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Suggest Treatment For Cold, High Fever And Vomiting In Infant
Question: Hi Doctor,
My 13 months baby (weight 16Kgs) was suffering from cold for last 7-8 days, however after administering T-mimic and Ambrodil she was recovered last Friday. (19th May)
However from yesterday night , 2 am all on a sudden she got a very high fever (103 deg ) and she vomited once.
We gave her Crocin DS (4ml) at 3 am and again she again vomited again at 3:30 am.
Her temperature was increasing again in the morning so we gave her another dose of Crocin at morning 7 am.
We have visited the local doctor and he prescribe Meftal P (6ml) at 8 hours interval and T-mimic. (prescription attached)
My questions are as below
1) Is there any way to understand if this is a seasonal or viral fever?
2) After giving Meftal P if her fever is back within 4-5 hours can we repeat the dose again or we need to wait for 8 hours? And is the dose of 6 ml is correct?
3) She is not having any mucus congestion now , then is it required to give T-mimic?
4) Is meftal P ok? or we need to give her Crocin DS?
My 13 months baby (weight 16Kgs) was suffering from cold for last 7-8 days, however after administering T-mimic and Ambrodil she was recovered last Friday. (19th May)
However from yesterday night , 2 am all on a sudden she got a very high fever (103 deg ) and she vomited once.
We gave her Crocin DS (4ml) at 3 am and again she again vomited again at 3:30 am.
Her temperature was increasing again in the morning so we gave her another dose of Crocin at morning 7 am.
We have visited the local doctor and he prescribe Meftal P (6ml) at 8 hours interval and T-mimic. (prescription attached)
My questions are as below
1) Is there any way to understand if this is a seasonal or viral fever?
2) After giving Meftal P if her fever is back within 4-5 hours can we repeat the dose again or we need to wait for 8 hours? And is the dose of 6 ml is correct?
3) She is not having any mucus congestion now , then is it required to give T-mimic?
4) Is meftal P ok? or we need to give her Crocin DS?
Brief Answer:
Details below
Detailed Answer:
Sorry for the delayed reply.
The most common cause of fever in this age is viral infection.So any fever unless associated with some specific signs is intially assumed to be viral in origin.
Even the investigations like hemogram and CRP takes time to suggest whether it is bacterial or viral infection.
The viral infection intially presents with fever only in most of the cases and after few days other symptoms like cough,cold or loose stool appear.
The vomiting associated with fever suggests gastritis.If vomiting is frequent acid reducing agent like lansoprazole and antiemetic like domperidone will be needed.
Meftal p contains mefenemic acid and the dose is 25 mg/kg/dose in three divided dosage or 8 mg/kg/dose. The 5 ml of meftal p contains 100 mg of mefenic acid so the dose of 6 ml is adequate for 16 kg baby (120 mg).
Mefenemic acid is more efficacious than paracetamol (Crocin ds) in controlling temperature.
If fever recurs in less than 8 hours tepid sponging of body will help.You can give paracetamol (Crocin ds 4 ml) in between.
I have gone through the prescription.You can give nasal saline drop as this does not has any side effect.
I won't suggest you to give tminic in the absence of any symptom of congestion/cold.
So in short continue giving meftal p in the same dose.Do tepid sponging and you can give paracetamol in between for controlling temperature.Maintain a temperature chart to monitor the pattern of fever.Give plenty of fluid to maintain adequate hydration.Watch for appearance of any new symptoms.
If fever persists for more than 3 days or in presence of frequent vomiting consult your pediatrician for further evaluation.
Please do ask if you have any more doubts.
Regards
Details below
Detailed Answer:
Sorry for the delayed reply.
The most common cause of fever in this age is viral infection.So any fever unless associated with some specific signs is intially assumed to be viral in origin.
Even the investigations like hemogram and CRP takes time to suggest whether it is bacterial or viral infection.
The viral infection intially presents with fever only in most of the cases and after few days other symptoms like cough,cold or loose stool appear.
The vomiting associated with fever suggests gastritis.If vomiting is frequent acid reducing agent like lansoprazole and antiemetic like domperidone will be needed.
Meftal p contains mefenemic acid and the dose is 25 mg/kg/dose in three divided dosage or 8 mg/kg/dose. The 5 ml of meftal p contains 100 mg of mefenic acid so the dose of 6 ml is adequate for 16 kg baby (120 mg).
Mefenemic acid is more efficacious than paracetamol (Crocin ds) in controlling temperature.
If fever recurs in less than 8 hours tepid sponging of body will help.You can give paracetamol (Crocin ds 4 ml) in between.
I have gone through the prescription.You can give nasal saline drop as this does not has any side effect.
I won't suggest you to give tminic in the absence of any symptom of congestion/cold.
So in short continue giving meftal p in the same dose.Do tepid sponging and you can give paracetamol in between for controlling temperature.Maintain a temperature chart to monitor the pattern of fever.Give plenty of fluid to maintain adequate hydration.Watch for appearance of any new symptoms.
If fever persists for more than 3 days or in presence of frequent vomiting consult your pediatrician for further evaluation.
Please do ask if you have any more doubts.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor,
Thanks for your reply.
One more doubt i have given her 5 ml dose of meftal P at 1 pm , so time for next dose is 9 pm.
But I just checked that she is not having temperature now.. So should I still give her another dose or wait for some more time and then give the second dose.
My concern is without temperature if I give her a dose that might impact adversely.
Another point though very minor is sometimes she is also coughing (once in an hr and so) for this do we need to give any medicine like T-mimic or Ambrodil or anything else?
Thanks and Regards
XXXX
Thanks for your reply.
One more doubt i have given her 5 ml dose of meftal P at 1 pm , so time for next dose is 9 pm.
But I just checked that she is not having temperature now.. So should I still give her another dose or wait for some more time and then give the second dose.
My concern is without temperature if I give her a dose that might impact adversely.
Another point though very minor is sometimes she is also coughing (once in an hr and so) for this do we need to give any medicine like T-mimic or Ambrodil or anything else?
Thanks and Regards
XXXX
Brief Answer:
No need of meftal P if temperature is normal
Detailed Answer:
Thanks for follow up
Yes you are right.Unwanted use of antipyretic (meftal p) may cause further fall in temperature.The monitoring of fever pattern would also be difficult if you give meftal when there is no fever.
So give meftal p or better calpol ds if you notice that the temperature is rising and it is more than 100 F.
For tminic I would suggest you to observe for any increase in symptoms of cough/cold.Till that time give nasal saline drop.
The falling trend of temperature is a good sign and more suggestive of viral infection.
I shall be glad to answer if you have any more queries.
Wish your baby speedy recovery.
Regards
No need of meftal P if temperature is normal
Detailed Answer:
Thanks for follow up
Yes you are right.Unwanted use of antipyretic (meftal p) may cause further fall in temperature.The monitoring of fever pattern would also be difficult if you give meftal when there is no fever.
So give meftal p or better calpol ds if you notice that the temperature is rising and it is more than 100 F.
For tminic I would suggest you to observe for any increase in symptoms of cough/cold.Till that time give nasal saline drop.
The falling trend of temperature is a good sign and more suggestive of viral infection.
I shall be glad to answer if you have any more queries.
Wish your baby speedy recovery.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
Thanks for your reply.
We are giving her Meftal P at 8-9 hours gap.
But from yesterday night she has developed some caugh and also vomited thrice at a 3 hours interval.
Just wanted to understand is there any kind of side effect of Meftal P which is causing this or vomiting ( as we are applying this thrice a day) or this can be due to some other reason and we need to check some doctor again?
Thanks and regards
XXXX
Thanks for your reply.
We are giving her Meftal P at 8-9 hours gap.
But from yesterday night she has developed some caugh and also vomited thrice at a 3 hours interval.
Just wanted to understand is there any kind of side effect of Meftal P which is causing this or vomiting ( as we are applying this thrice a day) or this can be due to some other reason and we need to check some doctor again?
Thanks and regards
XXXX
Brief Answer:
Give CrocinDS(paracetamol) instead of metal
Detailed Answer:
Thanks for follow up
Crocin DS(Paracetamol) is always preferred over mefenemic acid as first choice of antipyratic.
Chances of drug induced gastritis and vomiting is much more common with mefenemic acid in comparison to paracetamol.
Mefenemic acid should be used as an antipyratic in children only when fever is not responding well to paracetamol.
If you have noticed in my previous reply I have given you hint to switch over to paracetamol for managing fever.
The dose of paracetamol is 10-15 mg/kg/dose(4-5 ml of crocin DS) and it can be given 4-8 hourly.
It is better to start at 10 mg/kg/dose(4 ml) as and when required basis(when temperature is more than 100 F to see the pattern of fever).
As anticipated and mentioned earlier the viral infection initially presents with fever only in most of the cases and after few days other symptoms like cough,cold or loose stool appear.
This vomiting can also be due to viral infection induced gastritis.Give Domperidone suspension 5 ml thrice a day for vomiting.Also give lansoprazole(an acid reducing agent)15 mg mouth dissolving tablet once a day.
For cough you can give Tminic and ambroxol salbutamol combination as advised earlier.
If cough is severe,there is associated breathlessness or vomiting persists I would suggest you to consult your pediatrician for evaluation.
Regards
Give CrocinDS(paracetamol) instead of metal
Detailed Answer:
Thanks for follow up
Crocin DS(Paracetamol) is always preferred over mefenemic acid as first choice of antipyratic.
Chances of drug induced gastritis and vomiting is much more common with mefenemic acid in comparison to paracetamol.
Mefenemic acid should be used as an antipyratic in children only when fever is not responding well to paracetamol.
If you have noticed in my previous reply I have given you hint to switch over to paracetamol for managing fever.
The dose of paracetamol is 10-15 mg/kg/dose(4-5 ml of crocin DS) and it can be given 4-8 hourly.
It is better to start at 10 mg/kg/dose(4 ml) as and when required basis(when temperature is more than 100 F to see the pattern of fever).
As anticipated and mentioned earlier the viral infection initially presents with fever only in most of the cases and after few days other symptoms like cough,cold or loose stool appear.
This vomiting can also be due to viral infection induced gastritis.Give Domperidone suspension 5 ml thrice a day for vomiting.Also give lansoprazole(an acid reducing agent)15 mg mouth dissolving tablet once a day.
For cough you can give Tminic and ambroxol salbutamol combination as advised earlier.
If cough is severe,there is associated breathlessness or vomiting persists I would suggest you to consult your pediatrician for evaluation.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply.
My baby's fever has subsided but she is coughing a lot right now. Specially while eating, she is coughing and as a result vomitting most of the food.
Can we give her some safe medicine right now for her cough?
We can take her to doctor only tomorrow morning, but if you can suggest some immediate medicine, it will be very helpful.
Thanks
My baby's fever has subsided but she is coughing a lot right now. Specially while eating, she is coughing and as a result vomitting most of the food.
Can we give her some safe medicine right now for her cough?
We can take her to doctor only tomorrow morning, but if you can suggest some immediate medicine, it will be very helpful.
Thanks
Brief Answer:
Antiallergic with bronchodilator will help
Detailed Answer:
Thanks for the follow up
It's good to know that the fever has subsided.The subsidence of fever and persistent cough is due to the upper airway infection.
Giving antiallergic like cetrizine/chlorpheniramine with bronchodilator(to releive the spasm that may cause cough)like salbutamol will help.
In your earlier query you have mentioned that she was getting Tminic syrup.
You can give that for cough.
Giving steam inhalation will also be helpful.
Get him evaluated by a pediatrician if cough worsened or if there is any breathing difficulty.
Regards
Antiallergic with bronchodilator will help
Detailed Answer:
Thanks for the follow up
It's good to know that the fever has subsided.The subsidence of fever and persistent cough is due to the upper airway infection.
Giving antiallergic like cetrizine/chlorpheniramine with bronchodilator(to releive the spasm that may cause cough)like salbutamol will help.
In your earlier query you have mentioned that she was getting Tminic syrup.
You can give that for cough.
Giving steam inhalation will also be helpful.
Get him evaluated by a pediatrician if cough worsened or if there is any breathing difficulty.
Regards
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Brief Answer:
You can give cetrizine
Detailed Answer:
Thanks for writing back
Both mucolite and cetrizine contains different ingredient and the mechanism of action is different.
Mucolite contains ambroxol and it helps in thinning the mucus while cetrizine is an antiallergic.
So there is no harm in giving cetrizine and you can give it safely.
The dose of cetrizine for this baby of 16 kg weight is 2.5-5 mg per day.
Each 5 ml of cetrizine syrup contains 5 mg.So you can give her 2.5 to 5 ml safely depending on the severity of symptom.
Regards
You can give cetrizine
Detailed Answer:
Thanks for writing back
Both mucolite and cetrizine contains different ingredient and the mechanism of action is different.
Mucolite contains ambroxol and it helps in thinning the mucus while cetrizine is an antiallergic.
So there is no harm in giving cetrizine and you can give it safely.
The dose of cetrizine for this baby of 16 kg weight is 2.5-5 mg per day.
Each 5 ml of cetrizine syrup contains 5 mg.So you can give her 2.5 to 5 ml safely depending on the severity of symptom.
Regards
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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