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Even love is valuable only if it is given in the right dosage. Overdoses of drugs, specially the common paracetamol, need not be dangerous in adults, but can lead to serious complications, including liver failure, in children.

Over the past few weeks, with viral and flu infections rampant, a number of children have been admitted to the intensive care units, not for treatment of the primary illness, but for paracetamol poisoning. Janani Sankar, senior consultant, Kanchi Kamakoti CHILDS Trust Hospital, says kids come in with multi-organ failure, and while most of them could be saved, some have been beyond help as they have come too late.

“Two types of overdosing can occur: one is accidental, when the children drink up syrup because it is tasty; or two doses are taken by mistake. The other is what we are commonly seeing now: mothers with extreme anxiety feeding their children excessive dosages of paracetamol in order to bring the fever down,” Dr. Janani adds.

In a season when dengue cases are numerous, the course of the disease itself involves very high fever for several days. Mothers, in their anxiety to reduce the fever end up giving more than the recommended dosage, she says.

“In children, paracetamol overdosing can happen more easily than in adults. Doses are calibrated with body weight, and in children, even a little extra may be too much,” P. Ramachandran, director, Institute of Child Health, says. He adds that a number of private hospitals are reporting such cases increasingly.

Different values

Parents sometimes do not check the dosage of the drugs they are giving the child, as they are available in different values across different brands.

“There is the Double Strength version which they buy instead of the regular dose. With the increase in the number of dosages per day, the chances that it becomes too much for the child is high,” Rex Sargunam, senior paediatrician, explains.

Yet another complication arises because parents sometime mistake the ‘drops' version for the syrup. Deepa Hariharan, neonatologist at Sooriya Hospital says, “We had two cases recently of really sick children, where parents had bought drops instead of syrup.”

In the drops, there is 100 mg of drug in one ml while with the syrup, there is 125 mg in five ml. “When we ask the parent to give 5 ml of the syrup four times a day, we intend a dose of 500 mg. Instead the parent buys the drops, and lands up dosing the child with 2000 mg of paracetamol,” Dr. Deepa adds. In children, the liver is not very mature and therefore this overdose can be dangerous.

Dr. Janani cautions parents, “Do not be extraordinarily anxious and overdose the child. The paediatrician's recommended dosage must be stuck to at all times.”

Dr. Ramachandran also adds that parents and physicians should suspect and look for signs of paracetamol poisoning when a child is ill. “Initially there will be vomiting, maybe with some blood, the child will feel drowsy and will have liver damage within one to three days. Parents and physicians should watch out for this,” he says. Laboratory tests to confirm unacceptable paracetamol levels are available and once the diagnosis is confirmed, treatment can be started at once.