This one has a reasonably settled answer, so here it is. Concentration choice is a precision decision, not a preference. Reconstitute high and every dose is a tiny volume where one unit of syringe error is a large fraction of the dose. Reconstitute low and you get more graduations per dose, so the same hand tremor costs proportionally less. Against that, more diluent means more benzyl alcohol and a shorter comfortable in-use window.
I reconstituted a 10mg vial with 2ml of bacteriostatic water and I want someone to check my unit arithmetic before I draw anything, because I keep getting two different answers.
So the question, as narrowly as I can put it: how to check the arithmetic without trusting a website calculator, since three calculators gave me three answers.
If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
Dr.LipidDallas said:Concentration choice is a precision decision, not a preference.
Agreed, and it is worth saying that rounding to the nearest whole unit is usually acceptable at maintenance doses and is not acceptable at the bottom of a ladder, where one unit can be a fifth of the intended dose.
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View ResultsAmyNC_wife said:I reconstituted a 10mg vial with 2ml of bacteriostatic water and I want someone to check my unit arithmetic before I draw anything, because I keep…
This matches mine closely enough to be worth saying so. Dead space is the answer to the missing dose. A fixed-needle insulin syringe holds a few microlitres in the hub and needle after the plunger bottoms out, and on small draws that is a measurable percentage of every dose. Across ten draws it adds up to most of an eleventh, which is exactly the "nine draws from a ten-dose vial" complaint. Luer-lock syringes are worse; low-dead-space fixed-needle designs are better.
From the other side of the consultation, briefly.
Reconstitution tip for anyone mixing dosing arithmetic from lyophilized powder: use bacteriostatic water, NOT sterile water. The benzyl alcohol in BAC water preserves multi-dose vials for up to 28 days.
Inject the water slowly down the side of the vial. NEVER shake — gentle swirling only until fully dissolved. Should be crystal clear with no particles.