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ForumsCompounding & FormulationDumb question - what is bacteriostatic water exactly — need advice

Dumb question - what is bacteriostatic water exactly — need advice

AmyNC_wife Sun, Apr 6, 2025 at 12:08 AM 12 replies 1,479 viewsPage 1 of 3
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AmyNC_wife
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Apr 6, 2025 at 12:08 AM#1

This is the version of the explanation I wish somebody had given me, written down before I forget what confused me. It is about the dosing arithmetic, and it is deliberately narrow — everything I am not confident about is marked as such.

What is actually established

Do it in two steps and it stops being confusing. First concentration: 10mg into 2ml is 5mg/ml. Then volume: a 0.5mg dose is 0.5 ÷ 5 = 0.1ml. Then units, and this is where people go wrong — a U-100 syringe is graduated in hundredths of a millilitre, so 0.1ml is 10 units. The word "units" has nothing to do with milligrams; it is a volume marking that exists because insulin happens to come at 100 units per ml.

The condition it depends on

It is worth saying that rounding to the nearest whole unit is usually acceptable at maintenance doses and is not acceptable at the bottom of a ladder, where one unit can be a fifth of the intended dose.

The practical version

The three numbers to write on the vial: total mg, total ml, and mg per ml. Everything else is division. And the sanity check is that dose volume times number of doses should be less than the volume you put in, because dead space takes the difference.

What I am not sure about

The bit I cannot resolve on my own is how to check the arithmetic without trusting a website calculator, since three calculators gave me three answers. Numbers rather than impressions, if you have them.

— AmyNC_wife · corrections welcome and will be edited into this post with credit
36 14JessicaM_2024, TomFromTexas, mike.trainer_LA and 33 others
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RetaRick_CA
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Apr 6, 2025 at 12:15 AM#2
AmyNC_wife said:
Do it in two steps and it stops being confusing.

No disagreement with AmyNC_wife. One condition attached. Concentration choice is a precision decision, not a preference. Reconstitute high and every dose is a tiny volume where one unit of syringe error is a large fraction of the dose. Reconstitute low and you get more graduations per dose, so the same hand tremor costs proportionally less. Against that, more diluent means more benzyl alcohol and a shorter comfortable in-use window.

37 15AmyNC_wife, SkepticalSean, Dr.CardioMD and 34 others
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BethLabQueen
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Apr 6, 2025 at 12:22 AM#3
AmyNC_wife said:
Do it in two steps and it stops being confusing.

I am going to disagree with reconstituting low as a general rule. More diluent, more punctures, more in-use days at room temperature, and the stability trade-off is real. Precision is not the only variable being optimised.

38 16lori_vegas, Dr.PulmRoch, maya_sedona and 35 others
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hans_munich
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Apr 6, 2025 at 12:29 AM#4

Taking the question as asked, rather than the general version of it. Dead space is the answer to the missing dose. A fixed-needle insulin syringe holds a few microlitres in the hub and needle after the plunger bottoms out, and on small draws that is a measurable percentage of every dose. Across ten draws it adds up to most of an eleventh, which is exactly the "nine draws from a ten-dose vial" complaint. Luer-lock syringes are worse; low-dead-space fixed-needle designs are better.

Correct me if the detail matters more than I have assumed.

39 17tammy_FL, Dr.LipidDallas, alex_tucson and 36 others
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sean_dublin
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Apr 6, 2025 at 1:04 AM#5
RetaRick_CA said:
Concentration choice is a precision decision, not a preference.

Second this.

40 18quinn_sf, NurseLeah_Nash, gary_naperville and 37 others
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