Levosalbutamol Syrup Dosing for a 4-Year-Old Child (14kg)
For a 4-year-old child weighing 14kg, administer levosalbutamol 1.25 mg via nebulization every 4-6 hours as needed for bronchospasm, diluted to a minimum of 3 mL with normal saline. 1, 2
Weight-Based Calculation and Minimum Dose
The weight-based calculation is 0.075 mg/kg, which yields 1.05 mg for this 14kg child, but always use the minimum effective dose of 1.25 mg as recommended by the National Asthma Education and Prevention Program (NAEPP) guidelines. 3, 1
Levosalbutamol is administered at half the milligram dose of racemic albuterol for comparable efficacy and safety, which is why the minimum dose is 1.25 mg rather than 2.5 mg. 3, 2, 4
Acute Exacerbation Dosing Protocol
For acute asthma exacerbations or severe bronchospasm, the NAEPP recommends a more aggressive approach: 3, 2
- Initial treatment: 1.25 mg every 20 minutes for 3 doses
- Maintenance: 1.25 mg every 1-4 hours as needed based on clinical response
Nebulization Technique
The American Academy of Pediatrics emphasizes proper administration technique: 1, 2, 4
- Dilute levosalbutamol to a minimum 3 mL total volume with normal saline for optimal nebulizer delivery
- Use oxygen as the preferred gas source at 6-8 L/min flow rate
- Use a face mask that fits snugly over nose and mouth for children under 5 years
Alternative: Metered-Dose Inhaler (MDI)
If nebulization is unavailable, levosalbutamol HFA (45 mcg/puff) can be used: 3, 1, 4
- Maintenance dosing: 1-2 puffs every 4-6 hours as needed
- Acute symptoms: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed
- Critical requirement: Must use a spacer/valved holding chamber with face mask, as drug delivery is dramatically reduced without it in children under 5 years
Important Clinical Pitfall to Avoid
Oral levosalbutamol syrup formulations are not recommended when nebulized or inhaled options are available. 2 The NAEPP and other guideline societies implicitly recommend against oral salbutamol/albuterol formulations because they are:
- Slower acting with delayed onset of bronchodilation
- Less effective at reaching target airways
- Associated with more systemic side effects (tachycardia, tremor, hypokalemia)
Monitoring Requirements
After each treatment, monitor the following parameters: 1, 2, 4
- Heart rate (watch for tachycardia)
- Respiratory rate and work of breathing
- Oxygen saturation
- Tremor, hypokalemia, hyperglycemia, and headache with frequent administration
Compatibility and Mixing
Levosalbutamol nebulizer solution can be mixed with: 3
- Ipratropium bromide solution (0.25-0.5 mg can be added for severe exacerbations)
- Budesonide inhalant suspension
- Cromolyn solution