Teaspoons vs. milliliters- It does matter!

I receive the journal Contemporary Pediatrics. I have found the articles to be very practical for everyday use. For the most part the authors are reviewing a specific topic of interest. An author will condense a large volume of literature into a very readable format. Back in the day, I was asked to write an article about chronic hives for Contemporary Pediatrics. I titled that article ‘When the road gets bumpy, chronic urticaria’. I enjoy reading Contemporary Pediatrics and I have used interesting findings in this blog (see my note on the ’Patient History’)

I always scan the articles and a while back I came across a little quip that caught my attention. It made me wonder about the many times I had suggested using a teaspoon measure of medication.

When we prescribe medications we all have the tendency to use the teaspoon/tablespoon measure of delivery. Our assumption is that a teaspoon is five milliliters (mls) and a tablespoon is three teaspoons so that would equate to 15 mls. The question was asked whether or not teaspoons are standardized. I discovered that they clearly are not and the use of teaspoons for dosing could lead to more overdosing as opposed to under dosing.

So the question is, do you use mls or teaspoons?

The article was amazing- It was a clinical tip about the timely death of the ‘teaspoon’ at least for giving medications. The work was done by Alvin N. Eden, MD, and Mohammad Mir, MD Department of Pediatrics, Wyckoff Medical Center Brooklyn, N.Y. and appeared in the November 1, 2008 Contemporary Pediatrics.

The background is that more than 50% of liquid preparations given to children are written as a number of teaspoons. This small research project looked at the volume of 53 teaspoons brought in by physicians, nurses, and the receptionists at a general pediatric practice. Only one of the teaspoons actually measured 5 milliliters. The range was 4.3-12.9 mls! Based on these findings, using the tsp format could result in overdosing by 2.5 times the intended dose.

This made me think about the use of oral steroids for our children who have a flare of their asthma. The medications are 15 mg per 5 mls and the dose would be 2 mg/kg of body weight per day. If a teaspoon that measured 12.9 mls was used, then 38.7 mg were given and not the intended 15 mg! Steroid side-effects could occur due to the over-exposure via generous teaspoons.

Due to this extreme variability in volume and the chance of an overdose, the milliliter format was suggested as the proper way to administer liquid medications.

Go metric- ask for how many milliliters and use the proper dosing apparatus.

Fred Leickly

April 28, 2009 · fleickly · No Comments
Posted in: Interesting Stories