What is the recommended dose of albuterol (beta-2 adrenergic receptor agonist) for an 11.25 kg male patient?

Albuterol Dosing for an 11.25 kg Pediatric Patient

For an 11.25 kg child, administer albuterol nebulizer solution at 0.15 mg/kg, which equals 1.69 mg, but use the minimum dose of 2.5 mg every 20 minutes for 3 doses during acute exacerbations, then every 1-4 hours as needed. 1

Nebulizer Solution Dosing (Preferred for Acute Exacerbations)

Initial Treatment Protocol

• Weight-based calculation: 0.15 mg/kg × 11.25 kg = 1.69 mg 2, 1
• Actual dose to administer: 2.5 mg (the minimum dose overrides the weight-based calculation when it yields a lower amount) 1, 3
• Frequency: Every 20 minutes for 3 doses, then every 1-4 hours as needed based on clinical response 2, 1

Administration Technique

• Dilute the albuterol solution to a minimum of 3 mL with normal saline 1, 4
• Use a gas flow rate of 6-8 L/min for optimal aerosol delivery 1, 4
• Oxygen is the preferred gas source for nebulization, particularly during acute exacerbations 3

Metered-Dose Inhaler Alternative (For Mild-to-Moderate Exacerbations)

MDI Dosing with Valved Holding Chamber

• Dose: 4-8 puffs (90 mcg per puff = 360-720 mcg total) 1, 4
• Frequency: Every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 4
• Critical requirement: Must use a valved holding chamber (spacer) with face mask for children under 4 years of age 2, 1
• MDI with proper technique is as effective as nebulized therapy for mild-to-moderate exacerbations 1, 4, 5

Severe Exacerbations Requiring Escalation

Continuous Nebulization

• Dose: 0.5 mg/kg/hour for children 1, 4
• For this patient: 0.5 mg/kg/hr × 11.25 kg = 5.6 mg/hour 1
• Reserved for severe exacerbations remaining unresponsive after initial hourly treatments 1

Adjunctive Ipratropium Bromide

• Add ipratropium 0.25 mg to albuterol nebulizer solution for moderate to severe exacerbations 2, 1
• Can be mixed in the same nebulizer with albuterol 4
• Significantly reduces hospitalization rates in severe exacerbations 1

Critical Clinical Pitfalls to Avoid

Dosing Errors

• Never use oral albuterol formulations when nebulized or inhaled options are available—they are slower acting, less effective, and produce more systemic side effects 3
• Always apply the minimum dose rule: Even though weight-based calculation yields 1.69 mg, the minimum effective dose is 2.5 mg 1, 3
• Do not confuse albuterol (racemic) with levalbuterol dosing—levalbuterol is given at half the milligram dose (minimum 1.25 mg for children) 1, 3

Monitoring Requirements

• Watch for adverse effects: Tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 1, 4
• Assess response after each treatment: Include respiratory rate, work of breathing, oxygen saturation, and subjective symptom improvement 1, 3
• Signs of treatment failure: Inability to speak, altered mental status, intercostal retractions, worsening fatigue, or elevated carbon dioxide levels warrant immediate escalation of care 1

Treatment Response Indicators

• Response to initial treatment is a better predictor of hospitalization need than initial exacerbation severity 1
• Increasing albuterol use or lack of expected bronchodilator effect indicates worsening asthma control requiring medical attention 4

Systemic Corticosteroids (Essential Adjunct)

• Administer early in moderate to severe exacerbations 1
• Pediatric dose: 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 2, 1
• For this patient: 11.25-22.5 mg daily (typically rounded to practical dosing like 15-20 mg daily) 2