Effective Ventricular Fibrillation Treatment: Calculating Bretylium Dosage for Patient in Critical Condition

In the face of a life-threatening medical emergency, such as ventricular fibrillation, timely and precise intervention is crucial. A patient with ventricular fibrillation is prescribed bretylium at a rate of 5 mcg/kg/minute. The medication is supplied as a mixture of 50 mg in 50 mL of 0.9% normal saline. To ensure the effective treatment of this critical condition, it is essential to calculate how much of the medication should be administered per hour. In this article, we will guide you through the steps required to determine the appropriate dosage for managing ventricular fibrillation in a patient in distress.

Understanding Ventricular Fibrillation and Critical Care

Ventricular fibrillation is a life-threatening arrhythmia that can lead to cardiac arrest if not promptly addressed. It is characterized by chaotic and rapid electrical activity in the heart’s ventricles, causing them to quiver rather than contract effectively. Immediate medical intervention, often involving medication, is required to restore a normal heart rhythm.

The Role of Bretylium in Ventricular Fibrillation Treatment

Bretylium is an antiarrhythmic medication used in the treatment of ventricular fibrillation and other life-threatening arrhythmias. It works by stabilizing the electrical activity of the heart and restoring a more regular heartbeat.

Calculating the Dosage of Bretylium for Ventricular Fibrillation

To determine the amount of bretylium to administer per hour to the patient with ventricular fibrillation, a series of calculations is necessary. Here are the key steps:

  1. Calculate the Patient’s Weight in Kilograms: The prescribed dosage is 5 mcg/kg/minute. To calculate the patient’s weight in kilograms, divide the weight in pounds by 2.2.Patient’s Weight (kg) = Weight (lbs) / 2.2

    Patient’s Weight (kg) = 170 lbs / 2.2 ≈ 77.27 kg

  2. Calculate the Total Micrograms per Minute: To determine the total micrograms of bretylium needed per minute, multiply the patient’s weight in kilograms by the prescribed dosage.Total Micrograms per Minute = Patient’s Weight (kg) x Dosage (mcg/kg/minute)

    Total Micrograms per Minute = 77.27 kg x 5 mcg/kg/minute = 386.35 mcg/minute

  3. Convert Micrograms to Milligrams: Since the medication concentration is provided in milligrams, convert the total micrograms per minute to milligrams per minute. There are 1,000 micrograms in 1 milligram.Total Milligrams per Minute = Total Micrograms per Minute / 1,000

    Total Milligrams per Minute = 386.35 mcg/minute / 1,000 = 0.38635 mg/minute

  4. Calculate the Milligrams per Hour: To find the total milligrams of bretylium required per hour, multiply the milligrams per minute by 60 (since there are 60 minutes in an hour).Milligrams per Hour = Total Milligrams per Minute x 60

    Milligrams per Hour = 0.38635 mg/minute x 60 = 23.18 mg/hour

  5. Determine the Volume of Medication per Hour: To find the volume of the bretylium solution to be administered per hour, you need to know the concentration of the available solution, which is 50 mg in 50 mL.
  6. Calculate the Volume per Hour: Divide the milligrams per hour by the concentration of the solution (in mg per mL) to determine the volume of the medication to be administered per hour.Volume per Hour = Milligrams per Hour / Concentration of Solution (mg/mL)

    Volume per Hour = 23.18 mg/hour / (50 mg/50 mL) = 23.18 mL/hour

Given the concentration of the bretylium solution, the nurse should administer approximately 23.18 mL of medication per hour to the patient with ventricular fibrillation.

Nurse’s Responsibilities in Ventricular Fibrillation Treatment

In the treatment of ventricular fibrillation and other critical conditions, nurses play a pivotal role in ensuring patient safety and well-being.

  1. Patient Assessment: Conduct a thorough assessment of the patient’s condition, including continuous monitoring of heart rhythm, vital signs, and the severity of the arrhythmia. Watch for signs such as loss of consciousness and a lack of pulse.
  2. Informed Consent: Ensure that the patient or their caregiver understands the purpose and potential side effects of the medication. Obtain informed consent for treatment.
  3. Medication Preparation: Accurately prepare the medication, considering the prescribed dosage, concentration, and volume. Pay meticulous attention to the accuracy of the calculations.
  4. Dosage Calculation: Calculate the precise dosage, as demonstrated above, to ensure the patient receives the appropriate amount of medication.
  5. Administration: Administer the medication via the appropriate route (in this case, it’s often given intravenously) at the calculated rate.
  6. Monitoring: Continuously monitor the patient’s response to treatment, heart rhythm, vital signs, and any potential side effects. Adjust the treatment plan as needed.
  7. Documentation: Maintain precise and comprehensive documentation, noting the medication dosage, vital signs, and the patient’s response to therapy. This documentation is essential for the patient’s ongoing care.


Accurate medication dosage is crucial in the treatment of life-threatening arrhythmias such as ventricular fibrillation. By following the steps outlined in this article, nurses can ensure that patients receive the appropriate dosage of bretylium, aiding in the effective management of ventricular fibrillation and potentially saving lives. This meticulous approach is essential for providing optimal care to patients in critical conditions.


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