What is the recommended dosage and administration frequency of albuterol (salbutamol) 2.5mg/3 0.0083% inhalation solution for a 1-year-old patient with a respiratory condition?

Albuterol Dosing for a 1-Year-Old Child

For a 1-year-old child with respiratory symptoms, administer 0.63 mg/3 mL of albuterol nebulizer solution (not the 2.5 mg dose) for routine bronchodilator therapy, given three to four times daily as needed. 1, 2

Routine Maintenance Dosing

• The standard dose for children under 5 years of age is 0.63 mg/3 mL via nebulizer, which represents the FDA-approved and safest starting point for young children in this age group 1, 2
• The solution should be diluted to a minimum of 3 mL total volume with normal saline for optimal nebulization 2, 3
• Administer every 4-6 hours as needed for symptom control 3
• The 2.5 mg/3 mL concentration you mentioned is too high for routine use in a 1-year-old and should be reserved for acute exacerbations 1, 2

Acute Exacerbation Dosing (When Needed)

If the child is experiencing an acute asthma exacerbation or severe wheezing episode:

• Use weight-based dosing of 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for the first 3 doses 1, 2, 3
• For a typical 1-year-old weighing approximately 10 kg, the calculated dose would be 1.5 mg, but the minimum dose of 2.5 mg should be used since the calculated dose falls below the established minimum 2
• After the initial 3 doses, continue with 2.5 mg every 1-4 hours as needed based on clinical response 1, 2

Administration Technique

• Always use a properly fitted face mask that covers both nose and mouth snugly to ensure adequate drug delivery 2
• Use a gas flow rate of 6-8 L/min for nebulization 2, 3
• The treatment should be delivered over approximately 5-15 minutes 4
• Use oxygen as the driving gas when available, particularly if the child is hypoxic 2

Alternative: MDI with Spacer

• For mild-to-moderate symptoms, an MDI with valved holding chamber (spacer) and face mask can be equally effective as nebulized therapy 1, 2
• Administer 4-8 puffs (90 mcg/puff = 360-720 mcg total) every 20 minutes for 3 doses if treating an acute exacerbation 1

Critical Safety Monitoring

• Monitor closely for adverse effects including tachycardia, tremor, hypokalemia, and hyperglycemia, especially with frequent dosing 2, 5
• If regular use exceeds twice weekly for symptom control, this indicates poor disease control and requires reassessment of controller medication (such as inhaled corticosteroids) rather than simply increasing albuterol frequency 3
• Seek immediate medical attention if a previously effective dosage regimen fails to provide usual relief, as this often signals seriously worsening respiratory disease 4

Common Pitfall to Avoid

Do not use the 2.5 mg dose for routine maintenance therapy in a 1-year-old. The 0.63 mg dose is specifically designed for young children under 5 years of age for routine use, while the 2.5 mg dose is reserved for acute exacerbations or children weighing at least 15 kg 1, 2, 4