What is the recommended dose of albuterol (bronchodilator) for an 11-year-old child weighing 110 pounds?

Albuterol Dosing for an 11-Year-Old Weighing 110 Pounds

For an 11-year-old child weighing 110 pounds (50 kg), administer 2.5 mg of albuterol via nebulizer every 4-6 hours as needed for routine bronchodilator therapy, or 2 puffs (90 mcg per puff) via metered-dose inhaler (MDI) with spacer every 4-6 hours as needed. 1, 2, 3

Routine Maintenance Dosing

Nebulizer Solution

• Standard dose: 2.5 mg (one complete 3 mL vial of 0.083% solution) administered three to four times daily 3
• This applies to all children weighing ≥15 kg (33 pounds), which includes your 110-pound patient 3
• Dilute to a minimum of 3 mL total volume with normal saline for optimal nebulization at 6-8 L/min flow rate 2, 4
• Use oxygen as the preferred gas source for nebulization 1, 2

Metered-Dose Inhaler Alternative

• For children 5-11 years: 2 puffs (90 mcg per puff = 180 mcg total) every 4-6 hours as needed 1
• Critical requirement: Must use a spacer/valved holding chamber (face mask not required at this age) 1, 4
• Puffs can be taken in 10-15 second intervals 1

Acute Exacerbation Dosing

For Moderate to Severe Asthma Exacerbations

Nebulizer approach:

• Initial treatment: 2.5 mg every 20 minutes for 3 doses 1, 2
• Maintenance: 2.5 mg every 1-4 hours as needed based on clinical response 1, 2
• For severe exacerbations, the dose may be doubled to 5 mg 1, 2
• Add ipratropium bromide 0.25-0.5 mg to albuterol nebulization every 20 minutes for the first 3 doses during severe exacerbations 1, 2, 5

MDI with spacer approach (equally effective for mild-to-moderate exacerbations):

• 4-8 puffs (360-720 mcg total) every 20 minutes for 3 doses 1, 2
• Then every 1-4 hours as needed 1, 2

Weight-Based Dosing Alternative

• An alternative weight-based approach uses 0.075 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses 1, 2
• For your 50 kg patient: 0.075 mg/kg × 50 kg = 3.75 mg per dose
• For severe cases, doses up to 0.15-0.30 mg/kg may be used 1, 2

Continuous Nebulization for Status Asthmaticus

For severe status asthmaticus requiring continuous therapy:

• Dose: 0.5 mg/kg per hour up to 10-15 mg/hour 1
• For your 50 kg patient: 0.5 mg/kg/hr × 50 kg = 25 mg/hour (exceeds maximum, so use 10-15 mg/hour)
• Dilute in 25-30 mL of saline for 1 hour of nebulization 1
• Research shows doses ranging from 0.07-3.2 mg/kg/hr have been used, though no optimal dose has been definitively established 6, 7

Monitoring and Safety

Monitor for adverse effects:

• Tachycardia, skeletal muscle tremor, hypokalemia, hyperglycemia, and headache 1, 2, 4
• Monitor heart rate, respiratory rate, work of breathing, and oxygen saturation after each treatment 4
• Maintain oxygen saturation >92% during treatment 2

Critical Clinical Pitfalls to Avoid

• Failure to use a spacer with MDI dramatically reduces drug delivery 1, 4
• Increasing use or lack of expected effect indicates diminishing asthma control and requires immediate medical reassessment 1, 3
• Do not use oral albuterol formulations due to slower onset, reduced effectiveness, and increased systemic side effects 4

When to Escalate Therapy

Seek immediate medical attention if:

• Patient requires increasing frequency of treatments 2
• Oxygen saturation remains <92% despite treatment 2
• Signs of respiratory fatigue, altered mental status, or inability to speak in full sentences develop 2