Inpatient Fever Management for a 12-Year-Old Girl (27 kg)
Antipyretic Therapy
For this 12-year-old weighing 27 kg, prescribe paracetamol 405 mg (15 mg/kg) orally every 4-6 hours as needed for fever or discomfort, not exceeding 5 doses in 24 hours. 1, 2
Dosing Rationale
- Weight-based dosing at 15 mg/kg is superior to the older 10 mg/kg regimen, demonstrating significantly better efficacy comparable to NSAIDs while maintaining excellent safety 2
- For a 27 kg child: 27 kg × 15 mg/kg = 405 mg per dose 2
- Maximum daily dose should not exceed 75 mg/kg/day (approximately 2025 mg/day for this patient) 3
- Administer every 4-6 hours as needed, with careful documentation of each dose to prevent inadvertent overdosing 4
Alternative Antipyretic Option
- If fever persists or inadequate response occurs, ibuprofen 10 mg/kg (270 mg) every 6-8 hours may be added, though meticulous dose tracking is essential when using both medications 5, 4
- Combined therapy provides an additional 2.5-4.4 hours without fever over 24 hours compared to single-agent therapy 4
Important Clinical Considerations
When to Treat Fever
- Treat fever primarily for patient comfort and when associated with pain or discomfort, not fever alone 5, 6
- Fever itself does not require treatment and may be part of the normal immune response 6
- Paracetamol is ineffective for preventing febrile convulsions 6, 7
Monitoring and Documentation
- Maintain a written record of all medication doses and times to prevent exceeding maximum recommended doses, which occurred in 8% of children in clinical trials 4
- Ensure adequate fluid intake to prevent dehydration 5
- Physical cooling methods (sponging, fanning) are not recommended as they cause discomfort without proven benefit 5
Safety Profile
- Paracetamol at recommended doses has few side effects and is remarkably well tolerated 3
- Risk of hepatotoxicity occurs with single ingestions exceeding 150 mg/kg or chronic exposures greater than 140 mg/kg/day for several days 3
- When used for short-term fever management, paracetamol shows similar tolerability to placebo and lower risk of adverse events compared to NSAIDs with repetitive dosing 2
Prescription Format
Paracetamol 500 mg tablets
- Dose: Give 1 tablet (approximately 405 mg for 27 kg) orally every 4-6 hours as needed for fever >38.5°C or discomfort
- Maximum: 5 doses in 24 hours
- Duration: As needed for fever/discomfort
- Instructions: Document each dose time carefully. May be given with or without food 8