Accidentally doubled paracetamol suppository

[Otismom]

DS 15 months has had spiking temperatures and seeming in pain since 2am this morning, have been alternating nurofen and paracetamol suppositories which have brought temps down. Have just realised at last dosing I have given paracetamol when should have been nurofen, paracetamols were 2am, 11.30am, 6pm and 9pm and nurofen at 9am and 3pm. Is there anything I can do at this stage given that this was suppository as opposed to ingested orally?

I know many will think cyclical medicating for temperatures is unnecessary however after multiple hospital visits and stays for spiking temperatures with rigours and blue lips/hands and feet our doctor advised to always do our best to keep temperatures down. Hoping for some reassurance and confirmation that only thing I can do now is not give anymore paracetamol for 24hours?

thanks so much from a very panicked mum!

I would call 111 about this to check if he needs to be seen.

With paracetamol you need to either go to A&E or at the minimum get advice from 111 (who will almost certainly say to to A&E).
You don't muck around with paracetamol.

I would call 111 and double check. Often what’s reccomend on the box/bottle is a fair bit lower then what the real “safe limit” is for exactly this reason however check as weight also plays a part in dosage. I think all will be fine but bets to check xx

How many mg in total in the last 24 hours?

We were advised by out of hours gp to give more than on bottle for fever at a similar age but always best to check as there is a maximum safe amount and if over they need to be seen.

Call your local out of hours/111 (whichever you have). I did this recently and they asked for weight of child and times of doses. They then were able to calculate up of safe levels. Thankfully I was and was just told no more calpol for next however many hours.

How often can you give the suppositories? If that was calpol you just would have been an hour early for when he was allowed another dose (3 hours instead of 4?) if that's the case I wouldnt give it a thought.

You're giving your baby 6 suppositories a day? This is weird. I used to struggle to give one.

Depends on child's weight and dose. Ring 111. Rectal paracetamol has useless absorption vs oral hence we rarely use it in anaesthetics so that goes in the favour.

Is it any more weird than giving oral meds?

OP, I'd call 111 for advice as OP have said.

He'll need a blood test

Op try to work out the dose you gave and the dose he is allowed re his weight .

You still need to ring 111

Thanks all for quick responses, have spoken to out of hours (we do not have 111 access in Ireland) who have advised that given his weight and dosage he is within safe limits and to keep an eye for lethargy/vomiting which would require A&E visit.

Being particularly anxious of his health as it is I feel so terrible to have made such a stupid mistake.

For paracetamol you absolutely cannot assume that the safe dose will be much higher than the recommended dose. You may find it's okay on checking (e.g. if you have an 11 year old and they're a year off from the next dose up) but paracetamol is not a drug where you can assume it will be fine.

It is a bit more weird? Given that oral medications aren't that different from multivitamin syrups you might be giving anyway, and indeed all children ingested food; whereas having something passed into your bottom is a very uncommon experience and most people perceived it as adverse. Obviously it's a question of risks vs benefits but this scenario is pretty different from how most children are treated during an illness, qualifies as "weird" in a way oral treatments don't?

OP these things happen all the time . He is fine that's all that matters. So pleased it's good news .

He’ll be fine. He hasn’t had more than 4 doses in 24 hours, the dose being 1 hour early isn’t a massive issue. Skip the next parcetamol dose and give Ibuprofen instead. A&E won’t do anything from a paracetamol overdose point of view as it’s not actually an overdose, merely a dose being given 1 hour earlier than it should’ve been.

@otismum I felt so guilty as well until I started talking to friends and work colleagues about it and it turns out it happens a lot!!! I'm glad you have had your mind out at ease though. It's tough juggling everything, a ball will always fall sometime but no harm has been done!! I simply lifted the wrong bottle when I did it a few months back and the annoying thing is it didn't even cure dear child's headache 🤦🏻‍♀️ (she had headache from temp)

Why are you giving it via rectum!? Surely calpol is easy enough??

Rectal drugs are relatively common in paeds <3yo (stops them spitting it) we use it all the time in hospitals

In some conditions rectal anti inflammatories are first line treatment in adults (post csection initial dose, all kidney stones regularly) for eg

Rectal paracetamol isn't the best, just because the absorption isn't great. Rectal anti-inflammatories on the other hand are fantastic

Europe uses it way more than we do, England's bit oddly squeamish of rectal meds

You obviously never tried giving any medication including Calpol to my ds at that age.
You name the method; I'd tried and failed.

He had too much practice at avoiding taking medicine. Strangely enough he didn't, and still doesn't, mind having them intravenously. He'd choose that method every time.

How is he @Otismom ?

Just to update you all, no negative effect from the accidental mistiming of the paracetamol, temperatures still returning around every 3-4 hours unfortunately. Hopefully something viral that he’ll be able to shift himself but think will bring to GP/out of hours tomorrow if persists as he has no other symptoms beyond discomfort when temp is on the up. We had a hospital stay in December off the back of ear infection, bronchiolitis, hand foot and mouth and a virus (which couldn’t be identified following bloods and swabs) within a three week period, was hoping the time at home away from childcare over Christmas would give his little body a break but apparently not!

In terms of why we use suppositories, we initially started using as it was very difficult to get liquid medication into him, with it always being spat out we had no idea as to how much was being ingested. In addition GP had recommended the nurofen in particular for the speed with which it takes effect, we have had no issues with using this method to date however think will have to move to liquid soon for the nurofen as he is on 99.7 percentile so dosage will no longer be sufficient. In hospital we managed to get liquid nurofen into him when mixed with fruit or yoghurt but that just doesn’t work when administering in the middle of the night.

thanks all again for advice and quick responses last night, have never felt guilt or panic like it!