolone treatment ( 40mg qd during 1 month) may improve survival. Formula: Score =4.6* (PT - Control) + Bili Units: PT, Control [s], Bili [mg/dL] References: Ramond MJ. NEJM 1992 ; 326 : 507 - 512 Clinical use: Pediatric End-Stage Liver Disease. A disease severity scoring system for children under 18 years of age, designed to improve the organ allocation in transplantation based on the severity of liver disease rather than time on the waiting list. Formula: Score = 6.87 * Ln(Alb) + 4.8 * Ln(Tbil) + 18.57 * Ln(INR) + 4.36 (if age<1) + 6.67 (if growth delay) Units: Alb = serum albumine[g/dL] Tbil =total bilirubin [mg/dL] INR = international normalized ratio Rules applied to data: - Alb,Tbil and INR are always >=1 References: Transplantation. 2005 May 15; 79(9): 1273-6 Clinical use: If the delta gap is significantly positive (greater than +6), a metabolic alkalosis is usually present because the rise in AG is more than the fall in HCO3. Conversely, if the delta gap is significantly negative (less than -6), then a hyperchloremic acidosis is usually present because the rise in AG is less than the fall in HCO3. Delta gap is sometimes referred to as Delta-Delta. Formulas: Anion_Gap = Na - (Cl + HCO3) Delta_HCO3 = 25 - HCO3 Delta_AG = Anion_Gap - Normal_Gap Delta_Gap = Delta_AG - Delta_HCO3 Units: All units in [mmol/L] References: Ann Emerg Med. 1990 Nov;19(11):1310-3 Clinical use: Normal <= 10 [mosm/kg] Unmeasured osmotically active substances: methanol, ethylene glycol, sorbitol, mannitol Formula: Osm. gap = meas. osm. - calc. osm. Calc. osm. = 2*Na + Urea + Glucose Units: Na, Glucose [mmol/L], Urea [mmol/L] = BUN [mg/dL] / 2.8 Osm [mosm/kg] References: Gennari FJ. NEJM 1984 ; 310 : 102 - 105 Clinical use: The Glasgow Coma Scale is the most widely used scoring system used in quantifying level of consciousness following traumatic brain injury. Patients with score less than 8 are in Coma. References: Teasdale G, Jennet B. Lancet1974 ; 2 : 81 - 84 Formula: M.A.P. =(P.sys+2*P.dia)/3 Units: M.A.P., P.sys, P.dia [mmHg] Formula: pH = 6.1 + log(HCO3 / (0.03 * pCO2)) Units: HCO3 [mmol/L], pCO2 [mmHg] References: Henderson LJ. Am J Physiol 1908 ; 21 : 427 Hasselbalch KA. Biochem Z 1916 ; 78 : 112 Formula: Estimated delivery date is the last day of the 40th week, starting from the first day of the last menstrual period (LMP). Formula: NNT = 1 / ARR ARR = x - y RRR = (x-y)/x OR = y(1-x) / x(1-y) RR = y/x Units: x = event rate in control group = events in control group / N control group y = event rate in treatment group = events in treatment group / N treatment group NNT = Number Needed to Treat ARR = Absolute Risk Reduction RRR = Relative Risk Reduction OR = Odds Ratio RR = Relative Risk Clinical use: Only valid for adults. Formula: PEF(M) = exp(0.544 * log (age) - 0.0151 * age-74.7 / height+5.48) PEF(F) = exp(0.376 * log(age) - 0.0120 * age-58.8 / height+5.63) Units: PEF [L/min], age [y], height [cm] References: Nunn AJ, Gregg I. BMJ 1989 ; 298 : 1068 - 1070 Clinical use: Index of ammonia in urine. In normal AG (plasma) metabolic acidosis, helps find the origin of the bicarbonate-wasting process. UAG<0: GI loss UAG>0: distal or type IV RTA Formula: UAG = Na + K - Cl Units: UAG,Na,Cl,K [mmol/L] References: Ann Clin Biochem 1999; 36: 408-422 NEJM 1988;318:594. Formula: DR = DF*TA/TT Units: DR =drip rate [gtt/min] DF = drop factor [gtt/ml] (standard sets use10,15,20 or 60) TA = total amount to infuse [mL] TT = total time [min] Formula: OI = FIO2*MAP/PaO2 Units: FIO2 = fractional concentration of O2 MAP = mean airway pressure [cmH20] PaO2 = arterial O2 tension [mmHg] References: Ortiz RM. Ped Clin NA 1987 ; 34 : 39 - 46. Formula: VA = CO / (K * sqrt(MVG) * HR * DFP) Units: CO = cardiac output [mL/min] HR = heart rate [bpm] DFP = diastolic filling (or systolic ejection) period [seconds per beat] MVG = mean valve gradient [mmHg] K = 37.7 for mitral valve, 44.3 for other valves References: Gorlin R, Gorlin SG. Am Heart J. 1951 ; 41 : 1 - 29 Energy: 1 [kcal] = 4.1868 [kJ] 1 [kJ] = 0.2388 [kcal] Length: 1 [cm] = 0.01 [m] 1 [m] =100 [cm] 1 [ft] = 30.48 [cm] 1 [in] = 2.54 [cm] Pressure: 1 [bar] = 100 [kPa] 1 [atm] = 760 [mmHg] 1 [mmHg] = 1 [Torr] 1 [cmH20] = 0.7355 [mmHg] 1 [mmHg] = 0.13332 [kPa] 1 [kPa] = 7.5006 [mmHg] Temperature: 1 [°C] = 1.8*(x+32) [°F] 1 [°F] = (5/9)*(x-32) [°C] Weight: 1 [kg] = 2.205 [lb] 1 [lb] = 0.4536 [kg] Volume: 1 [L] = 1000 [mL] 1 [oz] = 29.5735 [mL] 1 teaspoon = 5 [mL] 1 tablespoon = 3 teaspoons References: Taylor BN. Guide for the Use of the International System of Units (SI). National Institute of Standards and Technology Special Publication 811. 1995 Edition. Formula: Cl = k * Height / Creat Units: Creat [mg/dL], Height [cm] References: Schwartz GJ. Pediatrics. 1976 ; 58 : 259 - 263 Clinical use: This formula is useful for plotting heights and weights on growth charts. It's meant for pediatric use and will give unpredictable results for older patients. Formula: As the value of years and months is variable in the calendar, a mean value of 365.2422 days per year and 30.4368 days per month is used for computing the age in years and months. Age in weeks and days is perfectly accurate. Clinical use: This formula helps calculate intravenous drug infusion rate. Clinical use: Changes in the tubular reabsorption of phosphate may reflect changes in levels of parathyroid hormone. Normal: TRP > 78% (normal diet); TRP higher on low phosphate diet Hyperparathyroidism: TRP < 74% (normal diet); < 85% on low phosphate diet Formula: TmP = 1 - (Upo * Pcreat) / (Ppo * Ucreat) Units: Ucreat,Pcreat,Upo,Ppo [mmol/L] TmP % References: Tietz NW (editor). Clinical Guide to Laboratory Tests, Third Edition. W.B. Saunders Co. 1995. pages 620-621 Formula: HR = 60 / RR Units: HR = Heart rate [bpm] RR = RR interval [s] Alcohol (ethanol): 1 [mg/dl] = 0.217 [mmol/L] Bilirubine: 1 [mg/dL] = 0.0171 [mmol/L] Calcium: 1 [mg/dL] = 0.25 [mmol/L] Cholesterol: 1 [mg/dL] = 0.02586 [mmol/L] Creatinine: 1 [mg/dL] = 0.0884 [mmol/L] Glucose: 1 [mg/dL] = 0.0555 [mmol/L] Hemoglobin: 1 [mg/dL] = 0.0006206 [mmol/L] Magnesium: 1 [mg/dL] = 0.411 [mmol/L] Phosphate: 1 [mg/dL] = 0.323 [mmol/L] Triglycerides: 1 [mg/dL] = 0.0113 [mmol/L] Urea: 1 [mg/dL] = 0.166 [mmol/L] Formula: First 10 kg : 100mL/kg/24h Next 10kg: 50mL/kg/24h Remaining kg: 20mL/kg/24h Clinical Use: BEE is usually multiplied by a correction factor to set a nutritional goal. Formula: BEE(M) = 66 + 13.7 * weight + 5 * height - 6.8 * age BEE(F) = 655+ 9.6 * weight + 1.8 * height - 4.7 * age Units: BEE [kcal], weight [kg], height [cm], age [y] References: Harris J, Benedict F. A biometric study of basal metabolism in man. Wash. DC, Carnegie Inst of Wash, 1919 Clinical use: This formula helps predict natremia changes associated with a given infusion. Use it to limit the risk of demyelinating encephalopathy secondary to rapid correction of hypo- or hypernatremia. Formula: Change in Na = (Infusate Na +Infusate K - Plasma Na) / (Total Body Water+1) TBW = coeff * weight [kg] The coeff is 0.6 in children; 0.6 and 0.5 in nonelderly men and women, respectively; and 0.5 and 0.45 in elderly men and women, respectively. [Na+] in each infusate: NaCl 5% : 855 [mmol/L] NaCl 3% : 513 [mmol/L] NaCl 0.9% : 154 [mmol/L] Ringer's : 130 [mmol/L] NaCl 0.45% : 77 [mmol/L] NaCl 0.2% : 34 [mmol/L] Dextrose 5% : 0 [mmol/L] References: Adrogué HJ,Madias NE, NEJM 2000 ; 342 : 1493 -1499 and 1581 - 1589 Formula: SVR = ((MAP-CVP) x 79.9) / CO PVR = ((MPAP-PCWP) x 79.9) / CO Units: SVR = Systemic vascular resistance [dynes*sec/cm^5] PVR = Pulmonary vasc. res. [dynes*sec/cm^5] MAP = Mean arterial press. [mmHg] CVP = Central veinous press. [mmHg] CO = Cardiac output [L/min] MPAP = Mean pulmonary art. press. [mmHg] PCWP = Pulmonary capillary wedge press. [mmHg] References: Marino PL. The ICU Book, Williams&Wilkins, 2nd ed.1997 Clinical use: Those equations are more accurate than creatinine clearance measured from 24-hour urine samples or predicted from the Cockcroft-Gault equations. Formula: GFR = 170 * Pcr^-0.999 * age ^-0.176 * 1.18 (if black) * 0.762 (if female) * BUN^-0.17 * alb^0.318 GFR = 270 * Pcr^-1.007 * age ^-0.18 * 1.178 (if black) * 0.755 (if female) * BUN^-0.169 GFR = 186 * Pcr^-1.154 * age ^-0.203 * 1.210 (if black) * 0.742 (if female) Units: Pcr = serum creatinine [mg/dL] BUN = Blood Urea Nitrogen [mg/dL] (BUN [mg/dL] = urea [mmol/L]*2.8) alb = serum albumine [g/dL] GFR [mL/min] References: Levey AS. Ann Intern Med. 1999 ; 130 : 461 - 470. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis 2002;39:Suppl 2: S1-S246 Formula: index = Ca / Creat Units: Ca = urinary calcium [mg/dL], Creat = urinary creatinine [mg/dL] References: J Pediatr 1993;123:393-397 Clinical use: Helps discriminate between secretory and osmotic diarrhea. OG<50 secretory diarrhea OG>100 osmotic diarrhea Plasma omolality is used rather than the osmolality measured in fecal fluid because the latter equilibrates with plasma osmolality and measured fecal osmolality begins to increase in the collection container almost immediately when carbohydrates are converted by bacterial fermentation to osmotically active organic acids. Formula: OG = Osm - 2*(Na + K) Units: OG, Osm [mosm/kg], Na, K [mmol/L] References: Shiau YF. Ann Int Med 1985 ; 102 : 773 - 5 Duncan A, Robertson C, Russell RI. J Lab Clin Med 1992;119 : 359 - 363. Clinical use: Neutropenia if A.N.C. < 1500 [c/mm³] Severe < 500 [c/mm³] Formula: ANC = WBC * (Polys + Bands) / 100 Units: Polys, Bands % ANC, WBC [cells/mm³] Clinical use: Recovery following anesthesia can be monitored by assessment of clinical findings. Score of 10 indicating best possible condition to leave recovery room. Scores of 8-9 are considered safe. Scores of 7 or lower are considered low or dangerous. References: Aldrete JA, Kroulik D. Recovery Score. Anesthesia Analgesia. 1970; 49: 924-933. Clinical use: The Apgar scoring system is used to assess newborn infants for depression of cardiopulmonary and neurological function, at 1, 5 and 10 minutes after birth. Low initial scores with no improvement in the 5 minute score is associated with neonatal problems including death. References: Graef JW. Manual of Pediatric Therapeutics, 5th edition. Little, Brown and Co. 1994. Clinical use: Amount of iv fluids (usually Lactated Ringers) to give in the first 24h following a burn injury in addition to maintenance fluid. Formula: Qty = 4*weight*tbsa Units: Qty [mL/24h], weight[kg] tbsa= percentage of total body surface References: "Parkland formula" Rosen, Emergency Medicine: Concepts and Clinical Practice, 4th Ed. Clinical use: The ideal body weight for an individual can be estimated from the person's height and gender. Formula: weight(M)=51.65+(1.85*(ht-60)) weight(F)=48.67+(1.65*(ht-60)) Units: weight [kg], height [in] References: Robinson JD, Lupkiewicz SM, et al.. Am J Hosp Pharm. 1983; 40: 1016-1019. Clinical use: Adjusts reticulocyte count for hematocrit. An index > 3 shows a normal marrow response to anemia. An index < 2 is an inadequate response to anemia. With a normal hematocrit, an index of 1 is normal. Formula: index = reti * (hct/45) / CF Units: CF = maturation correction factor. When the marrow is greatly stimulated, marrow reticulocytes enter the circulation prematurely. The index must be corrected to account for the longer circulation time of those 'shift reticulocytes'. The correction factor depends on the severity of the anemia. Hct 41%-50% (CF=1) Hct 30%-40% (CF=1.5) Hct 20%-39% (CF=2) Hct 10%-19% (CF=2.5) Score (mortality): <0 (100%) 1-2 (45%) 3-4 (36%) 5-6 (15%) 7-8 (3%) >8 (0%) References: Tepas JJ. J Trauma 1988; 28(4): 425-9. Clinical use: This score estimates the risk of life-threatening complications or death in patients with acute pancreatitis. References: Ranson JH. Surg Clin North Am 1981; 61(1): 55- 70. Clinical use: Estimated amount of blood a patient can loose before reaching a critical level of hemoglobin. Formula: EABL = (Hct_start - Hct_allow)*BV/Hct_start BV = 0.07 [L/kg] (blood volume) Units: Weight [kg], Hct %, EABL [L] References: Clinical Anesthesia Procedures of the Massachusetts General Hospital, 5th Ed. Formula: PV = 0.065*Weight*(1-Hct) Units: PV [L], Weight[kg], Hct % References: Kaplan AA, ASAIO Trans 1990; 36(3): M597 Formula: PhenC = phen / (0.2 * alb + 0.1) Units: phenytoin [µg/mL], albumin [g/dL] References: Martin E. Journal of Pharmacokinetics and Biopharmacology. 1977; 5: 579-96. Clinical use: Helps compute drug dosages based on body weight or surface. Calvert formula: Dose = AUC * (GFR+25) Unités: Dose [mg], GFR [mL/min] AUC=area under curve [min*mg/mL] References: Calvert AH et al. J Clin Oncol 1989; 7(11): 1748. Clinical use: Red blood cell indices reflect erythrocyte volume and hemoglobin concentration in the erythrocyte. MCV: mean cell volume MCH: mean cell hemoglobin MCHC: mean cell hemoglobin concentration Formulas: MCV = 1000 * Hct / RC MCH = 10 * Hb / RC MCHC = Hb / Hct Units: Hb [g/dL], Hct %, RC [millions/µL], MCV [fL], MCH [pg], MCHC [g/dL] Clinical use: Monitoring annualized growth velocity is useful for patients receiving growth hormone therapy. Clinical use: Given dose and desired infusion rate, this formula calculates the amount of drug to add to a given volume of I.V. fluid ("The rule of 6"). Clinical use: Microalbuminuria can be detected without resorting to 24-hour urine collections by calculation of the albumin-to-creatinine ratio. Normal: <30 mg/g (<3.4 mg/mmol) Microalbuminuria: 30-300 mg/g Clinical albuminuria: >300 mg/g (>34 mg/mmol) Formula: Ratio = U alb / U creat Units: Urine albumin [mg/L], Urine creat. [mg/dL] or [mmol/L], Ratio [mg/g] or [mg/mmol] References: Mogensen CE, Diabetes Care 1995;18:572 Clinical use: Estimates coronary heart disease risk using Framingham Heart Study Prediction Score Sheets. It calculates the risk of angina pectoris, MI or coronary disease over the next 10 years. Only applies to people without known heart disease. Avg risk compares to a man the same age. Low risk was calculated for a man the same age with normal BP and cholesterol, non-smoker, no diabetes. References: Wilson PWF. Circulation 1998; 97: 1837-47 Clinical use: Calculate equivalent dosing of various steroids. Units: Gluco. P = glucocorticoid power Mineralo. P = mineralocorticoid ... (relative to hydrocortisone) References: Goodman & Gilman's The Parmacological basis of therapeutics. McGrawHill, 1997. Clinical use: MELD stands for Model End Stage Liver Disease (ESLD), a disease severity scoring system applied to adult liver patients. It is designed to improve the organ allocation system in liver transplantion to ensure that available organs are directed to transplant candidates based on the severity of their liver disease. Formula: Score = 9.57 * Ln(Scr) + 3.78 * Ln(Tbil) + 11.2 * Ln(INR) + 6.43 Units: Scr = serum creatinine [mg/dL] Tbil =total bilirubin [mg/dL] INR = international normalized ratio Rules applied to data: - Scr,Tbil and INR are always >=1 - Scr is always <=4 - Maximum MELD score is 40 References: Kamath PS et al. Hepatology. 2001; 33(2): 464 Wiesner RH et al. Liver Transpl. 2001; 7(7): 567 Clinical use: Index of severity of hypoxemia. PIF ratio is used as part of the definition of ALI (acute lung injury) and ARDS (acute respiratory distress syndrome) For ALI, PIF = 200-300 [mmHg], for ARDS, PIF<200 [mmHg] (other criterias not listed) Clinical use: An RTS value < 4 has been proposed to identify those patients who should be treated in a trauma centre. References: Champion HR et al, J Trauma 1989; 29: 623 Clinical use: Oxygen transport equations are used in the ICU to evaluate the adequation of oxygen delivery and metabolic needs in a variety of situations. Formulas: CvO2=1.34*Hb*SvO2+0.003*PvO2 CaO2=1.34*Hb*SaO2+0.003*PaO2 C(a-v)O2 = CaO2 - CvO2 ERO2= (CaO2 - CvO2) / CaO2 DO2 = 10 * CO * CaO2 VO2 = 10 * CO * (CaO2 - CvO2) Units: Hb [g/dL], DO2, VO2 [mL/min], SaO2, SvO2 and ERO2 %, CaO2, CvO2 and C(a-v)O2 [vol%] or [mL/100mL], CO [L/min] References: Marino PL. The ICU Book, Williams&Wilkins, 2nd ed.1997 Clinical use: Useful to calculate the duration of certain procedures, stay times of patients, and so on... Clinical use: Gives expected pCO2 (respiratory compensation) in pure metabolic acidosis. Formula: pCO2 = 1.5*HCO3 + 8 (± 2 variation not applied here) Units: HCO3 [mmol/L], pCO2 [mmHg] References: Albert MS et al. Ann Int Med 1967; 66:312 Clinical use: Oliguria is usually defined as less than 0.5 mL/kg/h. Formulas: Crapo (USA): FVC (M) = 0.06*height - 0.0214*age - 4.65 FVC (F) = 0.0491*height - 0.0216*age - 3.59 FEV1 (M) = 0.0414*height - 0.0244*age - 2.19 FEV1 (F) = 0.0342*height - 0.0255*age - 1.578 Quanjer (ERS): FVC (M) = 0.0576*height - 0.026*age - 4.34 FVC (F) = 0.0443*height - 0.026*age - 2.89 FEV1 (M) = 0.043*height - 0.029*age - 2.49 FEV1 (F) = 0.0395*height - 0.025*age - 2.6 Units: Age [y], height [cm] FVC = Forced Vital Capacity [L] FEV1 = Forced Expired Volume in 1 second [L] References: Crapo RO et al. Am Rev Respir Dis 1981; 123: 659 Quanjer PH et al. Eur Respir J 1993, 6 (Suppl. 16), 5-40 Formula: PG = P2-P1 = 4*(V2²-V1²) Units: V1,V2 [m/s] P1,P2,PG [mmHg] References: Requarth JA. Am J Cardiol 1984; 53(9): 1369 Formulas: Prev=(TP+FN)/(TP+FP+TN+FN) Sens=TP/(TP+FN) Spec=TN/(TN+FP) LR+=Sens(1-Spec) LR-=(1-Sens)/Spec PPV=TP/(TP+FP) NPV=TN/(TN+FN) Definitions: TP = True Positive TN = True Negative FN = False Negative TN = True Negative Prev = Prevalence Sens= Sensitivity Spec = Specificity LR+ = Likelihood Ratio, positive LR- = Likelihood Ratio, negative PPV = Positive Predictive Value NPV = Negative Predictive Value Formulas: TH (M) = (FH + MH + 13) / 2 TH (F) = (FH + MH - 13) / 2 Units: FH = father's height [cm] MH = mother's height [cm] TH = target height [cm] References: De Luca F et al. The Endocrinologist 1999; 9: 286 Falkner F, Tanner JM (eds) Human Growth New York: Plenum Press. Volume 3, pp104-109 1.25.3MedCalc Ver. 5.3@“ú–{Œêƒ[ƒJƒ‰ƒCƒU[ Ver. 1.2i05/11/24j Go Matsuyama Toho University Sakura Hospital http://www.lab.toho-u.ac.jp/med/peds/palm.html mail: matuyama@med.toho-u.ac.jp€