Albuterol Dosing for a 130-lb (59 kg) Child
For a 130-lb (59 kg) child with acute asthma exacerbation, administer albuterol 2.5 mg via nebulizer every 20 minutes for 3 doses during the first hour, then continue every 1–4 hours as needed based on clinical response. 1
Weight-Based Dosing Calculation
- The weight-based dose is 0.15 mg/kg × 59 kg = 8.85 mg per dose 1, 2
- However, the standard adult dose of 2.5–5 mg applies to children weighing ≥15 kg (33 lb), and your patient at 59 kg falls well into this range 3
- The FDA-approved dosing for children ≥15 kg is 2.5 mg administered 3–4 times daily for maintenance therapy 3
Acute Exacerbation Protocol
Initial treatment (first hour):
- Administer 2.5 mg every 20 minutes for 3 consecutive doses 1, 2
- For severe exacerbations, you may use 5 mg every 20 minutes for 3 doses 1
- Dilute each dose in at least 3 mL normal saline and deliver at 6–8 L/min gas flow 1
Maintenance phase (after first hour):
- Continue 2.5–5 mg every 1–4 hours as needed, adjusting the interval based on symptom severity and clinical response 1, 3
- Select the specific interval (1,2,3, or 4 hours) according to ongoing symptoms 1
Severe or Refractory Cases
- For life-threatening exacerbations or inadequate response to intermittent dosing, consider continuous nebulization at 0.5 mg/kg/hour (approximately 30 mg/hour for this 59 kg child) 1
- Add ipratropium bromide 0.5 mg to each of the first 3 albuterol doses for moderate-to-severe exacerbations 1
- Initiate systemic corticosteroids early (prednisone 1–2 mg/kg/day, maximum 60 mg/day) 1
Alternative Delivery Method
- MDI with spacer delivering 4–8 puffs (360–720 mcg) every 20 minutes for 3 doses is equally effective as nebulization for mild-to-moderate exacerbations when proper technique is used 1
- This portable alternative is appropriate when nebulizers are unavailable 1
Critical Monitoring Points
- Watch for tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 1, 3
- Monitor for signs of impending respiratory failure: inability to speak, altered mental status, intercostal retractions, worsening fatigue 1
- Reassess clinical response, physical findings, and lung function after each treatment cycle 1
Common Pitfall to Avoid
Do not use the full weight-based calculation of 8.85 mg per dose. While the 0.15 mg/kg formula is appropriate for younger children to ensure they receive adequate dosing, older children and adolescents weighing ≥15 kg follow standard adult dosing of 2.5–5 mg 3. Using 8.85 mg would represent excessive dosing without established benefit and would increase the risk of cardiovascular side effects 3. The FDA labeling explicitly states that 2.5 mg is the usual dose for children weighing ≥15 kg 3, and guideline evidence supports 2.5–5 mg for this age and weight range 4, 1.