It is important as the triage nurse to
consider if paracetamol has already been
administered to the child by the parent
upon presentation to the emergency
department. Dosage as well as time or
times of administration during a 24-hour
period are important to reduce the risk
of toxicity in children. The safety margin
between a therapeutic and toxic dose
of paracetamol varies widely amongst
individuals and according to routes of
administration (Paul et al 2011).
Explicit variable doses of paracetamol
are reported throughout literature
without being able to make specific
recommendations. Paracetamol guidelines
(NPS 2012) in Australia recommend a
weight-based dose that is reiterated by
Glatstein and Scolnick (2008) as 15mg/
kg four hourly but not exceeding 80mg/
kg a day. Currently the dosages prescribed
are those specified by the medical officer,
as cannot be nurse initiated in the
current hospital environment. Therefore,
recommendations and dosages may change
depending on the doctors perception. It
is however, important for the triage
nurse to be aware of dosages, including
maximum dosages.
Risks of toxicity are variable throughout
literature. Most importantly, if the triage
nurse is concerned, paracetamol should
be withheld. Knowledge surrounding the
risk of toxicity including an increased risk in
the dehydrated child, and those with preexisting
conditions should be considered
(Dixon, Deehan, Dickson, Miller & Pegnam-
Mason 2006).