What is the recommended dose of paracetamol (acetaminophen) for a 47kg pediatric patient?

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Paracetamol Dosing for a 47kg Pediatric Patient

For a 47kg pediatric patient, administer 705 mg (15 mg/kg) of paracetamol every 4-6 hours, not exceeding 2820 mg per day (60 mg/kg/day) or 5 doses in 24 hours. 1

Weight-Based Dosing Calculation

  • The standard pediatric dose is 10-15 mg/kg per dose, with administration every 4-6 hours 1
  • For a 47kg patient:
    • Minimum single dose: 470 mg (10 mg/kg)
    • Optimal single dose: 705 mg (15 mg/kg) 1, 2
    • Maximum daily dose: 2820 mg (60 mg/kg/day) 1

Practical Administration Guidelines

  • Use the 15 mg/kg dosing for optimal analgesic and antipyretic effect, as this has been demonstrated to provide consistent therapeutic benefit in children 2, 3
  • Administer every 4-6 hours as needed 1
  • Never exceed 5 doses in a 24-hour period 1, 4
  • Oral syrup formulation is absorbed more rapidly and provides more consistent response compared to rectal suppositories 1

Transition to Adult Dosing

  • Children weighing more than 40 kg should receive adult dosing 1
  • Since this patient is 47kg, adult dosing guidelines apply:
    • Single dose: 650-1000 mg every 4-6 hours 4
    • Maximum daily dose: 4000 mg (not to exceed 6 doses in 24 hours) 4
  • However, the weight-based calculation of 705 mg (15 mg/kg) remains appropriate and safer for this transitional weight, staying well below adult maximum doses while providing adequate analgesia 1

Critical Safety Considerations

  • The maximum daily dose must never exceed 60 mg/kg/day or 5 doses in 24 hours to prevent hepatotoxicity 1
  • For this 47kg patient, the absolute maximum daily dose is 2820 mg 1
  • Monitor for signs of overdose, particularly with chronic use exceeding 140 mg/kg/day for several days, which carries risk of serious hepatic toxicity 5
  • Paracetamol is contraindicated in patients with hepatic insufficiency 3

Route of Administration

  • Oral administration is strongly preferred due to rapid and consistent absorption 1, 3
  • Rectal administration should be avoided due to erratic absorption patterns 1
  • If oral intake is not possible (active vomiting, perioperative restrictions), rectal administration can be considered but expect inconsistent therapeutic response 1

References

Guideline

Pediatric Acetaminophen and Ibuprofen Dosing Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Research

Pediatric dosing of acetaminophen.

Pediatric pharmacology (New York, N.Y.), 1983

Research

Paracetamol efficacy and safety in children: the first 40 years.

American journal of therapeutics, 2000

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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