IV Antipyretic Treatment for a 10-Year-Old, 21kg Child with Fever
For a 10-year-old child weighing 21kg with fever, administer IV acetaminophen (paracetamol) at 15 mg/kg every 6 hours, which equals 315 mg per dose, with a maximum daily dose of 75 mg/kg/day (1,575 mg/day). 1
Weight-Based Dosing Calculation
- For children weighing under 50 kg, the FDA-approved IV acetaminophen dose is 15 mg/kg every 6 hours or 12.5 mg/kg every 4 hours 1
- For this 21kg child: 15 mg/kg × 21 kg = 315 mg per dose 1
- Minimum dosing interval: 4 hours 1
- Maximum single dose: 15 mg/kg (315 mg for this child) 1
- Maximum daily dose: 75 mg/kg/day = 1,575 mg/day for this child 1
Administration Guidelines
- Withdraw the appropriate dose (315 mg) from the 100 mL vial using aseptic technique and place in a separate sterile container or syringe 1
- The entire 100 mL container is not intended for patients weighing less than 50 kg 1
- Administer over 15 minutes via IV infusion 1
- For small volume pediatric doses, use a syringe pump for controlled administration 1
- Monitor the end of infusion to prevent air embolism 1
Critical Safety Considerations
- Do not exceed 75 mg/kg/day from all routes of administration (IV, oral, rectal) and all acetaminophen-containing products combined 1
- Exceeding the maximum daily dose may result in hepatic injury, including liver failure and death 1
- Verify that no other acetaminophen-containing medications are being administered concurrently 1
- Do not add other medications to the acetaminophen IV solution 1
- Diazepam and chlorpromazine are physically incompatible with IV acetaminophen 1
Clinical Context
While the evidence provided focuses heavily on influenza antivirals 2, these are not appropriate for general fever management and should only be used for confirmed or suspected influenza with specific indications. IV acetaminophen remains the first-line antipyretic for hospitalized children requiring IV therapy 1, 3, 4.
The 15 mg/kg dose is supported by recent evidence showing superior efficacy compared to lower doses (≤10 mg/kg), with a safety profile similar to placebo when used appropriately 3. This dose provides effective antipyresis while maintaining an excellent safety margin when the maximum daily dose is not exceeded 5, 3.
Common Pitfalls to Avoid
- Never use the full 100 mL vial (1,000 mg) for children under 50 kg - this would result in severe overdose 1
- Always calculate the total daily acetaminophen exposure from all sources to prevent inadvertent overdose 1
- Do not infuse faster than 15 minutes, as this increases risk of adverse effects 1
- Ensure proper aseptic technique when withdrawing doses from the vial 1