What dose of a 15mg/5ml corticosteroid solution should be administered?

Corticosteroid Dosing for Acute Conditions in Pediatrics

For acute exacerbations of asthma or croup in children, administer prednisolone 1-2 mg/kg/day (maximum 60 mg/day) in single or divided doses for 3-10 days using the 15 mg/5 mL solution, which translates to 0.33-0.67 mL/kg/day. 1

Dose Calculation Framework

Standard Pediatric Dosing

• Weight-based calculation: The FDA-approved dosing range is 1-2 mg/kg/day for acute conditions 1
• For a 15 mg/5 mL concentration: Each mL contains 3 mg of prednisolone base
• Volume calculation: Divide the calculated mg dose by 3 to get mL volume needed 1

Specific Clinical Scenarios

Acute Asthma Exacerbation:

• Dose: 1-2 mg/kg/day in single or divided doses 1
• Duration: Continue until peak expiratory flow reaches 80% of personal best or symptoms resolve, typically 3-10 days 1
• No tapering needed: For courses <10 days, abrupt discontinuation is safe 2, 1

Croup (Laryngotracheobronchitis):

• While the evidence focuses on nebulized epinephrine for acute airway management 2, 3, systemic corticosteroids reduce hospitalization need 4
• Dose: 1-2 mg/kg/day using the same calculation as asthma 1

Practical Dosing Examples

For a 20 kg child:

• Low-end dose (1 mg/kg): 20 mg = 6.7 mL of 15 mg/5 mL solution
• High-end dose (2 mg/kg): 40 mg = 13.3 mL of 15 mg/5 mL solution

For a 10 kg child:

• Low-end dose: 10 mg = 3.3 mL
• High-end dose: 20 mg = 6.7 mL

Critical Safety Considerations

Dose Rounding:

• Corticosteroids generally allow 5-10% rounding for ease of home administration 2
• Round to the nearest 0.5 mL or whole mL for practical measurement 2

Maximum Daily Dose:

• Absolute maximum: 60 mg/day (20 mL of 15 mg/5 mL solution) regardless of weight 1
• This ceiling prevents excessive dosing in larger children

Concentration Confusion Prevention:

• The 15 mg/5 mL concentration means 3 mg per mL 1
• Always double-check calculations, as concentration errors are common and potentially dangerous 5, 6
• Express final dose in both mg AND mL to caregivers to prevent measurement errors 6

Duration and Monitoring

Short-Course Therapy:

• 3-10 days is standard for acute conditions 1
• No taper required for courses <10 days 2, 1
• Continue until clinical improvement, not a predetermined number of days 1

When to Use Higher Doses:

• Start at 2 mg/kg/day for severe exacerbations 1
• Use 1 mg/kg/day for moderate symptoms 1
• Adjust based on response within 24-48 hours 1

Common Pitfalls to Avoid

• Calculation errors: The most frequent mistake is confusing mg with mL—always convert the weight-based mg dose to volume 5, 6
• Underdosing: Using 1 mg/kg when 2 mg/kg is indicated for severe symptoms delays improvement 1
• Unnecessary tapering: For short courses, abrupt discontinuation after <10 days is safe and recommended 2, 1
• Exceeding maximum: Never exceed 60 mg/day total dose regardless of calculated weight-based dose 1