{
  "id": "medical/iv-antibiotic-dilution-error",
  "signature": "AI instructs to dilute IV vancomycin with 50mL D5W for a 1.5g dose, ignoring concentration limits for phlebitis risk",
  "signature_zh": "AI指示用50mL D5W稀释1.5g静脉注射万古霉素，忽略浓度限制导致静脉炎风险",
  "regex": "(vancomycin|antibiotic)\\s*(dilute|dilution)\\s*(with|in)\\s*(50|100)\\s*(mL|ml)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Vancomycin concentration should not exceed 5 mg/mL for peripheral IV administration; 1.5g in 50mL yields 30 mg/mL, causing high osmolarity and severe phlebitis; proper dilution requires at least 300mL.",
  "root_cause_type": "generic",
  "root_cause_zh": "万古霉素浓度在外周静脉给药时不应超过5 mg/mL；1.5g溶于50mL产生30 mg/mL，导致高渗透压和严重静脉炎；正确稀释至少需要300mL。",
  "versions": [
    {
      "version": "vancomycin 1.5g vial",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "D5W 250mL bag",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "ISMP guidelines 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Central line reduces phlebitis risk but does not eliminate need for proper dilution; concentrated solution still causes precipitation or red man syndrome",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Slow infusion does not reduce osmolarity damage; phlebitis occurs due to high concentration regardless of rate",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Volume still insufficient (1.5g/100mL = 15 mg/mL, 3x limit); NS vs D5W does not change concentration requirement",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Dilute 1.5g vancomycin in 300mL NS or D5W to achieve 5 mg/mL; use `python -c \"print(f'Required volume: {1500/5} mL')\"`",
      "success_rate": 0.95,
      "how": "Dilute 1.5g vancomycin in 300mL NS or D5W to achieve 5 mg/mL; use `python -c \"print(f'Required volume: {1500/5} mL')\"`",
      "condition": "",
      "sources": []
    },
    {
      "action": "If fluid restriction needed, consider central line with concentration up to 10 mg/mL (150mL); document in EHR with pump rate calculation",
      "success_rate": 0.85,
      "how": "If fluid restriction needed, consider central line with concentration up to 10 mg/mL (150mL); document in EHR with pump rate calculation",
      "condition": "",
      "sources": []
    },
    {
      "action": "Use premixed vancomycin bags (1g/200mL or 1.5g/300mL) from pharmacy to eliminate dilution errors",
      "success_rate": 0.92,
      "how": "Use premixed vancomycin bags (1g/200mL or 1.5g/300mL) from pharmacy to eliminate dilution errors",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Dilute 1.5g vancomycin in 300mL NS or D5W to achieve 5 mg/mL; use `python -c \"print(f'Required volume: {1500/5} mL')\"`",
    "If fluid restriction needed, consider central line with concentration up to 10 mg/mL (150mL); document in EHR with pump rate calculation",
    "Use premixed vancomycin bags (1g/200mL or 1.5g/300mL) from pharmacy to eliminate dilution errors"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.ismp.org/resources/vancomycin-administration-guidelines",
  "official_doc_section": null,
  "error_code": "IV-DILUTION-007",
  "verification_tier": "ai_generated",
  "confidence": 0.85,
  "fix_success_rate": 0.9,
  "resolvable": "true",
  "first_seen": "2024-01-20",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}