Nebulized Albuterol Dosing for a 7-Year-Old Weighing 48 Pounds
For a 7-year-old male weighing 48 pounds (21.8 kg), the recommended dose of nebulized albuterol is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed. 1
Initial Dosing Calculation
- Calculate weight-based dose: 21.8 kg × 0.15 mg/kg = 3.27 mg per dose 1, 2
- This exceeds the minimum dose of 2.5 mg, so 3.27 mg should be administered 2
- For practical administration, round to 3.25 mg or use the nearest available pre-packaged concentration 1
Administration Protocol
- Initial treatment: 3.27 mg every 20 minutes for 3 doses 1
- Maintenance dosing: 3.27-6.54 mg (0.15-0.3 mg/kg) every 1-4 hours as needed 1
- For continuous nebulization in severe cases: 0.5 mg/kg/hour (10.9 mg/hour) 1
Preparation and Delivery
- Dilute the albuterol solution to a minimum of 3 mL with normal saline for optimal delivery 1
- Use a gas flow of 6-8 L/min for nebulization 1
- May mix with ipratropium bromide nebulizer solution if indicated for moderate to severe exacerbations 1, 3
Monitoring and Adjustments
- Monitor clinical response after each treatment 2
- Watch for side effects such as tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 2, 4
- If response is inadequate after initial treatments, consider adding ipratropium bromide (0.25-0.5 mg) to the nebulizer solution 1, 3
Alternative Delivery Methods
- For mild-to-moderate exacerbations, MDI with valved holding chamber (4-8 puffs every 20 minutes for 3 doses) can be as effective as nebulized therapy when proper technique is used 1
Important Considerations
- Most children achieve maximum bronchodilation with cumulative doses of 7.5 mg of nebulized albuterol 5
- No significant advantage has been demonstrated for routine administration of doses higher than 2.5 mg every 20 minutes in most patients 6
- For severe exacerbations, the addition of ipratropium bromide to albuterol significantly decreases hospitalization rates 3
- Studies comparing different weight-based rates have not found an optimal dose, suggesting that lower doses may be as efficacious as higher doses in many cases 7
Cautions
- If a previously effective dosage regimen fails to provide usual relief, seek medical advice immediately as this may indicate worsening asthma requiring reassessment of therapy 8
- Monitor for signs of impending respiratory failure: inability to speak, altered mental status, intercostal retraction, worsening fatigue 1, 9