What is the recommended albuterol (salbutamol) nebulizer dose for a 3-year-old child weighing 15.6 kg?

Albuterol Nebulizer Dosing for a 3-Year-Old Weighing 15.6 kg

For a 3-year-old child weighing 15.6 kg, administer 2.5 mg of albuterol via nebulizer, diluted in 2-3 mL of normal saline. 1, 2, 3

Standard Dosing Protocol

• The fixed dose of 2.5 mg is recommended for children weighing less than 20 kg, rather than weight-based dosing, as this fixed dose is as effective as weight-based calculations in infants and young children with mild to moderate acute asthma 1, 2, 4

• The FDA-approved dosing for children weighing at least 15 kg is 2.5 mg (one vial of 0.083% solution, 3 mL total volume) administered three to four times daily 3

Administration Details

• Dilute the 2.5 mg dose in 2-3 mL of normal saline for adequate nebulization 1, 4

• Use a face mask rather than a mouthpiece for delivery, as young children will not tolerate a mouthpiece 1, 4

• Regulate the flow rate so that the nebulization is delivered over approximately 5-15 minutes 3

• Use oxygen as the gas source for nebulization when available, with supplemental oxygen administered to maintain oxygen saturation >92% during treatment 1, 4

Acute Exacerbation Protocol

For acute bronchospasm or asthma exacerbations:

• Administer 2.5 mg every 20 minutes for 3 doses in the first hour 1, 4

• After the initial 3 doses, continue with 2.5 mg every 1-4 hours as needed based on clinical response 1, 4

• Begin simultaneous treatment with systemic corticosteroids (prednisolone 1-2 mg/kg/day, maximum 60 mg/day) for acute asthma exacerbations 1

Monitoring Requirements

• Monitor continuously after each nebulization: heart rate, respiratory rate, oxygen saturation, and clinical response 1, 4

• Watch for side effects including tachycardia, tremors, and hypokalemia from overdosing 1, 4

• Assess the child's response after each nebulization to determine if additional doses are needed 4

Critical Pitfalls to Avoid

• Do not underdose: Using less than 2.5 mg may result in inadequate bronchodilation and treatment failure 1

• Do not use weight-based dosing for routine treatment: The fixed 2.5 mg dose is equally effective and simpler 1, 4

• Do not delay corticosteroids: Begin systemic corticosteroids early in acute exacerbations 1

• Do not routinely add ipratropium bromide: Reserve ipratropium (0.25 mg every 20 minutes for 3 doses) for severe exacerbations only, as it provides no additional benefit in mild-moderate cases 1