Kerala State Drug Formulary.pdf

Paediatrics
5. fatigue and exhaustion,
6. reduced level of consciousness,
7. silent chest on auscultation, cyanosis,
8. sudden onset of bradycardia and poor respiratory effort are all
indicative of life threatening asthma.Inhaled beta2 agonist is the
drug of choice.
a) Beta2 agonists-salbutamol/ terbutaline, preferably
using a Nebuliser.Dilute 0.5 mL (2.5mg) salbutamol
respirator solution with 4 mL normal saline and place
it in the nebulization chamber. Using pressurised air
or oxygen the solution can be nebulized into fine
particles which the child inhales using a mask or mouth
piece. Repeat nebulisation 4-6 hrly or earlier as
needed.
b) In small children the dose is calculated as 150 mcg/
kg/dose of salbutamol respirator solution diluted with
10 times volume of normal saline and then nebulised.
c) lf a nebulizer is not available a metered dose inhaler
can be used in a dose of 2 puffs of salbutamol every 4
to 6 hour or earlier.A volumatic spacer or a plastic
cup can be used for administering the drug in small
children.
d) Parenteral dose is 5mcg/kg of terbutaline/dose every
6 th hrly SC or it can be given as a bolus dose diluted
followed by an IV. infusion at a rate of 0.1 g/kg/minute
of terbutaline, increasing 0.1 mcg/kg every 15 minutes
to a maximum of 4 mcg/kg/minute.
e) Anticholinergic drug like Ipratropium bromide 0.5ml-
1mL(125-250mcg) can be added to salbutamol nebulizer
solution and the nebulized every 4-6 hrly in severe
cases.
f) Aminophylline. bolus dose of 6 mg/kg/diluted IV very
slowly followed by an infusion of 0.7-0.9 mg/kg/h. Give
only 3 mg/kg as bolus if child is already on theophylline
or omit the bolus dose.
g) Hydrocortisone 5 to 10 mg/kg/dose. Repeat 4 to 6
hrly or earlier in severe cases.
427