Albuterol Dosing for a 4-Month-Old Weighing 16 lbs
For a 4-month-old infant weighing 16 lbs (7.3 kg), administer 2.5 mg of albuterol via nebulizer every 20 minutes for 3 doses, then every 1-4 hours as needed for acute bronchospasm. 1
Initial Treatment Protocol
- Start with a fixed dose of 2.5 mg albuterol diluted in 2-3 mL of normal saline for adequate nebulization, rather than using weight-based dosing 1, 2
- Administer via face mask (not mouthpiece, which infants cannot tolerate) 1
- Give every 20 minutes for 3 doses in the first hour for acute exacerbations 1, 2
- After initial 3 doses, continue with 2.5 mg every 1-4 hours based on clinical response 1, 2
Critical Administration Details
- Use oxygen as the gas source for nebulization when available 1, 2
- Maintain oxygen saturation >92% during treatment 3, 1
- Monitor continuously after each nebulization: heart rate, respiratory rate, oxygen saturation, and clinical response 1, 3
- Watch for side effects: tachycardia, tremors, and hypokalemia 1, 3
Why This Dose is Appropriate
The fixed 2.5 mg dose is recommended over weight-based dosing (0.15 mg/kg, which would be approximately 1.1 mg for this infant) because fixed dosing is as effective as weight-based dosing in infants and young children with mild to moderate acute asthma 1. The 2.5 mg dose ensures adequate bronchodilation without risk of underdosing 1.
Adjunctive Therapy Considerations
- Begin systemic corticosteroids early in acute exacerbations: prednisolone 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1, 2
- Consider ipratropium bromide 0.25 mg (250 mcg) nebulized every 20 minutes for 3 doses only for severe exacerbations, not as first-line therapy 1, 2
- Ipratropium can be mixed with albuterol in the same nebulizer 1, 2
- Ipratropium provides benefit primarily in the first 3 hours of severe acute exacerbations and offers no additional benefit once hospitalized 3, 1
Common Pitfalls to Avoid
- Do not underdose: Using less than 2.5 mg may result in inadequate bronchodilation and treatment failure 1
- Do not use a mouthpiece: Infants require face mask delivery for effective nebulization 1
- Do not delay corticosteroids: Begin systemic corticosteroids early in acute exacerbations 1
- Do not add ipratropium routinely: Reserve for severe exacerbations only, as it provides no additional benefit in mild-moderate cases or after hospitalization 1, 3
- Do not use compressed air alone: Oxygen is the preferred gas source for nebulization 1, 2