Albuterol Nebulizer Dosing for a 35-Pound Child
For a 35-pound (approximately 16 kg) child with acute asthma, administer 2.5 mg of albuterol nebulizer solution every 20 minutes for 3 doses, then every 1-4 hours as needed based on clinical response. 1
Weight-Based Calculation and Minimum Dose Rule
- A 35-pound child weighs approximately 16 kg 1
- The weight-based dose is 0.15 mg/kg, which calculates to 2.4 mg for this child 1
- However, always use the minimum dose of 2.5 mg even when weight-based calculations yield a lower amount 1, 2
- This minimum dose rule prevents underdosing in smaller children and ensures adequate bronchodilation 1
Initial Treatment Protocol for Acute Exacerbations
- Administer 2.5 mg every 20 minutes for 3 doses during the first hour 1, 3
- After the initial three doses, continue with 0.15-0.3 mg/kg (2.4-4.8 mg for this child, rounded to 2.5-5 mg) every 1-4 hours based on severity and clinical response 1
- Dilute the nebulizer solution to a minimum of 3 mL total volume and deliver at 6-8 L/min gas flow 1
Severity-Based Adjustments
- For moderate-to-severe exacerbations that fail to improve after 15-30 minutes of initial beta-agonist therapy, add ipratropium bromide 0.25 mg to the albuterol nebulization 1, 3
- For life-threatening exacerbations, consider continuous nebulization at 0.5 mg/kg/hour (8 mg/hour for this 16 kg child), up to a maximum of 10-15 mg/hour 1
Administration Technique
- Use oxygen as the driving gas whenever possible for nebulization 4
- If oxygen is unavailable, use an electrical compressor or compressed air 4
- Each treatment should be delivered over approximately 5-15 minutes 5
Critical Monitoring Parameters
- Assess clinical response after each treatment: respiratory rate, work of breathing, oxygen saturation 1
- Monitor for tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 1
- Watch for signs of impending respiratory failure: inability to speak, altered mental status, intercostal retraction, worsening fatigue 3
Common Pitfalls to Avoid
- Never underdose based on weight alone—always use the 2.5 mg minimum even if calculations suggest less 1
- Do not delay adding ipratropium in moderate-severe cases; it should be added at presentation, not after prolonged failed therapy 1
- Ensure adequate systemic corticosteroids are administered early (prednisone 1-2 mg/kg/day, maximum 60 mg/day) 3