The little one’s fever is high and the parents are fearful. They give paracetamol but as they watch the clock and also the thermometer in desperation, the temperature of their son or daughter does not seem to respond to the medication.
Beware, for this is the time most mothers are tempted to give more and more paracetamol.Paracetamol over-dosage is dangerous, cautions Consultant Paediatrician Dr. Narada Warnasuriya, urging that you should never exceed the toxic level of this medication.
Explaining that paracetamol comes in different forms as syrups, paediatric tablets and adult tablets with different strengths, he points out that when giving adult tablets which are easily available not only at pharmacies but any corner shop, to children, sometimes parents may be careless in calculating the right dosage.
The right dosage is 15 milligrams of paracetamol per kilogram of the child’s weight per dose, with four such doses (six hourly) being given per day, MediScene understands.
Citing an example, he says that if a child is 10kg the parents will have to give 150mg per dose. But if they are giving part of the tablet meant for adults which is 500mg, how will they break it up?
“A quarter will be 125mg and half 250mg. You cannot break the tablets into anything smaller,” he points out, adding that it is important to round off to a lower level, keeping track of the amount being given each time, so that it can be evened out later. It is easier to give such precise small doses using a syrup containing 120mg of paracetamol per 5ml. Therefore, for a 150mg dose the child would be given 6.25ml of the syrup.
The other mistake anxious parents, especially those fearing that their child may get a febrile seizure (fever fit) do is to shorten the time between the doses. “If the fever is very high, you can give the second dose four hours later instead of six hours later as required, but it is crucial to give only four doses per 24 hours."
Dr. Warnasuriya stresses that it is not only essential for parents to ask but also for the doctor to indicate whether he is prescribing paracetamol or any other medication which contains paracetamol to the child. If not, the parents may unwittingly dose the child with paracetamol on their own, resulting in the child getting double doses.
Never must the child be given a total paracetamol dosage which is equal to or exceeds the toxic level of 90mg per kg of body weight per day, MediScene learns.
In the case of a child who is 10kg, if the parents carelessly give him half an adult tablet (250mg) four times a day, it amounts to a total dose of 1000mg when he should be getting only 900mg. Then he has got 100mg more than the toxic level which is dangerous, he says.
Toxic levels of paracetamol affect the liver, leading to acute liver failure but such children don’t present symptoms early, but are brought in with continuous fever and vomiting. Then doctors do a liver function test (SGPT) which is just a simple blood test, says Dr Warnasuriya, adding that if the SGPT is high, antidotes are available at hospitals to reverse this trend.
When asked what could be done to bring down a fever without overdosing a child with paracetamol, he says the “physical measures” that could be tried are removing the child’s clothing, keeping the fan on in the room and sponging the child with tepid (room temperature) water.
Don’t use ice-water or eau de cologne, he warns, as the child’s body will cool immediately but rebound very fast.
Then he has got 100mg more than the toxic level which is dangerous, he says.
Toxic levels of paracetamol affect the liver, leading to acute liver failure but such children don’t present symptoms early, but are brought in with continuous fever and vomiting. Then doctors do a liver function test (SGPT) which is just a simple blood test, says Dr Warnasuriya, adding that if the SGPT is high, antidotes are availa this trend.
When asked what could be done to bring down a fever without overdosing a child with paracetamol, he says the “physical measures” that could be tried are removing the child’s clothing, keeping the fan on in the room and sponging the child with tepid (room temperature) water.
Don’t use ice-water or eau de cologne, he warns, as the child’s body will cool immediately but rebound very fast.
Second drug not necessary
Routinely prescribing a second drug, in addition to paracetamol to reduce the fever, is not necessary, MediScene learns.
The drugs thus prescribed are non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or mefenemic acid which cause gastric irritation and gastric bleeding. This could be life-threatening especially if the fever is due to Dengue, it is understood.
Another practice by some doctors eager to allay the fears of parents about their children getting fever fits is to prescribe diclofenac suppositories.
This too is unnecessary, says Dr. Warnasuriya explaining that for such patients an occasional dose of ibuprofen could be prescribed in addition to paracetamol. If the baby goes into a convulsion then a diazepam suppository is the treatment of choice. It should certainly not be a diclofenac suppository as used by a few doctors.
Never-ever should aspirin be prescribed for a fever, especially when a viral infection is suspected, he emphasizes, adding that although it seems highly effective it can cause Reye’s syndrome which results in death due to severe liver failure along with brain damage. |
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