In a patient receiving hydromorphone PCA at 0.2 mg/hour basal, demand dose 0.1 mg, lock-out 6 minutes, hourly limit 2.2 mg, who used 5 on-demand bolus doses in 24 hours, how many milligrams of hydromorphone were delivered in 24 hours?

• A. 10 mg
• B. 4.8 mg
• C. 0.5 mg
• D. 5.3 mg

Answer: (D)

The question tests how to calculate total opioid delivery on a PCA that combines a continuous basal infusion with on-demand boluses, while considering the hourly limit.

First, compute what’s delivered as basal over 24 hours: 0.2 mg per hour times 24 hours equals 4.8 mg.

Next, compute the total on-demand bolus doses: 5 boluses times 0.1 mg per bolus equals 0.5 mg.

Check the hourly limit: 2.2 mg per hour. Even if all five boluses occurred in one hour, that hour would have 0.2 mg from basal plus 0.5 mg from boluses = 0.7 mg, which is below the limit. So the hourly limit does not reduce the amount delivered in this scenario.

Add basal and boluses: 4.8 mg + 0.5 mg = 5.3 mg.

Therefore, 5.3 mg were delivered in 24 hours.