Do NOT administer this intramuscular paracetamol formulation intravenously
This IM formulation containing lignocaine and benzyl alcohol is absolutely contraindicated for IV use and poses serious risks of toxicity and death if given intravenously to this child.
Critical Safety Issues
Benzyl Alcohol Toxicity
- Benzyl alcohol is a preservative that is contraindicated for IV administration in children, particularly those under 3 years of age, due to risk of "gasping syndrome" - a potentially fatal condition characterized by metabolic acidosis, gasping respirations, CNS depression, cardiovascular collapse, and death 1
- While this child is 10 years old, IV benzyl alcohol still poses unnecessary risks and is not approved for this route 1
Lignocaine (Lidocaine) Concerns
- The lignocaine in this IM formulation is intended for local anesthetic effect at the injection site, not for systemic IV administration 1, 2
- IV lignocaine requires specific dosing, dilution protocols, and cardiac monitoring - none of which apply to this IM formulation 2
- Rapid IV bolus of lignocaine without proper dilution and monitoring can cause cardiac arrhythmias, seizures, and cardiovascular collapse 2
Formulation Not Designed for IV Use
- IM formulations have different excipients, pH, and osmolality compared to IV preparations 3
- The absorption kinetics and safety profile of IM paracetamol are fundamentally different from IV paracetamol 3
Appropriate Paracetamol Dosing for This Child
Correct Dosing Calculation
- For a 21 kg child, the appropriate paracetamol dose is 10-15 mg/kg every 4-6 hours 4, 5
- This equals 210-315 mg per dose (maximum 60 mg/kg/day = 1,260 mg/day) 4
- The ampoule contains 300 mg total (150 mg/mL × 2 mL), which is within the appropriate single-dose range 4
Safe Administration Routes
- Oral route is first-line for paracetamol in children when feasible 6, 5
- Rectal administration is an alternative if oral route is unavailable 6
- IM injection should be avoided except in emergencies when no other route is available, as it causes significant pain and has erratic absorption 6, 3
- Only use IV paracetamol formulations specifically manufactured for IV use - never adapt IM formulations 1
Recommended Action
Use oral or rectal paracetamol instead 6, 5. If IV administration is absolutely necessary due to inability to use enteral routes and severe pain/fever requiring immediate treatment, obtain a proper IV paracetamol formulation (typically 10 mg/mL concentration) that is preservative-free and specifically manufactured for IV use 1.