What is the recommended dose of salbutamol (albuterol) per kg in pediatric patients?

Salbutamol (Albuterol) Dosing in Pediatric Patients

The recommended dose of nebulized salbutamol for pediatric patients is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed for acute asthma exacerbations. 1

Nebulized Salbutamol Dosing

• For children with acute asthma exacerbations requiring nebulized treatment:

  • Dose: 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed 1
  • For children weighing less than 20 kg: 2.5 mg per dose 1
  • For children weighing more than 20 kg: 5 mg per dose 1

• When administered via metered-dose inhaler (MDI) with spacer:

  • 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed 1
  • This delivery method is as effective as nebulized therapy with appropriate technique and coaching 1

Intravenous Salbutamol Dosing

For severe asthma exacerbations not responding to inhaled therapy:

• IV infusion: 15 mcg/kg loading dose (maximum 750 mcg) 2
• Continuous infusion: Start at lowest dose and titrate to desired clinical effect 2

Weight-Based vs. Fixed Dosing

Research has shown that fixed-dose nebulized salbutamol (2.5 mg) is as efficacious as weight-based dosing (0.1 mg/kg) in children with mild to moderate acute asthma 3. However, weight-based dosing remains the standard recommendation in most guidelines to ensure appropriate dosing across all pediatric age groups 1.

Special Considerations

• For children with upper respiratory infections (URI) under age 6, preoperative nebulized salbutamol (2.5 mg for <20 kg, 5 mg for >20 kg) administered 30 minutes before general anesthesia can reduce perioperative respiratory adverse events by approximately 50% 1

• For severe asthma exacerbations, consider adding ipratropium bromide to salbutamol nebulization for enhanced bronchodilation 4

• Salbutamol can be administered via various routes:

  • Nebulizer: Most common for acute exacerbations 1
  • MDI with spacer: As effective as nebulizer with proper technique 1
  • Intravenous: Reserved for severe cases not responding to inhaled therapy 5, 2

Common Pitfalls and Caveats

• Overdosing can lead to tachycardia, tremors, and hypokalemia 1
• Underdosing may result in inadequate bronchodilation and treatment failure 1
• For intubated children, both nebulized salbutamol (0.15 mg/kg) and MDI plus spacer (400 mcg) show comparable effects on respiratory mechanics 6
• Adding a loading dose of IV salbutamol (15 mcg/kg) to continuous infusion has not shown significant clinical benefit in children with severe acute asthma admitted to PICU 2

Always monitor heart rate, respiratory rate, oxygen saturation, and clinical response when administering salbutamol to pediatric patients, and adjust dosing based on response and side effects 1.