Intravenous Paracetamol Dosing for a 20 kg Child
For a 20 kg child, administer 300 mg (30 mL of 10 mg/mL solution) of intravenous paracetamol as a loading dose, followed by 200-300 mg every 6-8 hours for maintenance dosing. 1
Weight-Based Dosing Algorithm
The European Society for Paediatric Anaesthesiology provides clear weight-based dosing for IV paracetamol in children 1:
Loading dose: 15-20 mg/kg
- For 20 kg child: 300-400 mg (15 mg/kg = 300 mg; 20 mg/kg = 400 mg)
Maintenance dose: 10-15 mg/kg every 6-8 hours
- For 20 kg child: 200-300 mg per dose
Practical Administration Details
The standard IV paracetamol preparation is 10 mg/mL concentration 2, which means:
- 300 mg loading dose = 30 mL of solution
- 200 mg maintenance dose = 20 mL of solution
- 300 mg maintenance dose = 30 mL of solution
Maximum daily dose should not exceed 60 mg/kg/day 1, which equals 1200 mg/day for a 20 kg child.
Dosing Interval Considerations
The 6-8 hour dosing interval is based on paracetamol's pharmacokinetics 1:
- Every 6 hours provides more consistent analgesia for moderate-to-severe pain
- Every 8 hours is appropriate for mild pain or fever management
- The analgesic effect typically lasts approximately 6 hours 3
Important Clinical Caveats
Do not use the lower pediatric dose (10-15 mg/kg every 6 hours) intended for children under 10 kg 1, as this would result in underdosing for a 20 kg child. The loading dose of 15-20 mg/kg is specifically recommended to achieve therapeutic plasma concentrations more rapidly 1.
Monitor for inadvertent overdosing if combining with oral paracetamol or other acetaminophen-containing products 4. The maximum recommended dose can be exceeded in up to 8% of children when multiple formulations are used 4.
Infusion time matters: Administer the loading dose over 15 minutes and maintenance doses over at least 15 minutes to avoid adverse effects 5.