Continuing Education for Technicians

Understanding
milliequivalent concentrations. Inciden-
tally, a milliequivalent is one thousandth
(1/1000) of an equivalent. In pharmacy,

Milliequivalents we are generally dealing with milliequiva-

lent concentrations.
One of the pieces of information we
A means of expressing the amount of certain chemical substances need from the periodic table is the atomic
by Dave Brown, RPh weight of the elements. The atomic weight
given in the periodic table represents atomic
mass units. One atomic mass unit is equal
to 1.66 X 10-27 kilogram. Atomic weights
harmacy technicians fre- split apart. Molecules that remain intact can be added up according to a molecular
quently encounter the when they dissolve in water are known as formula to determine molecular weight. For
term “milliequivalent” in non-electrolytes. Sugar is an example of instance, the atomic weight of sodium is 23
the day-to-day practice of a non-electrolyte. When sugar dissolves, and the atomic weight of chlorine is 35.5.
pharmacy. Some tablets, the atoms in the sugar molecule remain The molecular weight of sodium chloride
powders, oral solutions together. The other molecules known as (NaCl) is 23 + 35.5 or 58.5. What is the
and parenteral solutions that pharmacy electrolytes dissociate or split apart when molecular weight of water? The atomic
technicians work with are labeled with they dissolve in water. Salt (NaCl) is a weight of hydrogen is 1 and the atomic
milliequivalent (mEq) terms. We know common substance that is an electrolyte. weight of oxygen is 16. The molecular
that grams and milligrams refer to the When an electrolyte splits apart, it pro- weight of water (H2O) is 1 + 1 + 16 = 18.
amount of drug present, as measured by duces charged atoms or charged groups of
weight. We can mentally visualize what a atoms. These charged atoms or charged OTHER ATOMIC WEIGHTS
gram or even a milligram of a drug is, but group of atoms are known as ions. They Chemical Atomic
what is a milliequivalent? carry either positive or negative charges. Atom Symbol weight Valence
Common questions asked by pharmacy When a sodium chloride (salt) molecule
Aluminum Al 27 +3
technicians, as well as a variety of other dissolves, it produces one positively-charged
Calcium Ca 40 +2
health care workers and patients, include sodium ion and one negatively-charged chlo-
Chlorine Cl 35.5 -1
ride ion. NaCl  Na+
Hydrogen H 1 +1
and Cl -. Examples of
Magnesium Mg 24 +2
some other ions that
Goal. The goal of this article is to help pharmacy technicians under- Oxygen O 16 -2
stand the value of milliequivalent labeling and learn how to perform are found in phar-
Potassium K 39 +1
milliequivalent calculations. maceutical solutions
Sodium Na 23 +1
Objectives. At the completion of this article, you will be able to deter-
include hydrogen,
mine: 1) The number of milligrams of an electrolyte in a milliequivalent sodium, potassium,
of the electrolyte; 2) The percent strength of a solution from the milli- calcium, magnesium, DETERMINING GRAM ATOMIC WEIGHT
equivalent concentration; 3) The milliequivalent strength from a percent
sulfate, carbonate AND MILLIGRAM ATOMIC WEIGHT
strength; and 4) The milliequivalents of a salt that are in a given percent The gram atomic weight of an element is
concentration of a solution. and chloride.
Electrolyte solu- the atomic weight labeled in grams. The
the following: How does a milliequiva- tions are labeled in milliequivalent con- milligram atomic weight of an element is
lent represent the amount of a drug? Is centrations. Milliequivalent labels reflect the atomic weight labeled in milligrams.
it the activity of the drug? Why do the the charges and therefore the combining The gram atomic weight of sodium is 23
labels on some solution containers list power of the ions produced from electrolytes. “grams.” The milligram atomic weight
milliequivalent concentration and others Milligram labels do not indicate combin- of sodium is 23 “milligrams.” The gram
do not? Why do some containers list mil- ing power. One milliequivalent of sodium atomic weight of chlorine is 35.5 grams.
ligram concentration and milliequivalent ion combines with one milliequivalent What is the milligram atomic weight of
concentration? How are milliequivalents of chloride to give one milliequivalent of chlorine? It is 35.5 milligrams. The same
calculated? sodium chloride. procedure can be used for molecules. The
milligram molecular weight of a compound
is the molecular weight labeled in milli-
ELECTROLYTES AND NON- DETERMINING ATOMIC AND
grams. The gram molecular weight of so-
ELECTROLYTES MOLECULAR WEIGHT
dium chloride is 58.5 grams. What is the
As you know, atoms combine to form The periodic table of elements provides a
gram molecular weight of water? What is
molecules. Some molecules will dis- great deal of information which helps us
the milligram molecular weight of water?
solve in water and some do not. Of the predict how various elements behave. Two
They are18 grams and 18 milligrams,
molecules that dissolve in water, some pieces of information found in the table
respectively. It is important to know the
remain intact and others will dissociate or are useful in determining equivalent or
milligram molecular weight of an electro-

12 JPSW January/February 2006

lyte to calculate milliequivalents.
An interesting fact is that when an
amount of an element is weighed out that
is equal to the gram atomic weight, it will
always contain 6.023 X 1023 atoms of
the element. Also, when an amount of a
substance is weighed out that is equal to
the gram molecular weight, it will always
contain 6.023 X 1023 molecules of the
substance.
CALCULATING MILLIEQUIVALENTS
The other piece of information we need
from the periodic table is the charge of the
atom. The charge is also known as the va-
lence. Valences help determine which atoms
will combine and in what ratio they will
combine. Ions with positive charges will
combine with ions with negative charges.
When added together, the total of the
positive and negative charges add up to
zero because molecules are always neutral.
Sodium has a valence of +1. Chlorine
has a valence of -1. They will combine in
a ratio of 1:1, making sodium chloride
(NaCl). Calcium has a valence of +2. It
will combine with two chlorine atoms to
make calcium chloride (CaCl2).
Combinations or groups of atoms
may also carry charges, such as acetate
(C2H3O2) or bicarbonate (HCO3) which
carry -1 charges. The sulfate group (SO4)
carries a -2 charge and the phosphate
group (PO4) carries a -3 charge. Know-
ing the charges gives us an indication of
the combining power of the ions. One
sodium ion, (+1), will combine with one
bicarbonate ion, (-1) to form sodium bi-
carbonate (NaHCO3).
Groups of atoms can act like a single
ion with a charge. They are called radicals.
Group Formula Charge
Acetate C2H3O2 -1
Ammonium NH4 +1
Bicarbonate HCO3 -1
Carbonate CO3 -2
Citrate C6H5O7 -3
Phosphate PO4 -3
Sulfate SO4 -2
The charges on the ions or ion groups
are used to calculate milliequivalents.
To calculate the number of milligrams
of an element in a milliequivalent (mEq)
of the element, ignore the positive or
negative charge sign, and divide the mil-
ligram atomic weight by the ion charge. In
the case of sodium, divide 23 mg by 1.
This means that 23 mg of sodium is equal
to 1 milliequivalent (mEq) of sodium.
How many milligrams of potassium make
up a milliequivalent (mEq) of potassium?
39 mg (39 mg divided by 1). How many
milligrams of calcium make up a milli-
equivalent (mEq) of calcium? 20 mg (40
mg divided by 2).
When dealing with a molecule such
as sodium chloride, divide the milligram
molecular weight by the greatest ion
charge, ignoring the positive or negative
sign of the charge. For sodium chloride,
divide 35.5 mg by the charge of 1. This
means that 35.5 milligrams of sodium
chloride is one milliequivalent of sodium
chloride. In the case of calcium chloride,
(CaCl2), calcium has a milligram molecu-
lar weight of 40 + 35.5 + 35.5 or 111 mg.
Calcium has a +2 charge and chlorine -1.
Two is larger that one, so divide 111 mg by
2. There are 55.5 mg of calcium chloride
for one milliequivalent of calcium chloride.
In the case of aluminum chloride, divide
the milligram molecular weight of 133.5
mg by the charge of 3, resulting in 44.5 mg
of aluminum chloride equaling one mil-
liequivalent of aluminum chloride.
Each milliequivalent of a molecule that
dissociates gives one milliequivalent of each
ion in it. For example, 10 mEq of NaCl
will dissociate into 10 mEq of Na+ and 10
mEq of Cl-. In the case of calcium chlo-
ride, 15 mEq of CaCl2 will dissociate into
15 mEq of Ca++ and 15 mEq of Cl-.
CALCULATING DOSES
Calculating doses is accomplished in the
same way a milligram dose is figured by
using a proportion. For instance, there
are 102 mg in a milliequivalent of potas-
sium citrate. How much potassium citrate
will provide 15 milliequivalents? Set up a
proportion with the known ratio on one side
(102 mg/mEq) and the unknown ratio (x
mg/15 mEq) on the other side of the equal
sign. 102 mg/1 mEq = x mg/15 mEq.
Cross multiply and divide (15 mEq x 102
mg/1mEq = 1,530 mg). Answer: 1.53 gm
An order is received for an IV solution
containing 65 mEq of ammonium chlo-
ride. The concentration in a vial is 5 mEq/
mL. How many milliliters must be drawn
up in a syringe to get 65 mEq? 13 mL (5
mEq/mL = 65 mEq/x mL)
CALCULATING PERCENTAGE
STRENGTH FROM MILLIEQUIVALENT
STRENGTH
There are times when the milliequivalent
strength is given and you want to convert
it to a percentage strength. This is done
by: (1) finding the number of milligrams
in a milliequivalent, (2) converting the
given mEq strength to a weight/volume
strength, (3) converting the results to a
percentage strength.
Practice Problem
The molecular weight of sodium bicar-
bonate is 84. What is the percent strength
of sodium bicarbonate injection if the
label on the vial reads 1.7 mEq sodium
bicarbonate per milliliter?
Step 1:
1 Find the number of milligrams
in a milliequivalent.
Since the charges of the ions are +1 and
-1, we divide the mg molecular weight of
84 mg by 1 to determine that 84 mg of
sodium bicarbonate equals one milliequiv-
alent of sodium bicarbonate.
Step 2: Determine the weight/volume
strength.
The vial label reads that the concentra-
tion is 1.7 mEq/mL. The 1.7 mEq can be
changed to a milligram number by using
our results from step 1.
84 mg/1 mEq = x mg/1.7 mEq. Solv-
ing this shows that 1.7 mEq = 142.8 mg.
Substitute the 142.8 mg for the 1.7 mEq.
There are 142.8 mg/mL.
Step 3: Change the concentration of
142.8 mg/mL to a percent concentration.
Remember that percentage strength is the
number of grams of a substance in 100 mL
of solution.
Since percent concentration is the
number of grams of a substance in 100
mL of solution, it can be determined by
proportion. (Remember that 142.8 mg is
the same as 0.1428 gm). 0.1428 gm/1mL
= x gm/100mL; x = 14.3 gm Since there
are 14.3 grams in 100 mL of solution, it is
therefore a 14.3% concentration.
CALCULATING MILLIEQUIVALENT
STRENGTH FROM PERCENTAGE
STRENGTH
This is the reversal of the last practice
problem. Again the key is to know the
number of milligrams in a milliequivalent.
Knowing that allows us to calculate the
mEq strength from a percentage strength.
January/February 2006 JPSW 13
The steps are: (1) Find the number of
milligrams in a milliequivalent, (2) Work
from the definition of percent and change
the concentration to a weight/volume
strength, (3) Convert mg/mL to mEq/mL.
Practice Problem
The pharmacy stocks 32-fluid ounce
bottles of 10% potassium chloride (KCl)
solution. How many milliequivalents of
potassium chloride are in each milliliter?
Step 1: Determine how many mg of
KCl are in a mEq of KCl. Divide the mg
molecular weight by the largest charge.
The mg molecular weight is 39 + 35.5 =
74.5 mg. Dividing by the charge of 1 tells
us that there are 74.5 mg/1 mEq.
Step 2: Ten percent means that there
are 10 grams of potassium chloride in
each 100 mL of the solution. (This is a
definition that you must know about per-
cent concentrations. The percent concentra-
tion is always the number of grams in each
100 mL of the solution.)
Remember 10 grams is 10,000 mg.
Use a proportion to determine that there
are 100 mg/mL. (10,000 mg/100 mL = x
mg/1 mL).
Step 3: We want to know mEq/mL,
but what we know is 100 mg/mL. We
want to convert the 100 mg in the nu-
merator to mEq. Ask yourself, what do
we know about the relationship between
milligrams and mEqs that would serve as
a conversion factor? Step one has the an-
14 JPSW January/February 2006
swer. 100 mg = 1.34 mEq (This is deter- mEq/500 mL). The proportion 84 mg/1
mined from 74.5 mg/1 mEq = 100 mg/x mEq = x mg/375 mEq shows 31,500 mg
mEq). Substitute the 1.34 mEq for the (31.5 grams) of sodium bicarbonate are
100 mg to give 1.34 mEq/mL. needed to prepare a 500 mL solution.
What is the percent concentration
MIXING AND LABELING AN ORDER of the sodium bicarbonate in this solu-
FOR AN ELECTROLYTE tion? In other words, how many grams
The molecular weight of sodium bicar- of sodium bicarbonate are in 100 mL of
bonate is 84. How many grams of sodium solution? We have determined the amount
bicarbonate (NaHCO3) are needed to necessary in 500 mL so a proportion
prepare 500 mL of a solution which will shows that 6.3 grams are in 100 mL (31.5
contain 75 milliequivalents of sodium per gm/500 mL = x gm/100 mL), which
100 mL? To determine the amount for a means that the solution should be labeled
milliequivalent, divide the mg weight of 6.3% sodium bicarbonate. ●
84 mg by the charge of 1 to give 84 mg/1 Dave Brown is the pharmacy technician
mEq. If there are 75 mEq per 100 mL, program director for M.S. Vocational &
a proportion shows that 375 mEq are Technical Education at Lakeshore Techni-
needed in 500 mL. (75 mEq/100 mL = x cal College in Cleveland, Wis.
Correction:
In the November/December 2005 Journal
Journal, some of the references to the article Chronic Depression by
Kimberly Lintner, PharmD were inadvertently omitted. They are printed here in their entirety.
1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the
national comorbidity survery replication. Arch Gen Psychiatry 2005; 62:617-627.
2. National Institute of Mental Health. The numbers count: mental disorders in America. 2001. Available at: http://www.nimh.
nih.gov/publicat/numbers.cfm. Accessed August 29, 2005.
3. Drug Topics. Top 200 generic/brand-name drugs by units in 2004. March 7, 2005. Available at http://www.drugtopics.com/
drugtopics/article/articleDetail.jsp?id=150068 and http://www.drugtopics.com/drugtopics/article/articleDetail.jsp?id=150069. Ac-
cessed August 29, 2005.
4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Wash-
ington, DC, American Psychiatric Association, 2000.
5. McEvoy, ed. AHFS Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists; 2005:28:16.04.
6. Gregorian RS, Golden KA, Bahce A, et al. Antidepressant-induced sexual dysfunction. Ann Pharmacother 2002; 36:1577-1589.
7. Clayton HA, Pradko JF, Croft HA, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry
2002; 63:357-366.
8. Boyer EW and Shannon M. The serotonin syndrome. N Engl J Med 2005; 352:1112-1120.
9. FDA. Labeling change request letter for antidepressant medications. October 28, 2004. Available at: http://www.fda.gov/cder/
drug/antidepressants/SSRIlabelChange.htm Accessed August 25, 2005.
SELF ASSESSMENT QUESTIONS

Understanding Milliequivalents

1. What is the molecular weight of aluminum chloride (AlCl3)? _________________________________

2. What is the milligram molecular weight of aluminum chloride (AlCl3)? _________________________________
3. How many acetate ions will combine with one sodium ion? _________________________________
4. One carbonate ion will combine with how many sodium ions? _________________________________
5. Magnesium has a milligram atomic weight of 24 mg and a valence of 2.
What is the milliequivalent weight? _________________________________
6. Aluminum has a milligram atomic weight of 27 mg and a valence of 3.
What is the milliequivalent weight? _________________________________
7. Magnesium sulfate (MgSO4) has a milligram molecular weight of 120 mg.
The charge on the magnesium ion is +2 and the charge on the sulfate ion is -2.
How many milligrams of MgSO4 make up one milliequivalent? _________________________________
8. K3PO4 has a milligram molecular weight of 212 mg. How many
milligrams make up one milliequivalent of K3PO4? _________________________________
9. Your pharmacy stocks a vial of calcium chloride solution that is labeled
1.4 mEq Ca++/mL. An order is received for 12.6 mEq Ca++ IV injection.
How many milliliters must be drawn up? _________________________________
10. You must add 13 mEq of potassium chloride to an IV solution.
The pharmacist provides you with a vial of potassium chloride which
is labeled 20 mEq/10 mL. How many milliliters must you draw up to get 13 mEq? _________________________________
11. Sodium acetate (molecular wt = 82, valence = 1) injection is available in
vials containing 2 mEq/mL. What is the percent concentration? _________________________________
12. If potassium carbonate (K2CO3, molecular wt = 138) is in solution
with 5 mEq/mL strength, what is the percent concentration? _________________________________
13. How many milliequivalents are in each milliliter of 10% calcium
chloride (CaCl2) injection? _________________________________
14. How many milliequivalents are in each milliliter of 23.4% sodium
chloride (NaCl) IV solution? _________________________________
15. If the concentration in a bottle of cherry flavored KCl is 9.93%,
how many milliequivalents are in 15 mL? _________________________________

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January/February 2006
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January/February 2006 JPSW 15