ID: 18 mos old male (=13kg) presenting with iron-deficiency anemia (= Ferratin <2, Hgb ~47g/L, and S/Sx of PICA and paleness)
Order for iron was written as: Iron 39 mg PO BID (=6mg/kg/day elemental iron)
However pharmacy supplied Ferrous Sulfate, which is supplied as 75mg/mL, with a 20% concentration of elemental iron per mg of ferrous sulfate.
Elemental Fe = 39mg / (20%) = 195mg Ferrous Sulfate (per dose)
Thus the nurses were administering 195mg (=2.6 mL) PO BID. However, as noted above this was not written as such on the order or in the MAR, which may lead to confusion later on as to why a dose of 195mg FeSO4 is given when 39mg is ordered.
Thus I provided the following clarification on the patient’s chart:
Clinical pharmacist clarification:
Ferrous Sulfate 195mg PO BID (=2.6mL/dose) (=6mg/kg/day of Elemental Iron).
Upon discharge I gave a similar note to the family to give to their community pharmacists to ensure that they pick up the correct formulation and strength of ferrous sulfate (which the parents were grateful for the verbal and written explanation).