What is the recommended paracetamol (acetaminophen) infusion dose for a 16 kg child with no underlying liver disease?

Paracetamol Infusion Dose for a 16 kg Child

For a 16 kg child without liver disease, administer paracetamol 15 mg/kg per dose intravenously, which equals 240 mg per dose, given every 4-6 hours, not exceeding 60-75 mg/kg/day (960-1200 mg/day total). 1, 2

Weight-Based Dosing Calculation

• Single dose: 15 mg/kg is the recommended upper end of the therapeutic range for optimal analgesic and antipyretic effect 1, 3, 2

  • For 16 kg: 15 mg/kg × 16 kg = 240 mg per dose

• Dosing interval: Every 4-6 hours as needed 1, 3

• Maximum daily dose: 60-75 mg/kg/day 1, 2, 4

  • For 16 kg: 60 mg/kg × 16 kg = 960 mg/day (conservative)
  • For 16 kg: 75 mg/kg × 16 kg = 1200 mg/day (maximum safe threshold)

Practical Dosing Schedule

• 240 mg every 4 hours = 6 doses/day = 1440 mg/day (exceeds safe maximum—not recommended) 1
• 240 mg every 6 hours = 4 doses/day = 960 mg/day (recommended safe regimen) 1, 2

The safest approach is 240 mg every 6 hours, which provides 960 mg/day and stays well within the 75 mg/kg/day safety threshold. 1, 2, 4

Critical Safety Considerations

• Avoid exceeding 75 mg/kg/day for more than 2 consecutive days, as repeated supratherapeutic dosing (>75 mg/kg/day for ≥2 days) carries risk of hepatotoxicity even in children without underlying liver disease 4

• Monitor for signs of liver injury if the child requires treatment beyond 2 days at higher doses: check liver transaminases, INR, and paracetamol levels if vomiting, right upper quadrant pain, or jaundice develop 4

• The 10 mg/kg dosing used in some countries (UK) may be subtherapeutic—clinical and pharmacokinetic data support 15 mg/kg as the optimal single dose for adequate analgesia and antipyresis 1, 3, 2

Common Pitfalls to Avoid

• Do not use 10 mg/kg dosing reflexively: While some guidelines recommend 10 mg/kg every 4 hours, this often provides inadequate pain/fever control compared to 15 mg/kg dosing 1, 3

• Beware of cumulative daily dose: Even appropriate single doses can exceed safe daily limits if given too frequently (e.g., 15 mg/kg every 4 hours = 90 mg/kg/day, which exceeds the 75 mg/kg/day safety threshold) 1, 4

• Infusion-specific considerations: If using IV paracetamol infusion rather than oral, ensure proper dilution and infusion time per manufacturer guidelines to avoid adverse reactions 2