Albuterol Nebulizer Dosing for a 9kg Patient
The recommended dose of albuterol via nebulizer for a 9kg patient is 1.35mg (0.15 mg/kg) every 20 minutes for 3 doses, then 1.35-2.7mg (0.15-0.3 mg/kg) every 1-4 hours as needed. 1
Dosing Calculation
- For children, albuterol nebulizer dosing is weight-based at 0.15 mg/kg (minimum dose 2.5 mg) for acute exacerbations 1
- For a 9kg child: 0.15 mg/kg × 9kg = 1.35mg per dose 1
- Since the calculated dose (1.35mg) is less than the minimum recommended dose (2.5mg), the minimum dose of 2.5mg should be administered 1
Administration Guidelines
- Initial treatment: 2.5mg every 20 minutes for 3 doses 1
- Maintenance dosing: 2.5mg every 1-4 hours as needed 1
- For continuous nebulization (severe exacerbations): 0.5 mg/kg/hour (4.5mg/hour for a 9kg child) 1
Preparation and Delivery
- For optimal delivery, dilute the albuterol solution to a minimum of 3mL with normal saline 1
- Use a gas flow of 6-8 L/min for nebulization 1
- Large volume nebulizers should be used for continuous administration 2
Formulation Considerations
- Albuterol nebulizer solutions are available in various concentrations (0.63 mg/3 mL, 1.25 mg/3 mL, 2.5 mg/3 mL, 5.0 mg/mL) 1
- When possible, use preservative-free formulations to avoid potential paradoxical bronchospasm from benzalkonium chloride (BAC) preservatives 3
Monitoring and Adjustments
- Monitor for clinical response after each treatment 1
- Assess for side effects including tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 2
- For moderate exacerbations, consider adding ipratropium bromide to the nebulizer solution 1
Special Considerations
- MDI with spacer is as effective as nebulized therapy for mild-to-moderate exacerbations when proper technique is used 1, 2
- Higher doses of albuterol (beyond standard recommendations) have not shown significant advantages in improving outcomes in most cases 4, 5
- Increasing fill volume in the nebulizer decreases the amount of medication trapped in dead volume and increases the amount delivered to the patient 6
Remember that while the calculated weight-based dose is 1.35mg, clinical guidelines recommend a minimum dose of 2.5mg even for small children to ensure adequate delivery of medication to the airways 1.