A 72-year-old, underweight female underwent colon resection for cancer and requires TPN. Her labs show low sodium, potassium, chloride and albumin. The document calculates her nutritional needs using pre-set volume and pump methods for TPN. It recommends a target volume of 1500 ml/day based on her low weight and kidney function. Electrolyte amounts are calculated to supplement her low values. Both methods provide balanced nutrition within recommended intake levels.
It is used in two ways as a supportive treatment for asthapana in different protocols like yoga, kala, karmavasthi and as a kevala snehavasthi in the form of matravasthi.
Mainly used in conditions of vata for the purpose of snehana but in some cases like arshas, Vasthi like Pippalyadi Anuvasana can be given.
It is used in two ways as a supportive treatment for asthapana in different protocols like yoga, kala, karmavasthi and as a kevala snehavasthi in the form of matravasthi.
Mainly used in conditions of vata for the purpose of snehana but in some cases like arshas, Vasthi like Pippalyadi Anuvasana can be given.
From: Dr. Chaakradhar Maddela MSc Neonate,Cardiff MD DCH ,DHSc 2D ECHO FC Cardiology, DHSc Diabetology, FC Health Research,NeoNate Neurology,BPNA, Simplified and made easy form of neonatal parenteral nutrition
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
From: Dr. Chaakradhar Maddela MSc Neonate,Cardiff MD DCH ,DHSc 2D ECHO FC Cardiology, DHSc Diabetology, FC Health Research,NeoNate Neurology,BPNA, Simplified and made easy form of neonatal parenteral nutrition
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
1. 2. A 72yo, 96 lb, 5’ 2” female receives a colon resection after a diagnosis of obstructive colon cancer. She is to be
placed on TPN while her bowel heals. Labs are:
sodium 132 mEq/L normal range 135 – 150 mEq/L
potassium 3.2 mEq/L normal range 3.5 – 5.0 mEq/L
chloride 99 mEq/L normal range 100 – 106 mEq/L
bicarbonate 29 mEq/L normal range 24 – 30 mEq/L
BUN 3 mg/dL normal range 8 – 20 mg/dL
creatinine 0.5 mg/dL normal range 0.6 – 1.2 mg/dL
glucose 101 mg/dL normal range 70 – 110 mg/dL, fasting
calcium 7.8 mEq/L normal range 8.5 – 10 mEq/L
phosphate 3.1 mg/dL normal range 2.6 – 4.5 mg/dL
magnesium 1.4 mEq/L normal range 1.8 – 2.5 mEq/L
preablumin < 7.0 mg/dL normal range 16 – 40 mg/dL (acute nutritional status)
albumin 2.1 g/dL normal range 3.5 – 5 g/dL (long-term nutritional status)
trigycerides 125 mg/dL desired range < 200 mg/dL (if these are high need to limit fat calories)
Calculate her nutritional needs using both the pre-set volume and the pump methods.
Analysis of patient situation:
• She is hospitalized and S/P (status post: this means that she is just after experiencing…) surgery and thus
needs a low stress adjustment of around 1.2.
• Her ABW = 43 kg and IBW = 50 kg, so a feed weight could be anything from 44-50 kg. Since she is
underweight, most pharmacists would choose a feed weight higher than 44 kg. In this case I shall choose
a feed weight in the middle of the range.
• Most of her electrolyte values are on the lower end of the average range. One of the things that could
cause this would be overhydration after surgery (not difficult to do with such a small individual) causing
dilution of her blood and therefore her serum electrolyte concentrations. If her kidneys are in good
shape, this will correct itself pretty quickly (i.e., within a few days) as long as the amount of fluid going
into her slows down. It would be useful to know her blood pressure, urine output, and other signs of
volume status in order to determine a good volume for her TPN. In the absence of such information it
would be prudent to go on the low side with volume, because of the effect of age on kidney function.
• Her calculated creatinine clearance is anywhere from 34 – 70 ml/min/ depending upon whether you
correct the serum creatinine to 1.0 [(140-72)(44)/(85)(1.0) = 34 ml/min] or you leave it as it is [(140-
72)(44)/(85)(0.5) = 70 ml/min]. Notice that the ABW was used in these calculations instead of the IBW –
this is because creatinine is a byproduct of muscle breakdown and she can only break down muscle that
she has (44 kg). If we were to use the IBW of 50 kg, we would be assuming that she has 6 kg more muscle
than she really has.
• Her albumin is low so her calcium needs to be corrected to reflect this and determine whether she needs
extra calcium or is probably fine to receive the recommended daily amount. Her corrected calcium is (4.0
– 2.1)(0.8) + 7.8 = 9.3 mEq/L, which is in the normal range. Her calcium and albumin may actually be
higher; as mentioned previously, if she is volume overloaded then her labs will appear lower than they
actually are secondary to dilution.
• Most of her lab values are a bit on the low side, but will correct within the next few days if this is due to
post-surgical overhydration and if her kidneys are in good enough shape to excrete the excess volume.
There is no reason at this point to go low or high on administration of any of the electrolytes.
• Her chloride is low and her bicarb is high, so she is somewhat alkalotic. You will therefore want to give
sodium as the chloride salt, rather than the acetate salt.
• Her triglycerides are OK, so don’t need to restrict fat amount at this time.
2. TPN Worksheet using pre-set volumes age: 72 sex: F
height: 157 cm ABW: 44 kg IBW: 50 kg feed weight: 47 kg
anything 44-60 would be fine here
Targets:
1. Daily fluid needs.
>20 kg: 1500ml + (20 ml)(W - 20 kg) 2040 calculated target: 1410 - 2040 ml/day
30 - 35 ml/kg/day 1410 – 1645 I will stay low so choose target volume of 1500 ml/day
2. Protein requirements.
normal, unstressed individual: 0.8g/kg/day calculated target: 47 - 56 g protein/day
hospitalized patient: 1-1.2g/kg/day
stressed patient: 1.5-2g/kg/day
3. Non-protein calories
BEEmen = 66.67 + 13.75(W) + 5.0(H) - 6.76(A) calculated target: 1500 kcals/day
BEEwomen = 665.1 + 9.56(W) + 1.86(H) - 4.68(A) 1070
activity factors: confined to bed: 1.2 , out of bed: 1.3 1283
stress factors: surgery: 1.2 ; infection: 1.4; trauma: 1.5; burns: 1.7 1540
TDE = (BEE) (activity factor) (stress factor)
Amounts:
4. Total TPN volume 1500 ml/day; volume for each TPN: 1000 ml/bag; # bags/day: 1.5
5. Protein Volume choose one:
27.5g in 500ml 5.5% AA 42.5g in 500ml 8.5% AA 50g in 500ml 10% AA or
41 g/day 64 g/day either are outside recommendations – will go high
10% AA calculated volume: ml since this gives her <1.4 g/kg/day – not excessive
6. Dextrose volume (3.4 kcals/g) choose one 3.5 mg/kg/min = 237 g/day = 158 g/bag
100g in D20W 500ml 250g in D50W 500ml 350g in D70W 500ml or
have to do 20% since 50% would be too high. (100 g/bag)(1.5 bags/day)(3.4 kcals/g) = 510 kcals CHO
D70W calculated volume: ml 1500 kcals – 510 kcals CHO = 990 kcals to give as fat
7. Fat volume (9 kcals/g) choose one:
550kcals/500ml 10% lipid 900kcals/ 500ml of 20% lipid or
20% lipid calculated volume: ml plus sterile water volume: ml
Electrolytes:
8. Daily electrolyte needs total amt of kcals/day from fat and dextrose: 510 + 900 = 1410 kcals (64% fat)
amt/1000 calories (amt)(# daily cals)/1000 amount/bag
sodium 40-50 mEq 63 – 79 divide 48 mEq
potassium 40mEq 63 each 42 mEq
magnesium 8-12mEq 13 – 19 by 1.5 10 mEq
calcium 2-5 mEq 3 – 8 to get 3.3 mEq
phosphate 15-25mMol 24 – 39 amt/bag 18 mMol
chalk test: (18)(2) + 3.3 = 39.3;so OK
9. Calculate the volume of each electrolyte solution that you will add volume to add
sodium chloride 23.4% (4mEq/ml) 12.0 ml
sodium acetate 16.4% (2mEq/ml) 0.0 ml
potassium phosphate: 3mMol phosphate/ml, 4.4 mEq potassium/ml 6.0 ml
potassium chloride 2mEq/ml 7.8 ml
magnesium sulfate 4mEq/ml 2.5 ml
calcium gluconate 10% (0.465mEq/ml) 7.1 ml
infusion rate: 63 ml/hr 1500 ml ÷ 24 hrs = 63 ml/hr
3. TPN Worksheet using pump age: 72 sex: F
height: 157 cm ABW: 44 kg IBW: 50 kg feed weight: 47 kg
anything 44-60 would be fine here
Targets:
1. Daily fluid needs.
>20 kg: 1500ml + (20 ml)(W - 20 kg) 2040 calculated target: 1410 - 2040 ml/day
30 - 35 ml/kg/day 1410 – 1645 I will stay low so choose target volume of 1500 ml/day
2. Protein requirements.
normal, unstressed individual: 0.8g/kg/day calculated target: 47 - 56 g protein/day
hospitalized patient: 1-1.2g/kg/day I will choose 56 g/day to reflect stress level
stressed patient: 1.5-2g/kg/day
3. Non-protein calories
BEEmen = 66.67 + 13.75(W) + 5.0(H) - 6.76(A) calculated target: 1500 kcals/day
BEEwomen = 665.1 + 9.56(W) + 1.86(H) - 4.68(A) 1070
activity factors: confined to bed: 1.2 , out of bed: 1.3 1283
stress factors: surgery: 1.2 ; infection: 1.4; trauma: 1.5; burns: 1.7 1540
TDE = (BEE) (activity factor) (stress factor)
Amounts:
4. Total TPN volume 1500 ml/day; volume for each TPN: 1500 ml/bag; # bags/day: 1
5. Protein Volume choose one:
27.5g in 500ml 5.5% AA 42.5g in 500ml 8.5% AA 50g in 500ml 10% AA or
10% AA calculated volume: 560 ml (56 g/day)(100 ml/10 g) = 560 ml
6. Dextrose volume (3.4 kcals/g) choose one 3.5 mg/kg/min = 237 g/day
100g in D20W 500ml 250g in D50W 500ml 350g in D70W 500ml or
D70W calculated volume: 340 ml (237 g/day)(100 ml/70 g) = 339 ≈ 340ml
(340 ml)(70 g/100 ml)(3.4 kcals/g) = 809 kcals from CHO
7. Fat volume (9 kcals/g) choose one: 1500 kcals – 809 CHO kcals = 691 kcals to give as fat
550kcals/500ml 10% lipid 900kcals/ 500ml of 20% lipid or
(691 kcals fat)(1 g fat/9 kcals)(100 ml/20 g fat) = 384 ml 20% fat
20% lipid calculated volume: 384 ml plus sterile water volume: 157 ml
1500ml – 560ml AA – 340 ml CHO – 384 ml fat = 216 ml remaining
Electrolytes: 59 ml given as e’lytes so 157 given as water
8. Daily electrolyte needs total amt of kcals/day from fat and dextrose: 809 + 691 = 1500 kcals (46% fat)
amt/1000 calories (amt)(# daily cals)/1000 amount/bag
sodium 40-50 mEq 60 – 75 68 mEq
potassium 40mEq 60 60 mEq
magnesium 8-12mEq 12 – 18 16 mEq
calcium 2-5 mEq 3 – 8 4.65 mEq
phosphate 15-25mMol 23 – 38 30 mMol
chalk test: (30)(2) + 5 = 65 ÷ 1.5 ≈ 43/L so OK
9. Calculate the volume of each electrolyte solution that you will add volume to add
sodium chloride 23.4% (4mEq/ml) 17.0 ml
sodium acetate 16.4% (2mEq/ml) 0.0 ml
potassium phosphate: 3mMol phosphate/ml, 4.4 mEq potassium/ml 10.0 ml
potassium chloride 2mEq/ml 8.0 ml
magnesium sulfate 4mEq/ml 4.0 ml
calcium gluconate 10% (0.465mEq/ml) 10.0 ml
vitamins 10.0 ml
total: 59 ml
infusion rate: 63 ml/hr