Intended for healthcare professionals

Rapid response to:

Practice Lesson of the Week

Acute liver failure after administration of paracetamol at the maximum recommended daily dose in adults

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6764 (Published 02 December 2010) Cite this as: BMJ 2010;341:c6764

Rapid Response:

Importance of patient weight

As a paediatrician I have been trained for many years to prescribe
medication by weight. This case highlights the importance of dosing
according to patient weight in adults as well as in children. If the
patient described in case 1 had received paracetamol according to "by
weight" dosing used in paediatric patients he would have received 450mg 4
times a day (15mg/kg/dose). Similarly, the patient described in case two
would have received a maximum of 660 mg 4 times a day.

Adult patients come
in as many varied shapes and sizes as paediatric patients and assuming a
one size fits all approach to prescribing will inevitably lead to
overdosing (as described) and under dosing. The impact of patient weight
on dosing merits further study as I suspect there are other areas where
weight is an important factor in correct dosing - fluids prescriptions and
the risk of fluid overload in underweight patients and failure to reach
therapeutic levels with antibiotic prescribing in heavier patients are two
areas which may reveal interesting results if studied with respect to
patient weight and dosing.

Competing interests: No competing interests

12 December 2010
Sophie H. Wilne
Paediatric Oncologist
Nottingham University Hospitals NHS Trust