Albuterol Dosing for a 7-Year-Old Weighing 42 Pounds
For a 7-year-old child weighing 42 pounds (19 kg), administer 2.5 mg of albuterol via nebulization every 4-6 hours as needed for routine symptom control, or 2.5 mg every 20 minutes for 3 doses during acute exacerbations. 1, 2, 3
Weight-Based Calculation and Minimum Dose
- The weight-based calculation for this child is 0.15 mg/kg × 19 kg = 2.85 mg, which rounds to the standard minimum dose of 2.5 mg 2
- The FDA-approved dosing for children weighing at least 15 kg (33 pounds) is 2.5 mg administered three to four times daily by nebulization 3
- Always use the minimum dose of 2.5 mg even when weight-based calculations suggest lower amounts, as this ensures adequate bronchodilation 1, 2
Routine/Maintenance Dosing Protocol
- Administer 2.5 mg in 3 mL of saline every 4-6 hours as needed for symptom control 1, 2
- Regular use exceeding twice weekly for symptom control indicates poor asthma control and requires reassessment of controller medication rather than simply increasing albuterol frequency 2
- The nebulizer should deliver the medication over approximately 5-15 minutes using a gas flow rate of 6-8 L/min 1, 2
Acute Exacerbation Dosing Protocol
- For acute asthma exacerbations, administer 2.5 mg every 20 minutes for 3 doses during the first hour 1, 2
- After the initial three doses, continue with 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, though studies show no consistent advantage to routine use of higher doses 1, 4
- Consider adding ipratropium bromide (0.25-0.5 mg) to the nebulizer solution for moderate-to-severe exacerbations, which provides additive benefit in the emergency department setting 1, 2
Alternative: Metered-Dose Inhaler (MDI)
- MDI with spacer can be equally effective as nebulized therapy for mild-to-moderate exacerbations when proper technique is used 2, 5
- For acute symptoms, administer 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- For routine use, administer 2 puffs every 4-6 hours as needed 1
- A valved holding chamber (spacer) is essential for optimal drug delivery in children 1, 2
Monitoring Requirements
- Monitor heart rate, respiratory rate, work of breathing, and oxygen saturation after each treatment 2
- Watch for side effects including tachycardia, tremor, hypokalemia, and hyperglycemia, especially with frequent administration 1, 2
- Patients who require admission typically show diminished response to albuterol with the first treatment, and this decreased responsiveness is unaffected by increasing the dose 4
Critical Pitfall to Avoid
- Do not use albuterol as the sole treatment for persistent asthma—increasing frequency of use signals inadequate disease control and necessitates initiation or escalation of inhaled corticosteroid therapy 2
- If a previously effective dosage regimen fails to provide usual relief, this is a sign of seriously worsening asthma requiring immediate reassessment of therapy 3