Albuterol Dosing for a 121 lb (55 kg) Child
For a child weighing 121 lb (55 kg), administer 2.5 mg of albuterol nebulizer solution (one full 3 mL vial of 0.083% solution) every 20 minutes for 3 doses, then every 1-4 hours as needed for acute exacerbations. 1
Weight-Based Dosing Calculation
- The standard weight-based dose for acute asthma exacerbations is 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses 1
- For this 55 kg child: 0.15 mg/kg × 55 kg = 8.25 mg per dose
- However, the practical maximum single nebulized dose is 2.5-5 mg per the guidelines, with 2.5 mg being the standard starting dose 1, 2
- For children weighing >20 kg, 5 mg per dose is appropriate for acute exacerbations 3
Recommended Dosing Protocol
For Acute Exacerbations (Emergency/Urgent Care):
- Initial treatment: 2.5-5 mg (one full vial) every 20 minutes for 3 doses 1
- Maintenance: 2.5-5 mg every 1-4 hours as needed based on clinical response 1
- Severe exacerbations: May escalate to 0.15-0.3 mg/kg (up to 10 mg) every 1-4 hours 1
For Routine Maintenance (Non-Acute):
- 2.5 mg administered 3-4 times daily by nebulization 2
Administration Guidelines
- Dilution: Administer the entire 3 mL vial; if using concentrated solution, dilute to a minimum of 3 mL with normal saline 1
- Flow rate: Use oxygen at 6-8 L/min for optimal nebulizer delivery 1, 4
- Duration: Treatment should deliver over approximately 5-15 minutes 2
- Gas source: Oxygen is the preferred gas source for nebulization 1, 5
Alternative: Metered-Dose Inhaler (MDI)
If MDI with spacer is preferred (equally effective in mild-to-moderate exacerbations):
- Acute treatment: 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- A spacer/holding chamber must be used for optimal delivery 1
Critical Monitoring Parameters
- Heart rate and rhythm: Watch for tachycardia 1
- Respiratory rate and work of breathing 3
- Oxygen saturation: Maintain >92% during treatment 3
- Clinical response: Reassess 15-30 minutes after each dose 3
- Side effects: Monitor for tremor, hypokalemia, hyperglycemia 1, 5
Important Clinical Pitfalls to Avoid
Do not underdose based on the 2.5 mg vial size: While the weight-based calculation suggests 8.25 mg, the standard practice is to use 2.5-5 mg per dose rather than attempting to measure out exact weight-based amounts from multiple vials 1, 2. For this weight category (>20 kg), 5 mg per dose is appropriate for acute exacerbations 3.
Consider adding ipratropium bromide (0.5 mg) to the nebulizer for severe exacerbations during the first 3 hours of treatment, as this combination provides superior bronchodilation 1, 5.
Escalate to continuous nebulization (0.5 mg/kg/hour, maximum 10-15 mg/hour) if the patient shows inadequate response to intermittent dosing 1. For this 55 kg child, continuous nebulization would be capped at the 10-15 mg/hour maximum 1.
Avoid oral albuterol formulations: Inhaled delivery provides superior bronchodilation with fewer systemic side effects compared to oral syrup 5, 3.