Levosalbutamol Dosing for a 14kg, 4-Year-Old Child
For this 14kg, 4-year-old child, administer 1.25 mg of levosalbutamol via nebulizer, as this is the minimum effective dose recommended by the American Academy of Pediatrics for children in this age and weight range. 1, 2
Standard Dosing Approach
Weight-based calculation (0.075 mg/kg) would yield only 1.05 mg for this 14kg child, but guidelines explicitly state to always use the minimum dose of 1.25 mg even when weight-based calculations result in lower numbers. 1, 2 This ensures adequate bronchodilation, as doses below 1.25 mg have not demonstrated reliable efficacy in pediatric patients. 3
Nebulizer Administration
- Dilute the 1.25 mg dose to a minimum total volume of 3 mL with normal saline 1, 4
- Use oxygen as the preferred gas source at 6-8 L/min flow rate 1, 4
- Administer every 4-6 hours as needed for routine bronchospasm 5, 2
Acute Exacerbation Protocol
If treating an acute asthma exacerbation rather than routine symptoms:
- Give 1.25 mg every 20 minutes for 3 doses initially 1, 4
- Then continue with 1.25 mg every 1-4 hours as needed for maintenance 1, 4
- Consider adding ipratropium bromide 0.25 mg to the first 3 doses during severe exacerbations 2
Key Dosing Principle: Half-Dose Equivalence
Levosalbutamol is administered at half the milligram dose of racemic albuterol/salbutamol for comparable efficacy. 1, 4 This means 1.25 mg levosalbutamol equals 2.5 mg racemic albuterol in therapeutic effect. 6, 7 The (S)-enantiomer present in racemic formulations may contribute to airway hyperreactivity, making levosalbutamol theoretically advantageous. 6
Alternative: Metered-Dose Inhaler Option
If using an MDI instead of nebulizer:
- Administer 4 puffs (45 mcg/puff = 180 mcg total) every 4-6 hours for routine use 1, 4
- Must use a spacer with face mask for children under 4 years; drug delivery is dramatically reduced without proper technique 2
- For acute symptoms: 4-8 puffs every 20 minutes for 3 doses 1, 4
Monitoring Requirements
After each treatment, assess:
- Respiratory rate and work of breathing 1, 4
- Oxygen saturation 1
- Heart rate (watch for tachycardia) 1, 4
- Tremor and signs of hypokalemia with frequent dosing 1, 4
Critical Pitfall to Avoid
Never dose levosalbutamol on a milligram-per-milligram basis equivalent to racemic albuterol—this results in overdosing. 4 The 1.25 mg levosalbutamol dose for this child is therapeutically equivalent to 2.5 mg of racemic albuterol, which is the standard pediatric dose for children weighing less than 20 kg. 5