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c/reconstitution·posted 1 year ago by u/niels_roos

bacteriostatic water is the most under-discussed thing on this board

PSA Long Haul ×4 The Quiet One ×2 Well Actually ×3

bacteriostatic water is the most under-discussed thing on this board. Not a hot take, just something I have not seen said plainly here.

Wrote the date on the vial as well as the concentration after losing track of which one was opened first.

Shook the first vial because nobody told me not to. It was fine, but I have swirled every one since.

The dead space question sent me down a rabbit hole for a week. It is a fraction of a unit and it is the same every draw.

Tell me where this is wrong. That is the useful part of posting it.

11,589 up / 386 down97% upvoted32 commentsid 13tujb26 Nov 2024

32 comments

23 in this archive, depth 4

best — the order this archive was captured in

u/liv_nkemelu2.7k points·1 year ago

Aim the stream down the wall of the vial rather than into the cake. Reconstitution is a solubility problem, not a mixing problem, and mechanical shear does nothing helpful.

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u/ilias_steiner2.1k points·1 year ago

units are a volume on a U-100 syringe, not a dose

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u/lyophile_lou1.3k points·1 year ago

The arithmetic in full: concentration is mass over volume, so 5mg into 1mL gives 5mg/mL. A U-100 syringe is graduated at 100 units per millilitre, so 2mg is 2 divided by 5 millilitres, which is 40 units.

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u/julia_erdogan0 points·1 year ago·edited

Agreed — units are volume. Once that lands, the rest of the arithmetic is one division.

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[removed]1 point·1 year ago

[removed by moderator]

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u/aurel_boateng-37 points·1 year ago

label the vial with the date as well as the concentration

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u/quiet_reader_99741 points·1 year ago

I keep a laminated card in the drawer with the arithmetic on it. Looks ridiculous. Has never once let me draw the wrong volume.

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u/viktor_kirchner406 points·1 year ago

Bacteriostatic or plain sterile water?

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u/julia_erdogan828 points·1 year ago

swirl, never shake

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u/rasmus_kuipers402 points·1 year ago

Pushback on the syringe advice: a U-100 barrel reads units of volume. Calling them "doses" is how the confusion starts.

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u/iman_falk157 points·1 year ago

write the concentration on the vial in marker, that is the whole post

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u/dexa_twice_yearlybody comp203 points·1 year ago

Right — the volume you add is the only variable you control here, and the cake does not change it meaningfully.

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u/piotr_bruun347 points·1 year ago

Agreed on the swirl. There is no reason to shake it and a good reason not to.

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u/ilias_steiner225 points·1 year ago

I would not round that figure. At 5mg/mL a rounding error of two units is a real fraction of the intended amount.

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u/honest_syringe_maybe626 points·1 year ago

The whole calculation, once, with real numbers.

You have a 20mg vial. You add 3mL of bacteriostatic water. Concentration is mass over volume: 6.67mg/mL. A U-100 insulin syringe is graduated at 100 units per millilitre, so one unit is 0.01mL.

To draw 5mg you need 5 divided by 6.67 millilitres, which is 75 units on the barrel. Write "6.67mg/mL" on the vial in marker before you put it away, and you never have to do this again for that vial.

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u/gradient_goblin470 points·1 year ago

Cosigning the round-number approach. Reconstituting to something awkward is how you end up drawing 27.5 units at six in the morning.

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u/saskia_mwangi390 points·1 year ago

aim the stream at the glass wall, not at the cake

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u/wanjiru_varga310 points·1 year ago

Small fix — a U-100 syringe is 100 units per mL. If yours is marked differently it is not U-100 and the whole calculation changes.

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u/niels_roosOP243 points·1 year ago

dead space in the needle hub is real and it is small

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u/niels_roosOP218 points·1 year ago

What concentration did you actually reconstitute at, rather than what did you intend to?

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u/anya_antonsen0 points·1 year ago

What concentration did you actually reconstitute at, rather than what did you intend to?

This is the sentence that makes the rest unnecessary. Write it on the vial and the problem is gone.

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u/priya_guerrero1 point·1 year ago

This is the sentence that makes the rest unnecessary.

Adding one thing — put the date on the label too. Concentration plus date and you can never mix two vials up.

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u/aurel_boateng1 point·1 year ago

Yes. Writing 5mg/mL on the vial takes four seconds and removes the entire class of error this board exists to fix.

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About c/reconstitution

The arithmetic and the technique. Bacteriostatic versus sterile water, reconstitution volume as a concentration choice, converting mg/mL into insulin-syringe units, dead space, swirl-not-shake, stopper coring, and how long a reconstituted vial is actually good for. Math errors get corrected fast and politely.

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