Toddler overdose

[tripledose]

What would you do in this scenario?

I left DH alone with DD, who is two, for the long weekend to see friends. I take one weekend off a year.

While I was away she came down with a fever and he gave her TRIPLE the dose of paracetomol every 6 hours for all of the three days. I asked him have you double and triple checked the dosage and he said yes yes. I didn't want to second guess him even though I was worried because we have had arguments in the past about me double checking what he says/researches when DD is ill - he says it shows I don't trust him and I am too controlling.

We have spent the day in hospital because I came back to him giving this dosage and was worried about liver damage. Thankfully she is ok but I am furious with him and was out of my mind with worry that DD would suffer permanent damage in some way.

He's pretty competent on the whole but I feel he let his pride and ego get in the way here and risked DD's health as a result.

What do I do? I am so angry.

He didn’t look up any website. Check his phone. He gave about 15-20 spoons of paracetamol to a toddler in 24 hours.

Ok, ok, so it’s a “stupid” mistake. So what. Mistakes happen, we all have moments of stupidity. Still understandable and an honest mistake. There’s zero evidence he was dosing the child for nefarious reasons or so egotistical he just decided to eyeball the dosage without doing any reading on dosage beforehand or was on mumsnet getting the dosage (and we get people on here all the time asking for medical advice when mumsnet is far less reliable than an NHS webpage FFS).

Yes it’s understandable to be angry, but not in my opinion to hold it over his head or refuse to speak to him as he is reported to feel terrible about it. Nor is one mistake adequate reason to never trust him ever again. The child has suffered no harm as a result of the mistake. It’s pointless to punish him for something that did not happen.

I think @NumberTheory has it right,
It may be that what needs to happen (if OP can forgive him) is marriage counselling with an emphasis on communication and rebuilding trust.

If you’d read the thread, you’d know how wrong you are. He used the NHS website which was based on paracetamol medicine of lower strength than what they had bought locally. The issue is what they had was stronger and so when he gave the NHS “number of spoons” it led to an overdose. He didn’t give her more spoons than the NHS website said. He just failed to note the difference in strength.

But you'd have to be stupid not to check the dosage! I took different painkillers when I had a toothache last year. Codeine, cocodamol, ibuprofen, paracetamol. I triple checked the doses, I read what could be taken with what and for how long. I wrote down what I had taken when and calculated what to take and dosage times. It isn't something you mess with.

I've rarely had to give my kids more than 1 dose of medicine in a day but when I have, I check the instructions, reread how often they can take it etc. And if I am reading websites I check the strength.

It is normal and common sense and this idiot even had his wife repeatedly tell him.

OP hasn't said what her daughter's levels were but this is something that is a blood test to measure and would right away tell the doctors if she had been taking more than a safe dose and if there was an overdose

no. Not in a staggered dose. A paracetamol level is useless.

so much misinformation on this thread.

He didn’t look up any website. Check his phone. He gave about 15-20 spoons of paracetamol to a toddler in 24 hours

where does it say this? The o/p clearly states they are not in the uk, it is not a uk preparation.

o/p says 3x500 mg in 24 hours. Which even for u6 calpol is not 15 spoons.

for anyone reading this thread if your child has taken more than the recommended dose of paracetamol it is worth checking with 111. Most calpol preparations the concentration is low enough that a serious accidental OD is rare, so 111 is appropriate. You need the weight of your child and as best an estimate of the amount.

but please ignore any medical “facts” on this thread.

@Vikinga
But he did check the dosage. As OP asked him to do. I don’t think it takes a complete idiot to initially think that paracetamol medication for under 6s sold OTC is probably made in the same strength locally as it is listed on the NHS webpage. It’s a mistake any first time parent could make in my opinion. Of course in hindsight, it’s easy to criticise but I’m positive he’s not the only parent that has made this mistake.

You are correct, I’m sorry. That’s 1500mg, a spoon of calpol is 120mg so he gave 12 or or 13 spoons. That’s still a lot to get into a toddler.

im in Portugal and the paracetamol childrens medicine here is 40mg per ml here, so that’s still 8x 5ml spoons. That’s a lot too. Wouldn’t he just contact the mum and ask if she is usually the person giving it?

sorry if my maths are wrong there

You are correct, I’m sorry. That’s 1500mg, a spoon of calpol is 120mg so he gave 12 or or 13 spoons. That’s still a lot to get into a toddler

he didn’t give calpol. He gave whatever their local preparation is. Presumably it’s stronger so when he looked up uk advice to give 5ml, giving the local version meant 500mg in 5 ml. So it wouldn’t necessarily be an alarming amount- most of us would question giving 4 spoons of calpol at a time.

No, it is not useless and advised in many guidelines. Most guidelines talk about dosing over 24, 48, 72 hours and that levels and toxicity should be assessed.

www.rch.org.au/clinicalguide/guideline_index/Paracetamol_poisoning/#:~:text=Potential%20toxicity%20should%20be%20assessed,over%20a%2072%20hour%20period

No, it is not useless and advised in many guidelines. Most guidelines talk about dosing over 24, 48, 72 hours and that levels and toxicity should be assessed

the link you posted does not back up your claim. It refers to paracetamol levels being used to guide antidote treatment only in acute OD.

The bit you refer to about guidelines over 24/48/72 is ingestion amount, not blood levels.

for staggered and supertherapeutic OD it does recommend levels, but only in the negative- if levels are below a certain amount AND liver function is normal there is no risk.

nowhere does it say to measure blood paracetamol level and use the result to guide NAC administration in staggered OD.

Here is the NHS website:

www.nhs.uk/medicines/paracetamol-for-children/

I think that is crazy that they would have that on the site. It should just say ‘All medicines are different, please read the label’

sorry again about my post, please ignore it.

I was just thinking about my children and even getting one spoon of medicine is a wrestling match. I shouldn’t be projecting! Apologies again.

Yes the website is misleading.
It says
”There are different types of paracetamol for children, including 2 strengths of syrup. The strength and dosage depends on your child's age (and sometimes weight), so always read the instructions carefully.”

But this paragraph is clearly referring to the two strengths of syrup listed further down:
”Infant syrup (sometimes called "junior syrup") is for children under 6 years old. A 5ml dose contains 120mg of paracetamol.

Six plus syrup is for children aged 6 years and older. A 5ml dose contains 250mg of paracetamol.”

So a new parent reading this could easily conclude that paracetamol syrup for children only comes in these two strengths.

Furthermore, it says
“Paracetamol is known by many different brand names, including Disprol, Hedex, Medinol and Panadol. Paracetamol syrup is also known by the brand name Calpol.”

Which would imho lead an inexperienced reader to think, it’s all the same/standard just has different brand names.

Different places have different protocols. At my hospital we would check acetaminophen levels for a child like in the OP who came in with 72 hour staggered overdose, in your hospital you wouldn't and you would call it bad practice and misinformation. DIfferent hospitals follow different best practice guidelines. Just because yours would never check acetaminophen levels for a situation like OPs, doesn't mean that none would.

in your hospital you wouldn't and you would call it bad practice and misinformation. DIfferent hospitals follow different best practice guidelines. Just because yours would never check acetaminophen levels for a situation like OPs, doesn't mean that none would

i didn’t say that. I said a paracetamol level is useless for making a decision to give nac.

levels can tell you if there is any on board, to corroborate history. So if a level is negative at 72 hours, and lft/inr are all normal, then that indicates the amount taken isn’t a problem.

it’s part of the picture in staggered od. Wheres acute od with reliable history treatment is solely on levels and the nomogram.