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Practice · Reconstitution · continued

Second pass at: Choosing a concentration on purpose rather than by accident posts 31–49

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

PN
plateau_notesTL2Regular30 Nov 2024#31

That matches what I have seen, for whatever a single anecdote is worth.

21 likes 20mo
CH
c.haddadTL21 Dec 2024#32

Coming back to post #29, because the follow-up matters more than the original answer.

What I would tell a new member reading about Choosing a concentration for the first time: the confident posts are not the reliable ones, and the reliable ones are longer.

0 likes 20mo
OL
o.lindgrenTL2Regular2 Dec 2024#33
IHollingworth, post #5: Two claims get bundled together under Choosing a concentration and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not. Almost every disagreement in threads like this one dissolves once you say which of the two you are making. Go to post

Choosing a concentration on purpose rather than by accident: starting with "I want to draw 0.5 mL per dose" and working backward to the required concentration is more efficient than picking a diluent volume and hoping the math works out. State your target volume, then the required concentration follows.

0 likes in reply to #5 20mo
NV
n.vukovicTL23 Dec 2024#34

If your arithmetic gives a volume smaller than one graduation on your syringe, the answer is a lower concentration rather than a more careful hand.

5 likes 20mo
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preregisteredTL3Research methods4 Dec 2024#35

Confirming post #32 from a second method, which matters more than confirming it from a second person.

Worked example, since the arithmetic is the whole question. Five milligrams into one millilitre is 5 mg/mL. A 0.25 mg dose is 0.05 mL, which is five units on a U-100 syringe. Check that against your own numbers rather than taking mine.

15 likes 20mo
NC
n.cardosoTL25 Dec 2024#36
o.lindgren, post #33: Choosing a concentration on purpose rather than by accident: starting with "I want to draw 0.5 mL per dose" and working backward to the required concentration is more efficient than picking a diluent volume and hoping the math works out. State your target volume, then the required concentration follows. Go to post

Reconstituting a multi-strength kit: if a kit contains 5 mg, 10 mg, 15 mg vials and you are reconstituting all of them, writing the concentration on each vial in permanent marker as you go is the single most useful thing you can do to avoid dose errors later.

30 likes in reply to #33 20mo
PE
ppm_errorTL35 Dec 2024#37
RP
r.petrovTL26 Dec 2024#38

Do not shake. Swirl, or leave it. Vigorous agitation introduces air and shear, and neither helps a peptide go into solution any faster than patience does.

It is the sort of thing that seems obvious in retrospect and was not at the time.

3 likes 20mo
G
GEldridgeTL3Regular7 Dec 2024#39

Choose the concentration so that a typical dose lands on a graduation you can actually read. A dose that falls between two marks on a 1 mL barrel is a dose you will get wrong sooner or later.

10 likes 20mo
HJ
h.jansenTL28 Dec 2024#40
c.marchetti, post #24: Write the reconstitution date and the concentration on the vial. Not on a note, on the vial. Every account here of a dosing error involving the wrong concentration involves a vial with nothing written on it. That much is documented. The rest is how I have interpreted it. Go to post

This is the answer, and the reason it is the answer is the more useful part.

22 likes in reply to #24 20mo
FV
first_vialTL1Member9 Dec 2024#41

Answering the question post #39 raises rather than the one it answers.

How much of the diluent volume the powder itself displaces: for a small peptide vial, the powder volume is negligible. For a larger vial or a kit with multiple compounds, the displacement can be a few tenths of a millilitre. If precision matters to you, account for it by targeting a final weight rather than a final volume.

4 likes 20mo
II
i.ilungaTL210 Dec 2024#42
DOdendaal, post #21: Everything in post #17 holds. The case it does not cover is the one I have. If your arithmetic gives a volume smaller than one graduation on your syringe, the answer is a lower concentration rather than a more careful hand. Go to post

Add the diluent down the side of the vial rather than directly onto the cake. It is slower and it avoids the foaming that makes people think something has gone wrong.

That has been true for the cases I have seen and I have not seen many.

0 likes in reply to #21 20mo
SL
sleep_logTL210 Dec 2024#43
JB
j.bhattacharyaTL211 Dec 2024 · edited#44

Post #42 is the version of this I will quote in future. One addition.

A vial that will not fully dissolve: check in order: is the diluent genuinely room temperature (some preservatives crystallise in cold), is the vial being warmed gently rather than shaken hard, is the injection technique clean, is the vial integrity intact. Work through that checklist before concluding the powder is insoluble.

12 likes 20mo
SC
s.chowdhuryTL3Regular12 Dec 2024#45

Saving this. It is the version I will quote when the question comes round again.

1 like 20mo
AI
an.ibarraTL213 Dec 2024#46

Adding the measurement that post #44 says would settle it.

A cake that takes a few minutes to dissolve is ordinary. A cake that will not dissolve after gentle swirling and standing at room temperature is worth raising with the supplier rather than working around.

0 likes 19mo
FN
formulary_notesTL3Regular14 Dec 2024#47
t.marchetti, post #8: Post #5 is the version of this I will quote in future. One addition. Choose the concentration so that a typical dose lands on a graduation you can actually read. A dose that falls between two marks on a 1 mL barrel is a dose you will get wrong sooner or later. Go to post

The best check on any reconstitution calculation is to do it twice by two different routes — mass per volume, then volume per dose — and see whether they agree. They should, and when they do not it is nearly always the concentration step.

Reporting the observation and leaving the explanation open deliberately.

18 likes in reply to #8 19mo
CA
c.amankwahTL214 Dec 2024#48

A request rather than an answer: could whoever has the primary source for Choosing a concentration post it? I have seen the claim three times this month and each version had lost a qualifier.

7 likes 19mo
TH
TL4_HalvorsenTL4Leader · Journal club15 Dec 2024#49
a.stephanopoulos, post #25: What I would check first on Choosing a concentration is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph. Go to post

Concentration is total mass divided by total volume, and everything else follows from that. Ten milligrams into two millilitres is five milligrams per millilitre, and it does not matter how the vial was labelled before you added anything.

That has held every time I have looked, which is not the same as always.

11 likes in reply to #25 19mo
Moved from Dosing & titration by j.mwangi. Category placement is not obvious from outside and getting it wrong is expected. This topic will get better answers here. The move is recorded in the public log citing R7.

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