Monday, September 26, 2011

Author Beware: Medication Concentrations

Flashpoint is one of my favorite television shows. Within the last month was a fairly intense episode where an officer was shot six times at near point blank range in the chest. Luckily, he had his vest on (thank goodness because he is my favorite character) and suffered some gunshot wounds to the arms but was otherwise in good shape.

Off to the ER he goes.

Now, of course, my nursing/analytical brain turns on and I begin to look at every nuance to see how accurate they'll portray the scene. They didn't do too badly until the doctor orders the nurse, "Give the patient 10ml of Morphine."

Nice... if you want to kill your patient.

The issue with morphine is that it is prepared in multiple concentrations. The lowest concentration is 1mg/ml. In this scenario, the patient would have received 10mg of morphine which would have been okay. Most often you'll see smaller doses titrated up for pain control.

On our unit, we have two concentrations of morphine: 2mg/ml and 4mg/ml. I know I have very smart readers so you can see the potential problem. The physician ordering 10ml without specifying the concentration means this patient could either get 20mg or 40mg of Morphine. These are both potentially lethal doses and would have put our fine character in serious trouble.

The morphine dose should have been ordered in milligrams not milliliters. Drugs are rarely, if ever, just ordered in milliliters.

Be careful with drug dosing. You don't want to accidentally kill off a character you want to have around for awhile... or do you?


  1. Thanks for another thought-provoking post, Jordyn! On a related note, I've been thinking lately about the dramatic possibilities of how long a medication is effective. Given the different concentrations/formulations available to a doctor, is there a difference in how long the morphine is effective (reduces pain)? Would the ER opt for a long term effectiveness or prefer the short term (which would allow more flexibility in adjusting the treatment of acute pain episodes)?

  2. Thanks for your comment, Anne. I always love it when you stop by.

    Shandiss-- glad you are here. Before I forget, that piece by Dr. Edwards on aortic dissection will be up in October for sure. I wanted him to do something special for 9/11 but as soon as I pulled that piece I thought of you. I promise-- October for sure.

    As to your question: The concentrations generally don't influence the half-life of the medication as the actual dose given to the patient should be consistent (based on age and weight) regardless of the concentration.

    You are correct that we do prefer shorter acting meds in the acute injury phase more because it allows us closer observation and to control their pain better.

    Long acting pain meds are good for home scripts.

    Hope this helps.


  3. Thanks, Jordyn! That does help a lot. I will be squirreling (or is it chipmunking?) those facts into my medical info file. Shandiss