Salbetomon indications mechanism contradiction how to give and how to dilute
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salbutamol AND administration
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salbutamol sulfate prescribing information nebulizer dilution IV contraindications administration
Assuming you mean salbutamol (albuterol).
What it is and mechanism
A short-acting beta-2 agonist (SABA) bronchodilator. It stimulates beta-2 receptors in airway smooth muscle, increasing cAMP and causing rapid airway relaxation. It usually starts working within about 5 minutes and lasts 4 to 6 hours. It can also shift potassium into cells, so it is sometimes used as an adjunct in hyperkalaemia.
Indications
- Relief of acute bronchospasm or wheeze in asthma
- COPD with reversible bronchospasm
- Prevention of exercise-induced bronchospasm
- Acute severe asthma, given repeatedly or continuously under clinical monitoring
- Adjunct for hyperkalaemia, using a hospital protocol
It relieves bronchospasm but does not treat airway inflammation. Frequent need for it suggests uncontrolled asthma and need for controller treatment review.
Contraindications and important cautions
Absolute contraindication
- Known hypersensitivity/allergy to salbutamol or a product ingredient
Use carefully and monitor in
- Tachyarrhythmia, ischemic heart disease, heart failure, or uncontrolled hypertension
- Hyperthyroidism
- Diabetes, since it may raise glucose
- Existing hypokalaemia or patients on diuretics, corticosteroids, or xanthines, since high doses may lower potassium
- Phaeochromocytoma
- Concomitant non-selective beta-blockers, such as propranolol, which can block its effect and provoke bronchospasm
Stop and urgently assess if it causes paradoxical bronchospasm: breathing becomes suddenly worse immediately after the dose.
Common adverse effects: tremor, palpitations, tachycardia, headache, anxiety, muscle cramps. High or repeated nebulised doses can cause hypokalaemia and lactic acidosis.
How to give it
1. Metered-dose inhaler (preferred for most mild to moderate attacks)
- Use with a spacer.
- Shake inhaler, attach spacer, exhale fully, press one puff into spacer, then inhale slowly and deeply. Hold breath for about 10 seconds if able.
- If another puff is prescribed, wait about 30 to 60 seconds.
- Do not dilute an inhaler.
For most patients with an asthma flare, inhaler plus spacer works at least as well as nebulisation when used correctly, and is often quicker with fewer adverse effects.
2. Nebuliser solution
Use only by inhalation through an appropriate nebuliser. Do not inject or swallow it.
The exact volume depends on the product concentration, commonly either:
- Ready-made unit-dose nebules, or
- Concentrated solution, such as 5 mg/mL
For a commonly used 5 mg/mL concentrated solution:
- 2.5 mg = 0.5 mL
- 5 mg = 1 mL
Add sterile 0.9% sodium chloride only to make the nebuliser chamber’s required fill volume, commonly 2 to 4 mL total. For example:
| Prescribed salbutamol dose | If concentration is 5 mg/mL | Dilute with 0.9% saline to total |
|---|---|---|
| 2.5 mg | 0.5 mL | 2 to 4 mL |
| 5 mg | 1 mL | 2 to 4 mL |
Some ready-to-use nebules may be administered undiluted. Whether dilution is needed depends on the nebuliser’s minimum operating volume and the specific product label. The MSF nebuliser guidance advises using normal saline to reach a 4 mL chamber volume when necessary; the product information states prolonged nebulisation can be diluted with sterile normal saline.
3. Continuous nebulisation or IV salbutamol
These are hospital-only treatments for severe or life-threatening bronchospasm, with ECG, pulse, oxygen saturation, potassium, and glucose monitoring. IV preparation and dilution vary by local protocol and formulation. Do not attempt to prepare or administer IV salbutamol from a nebuliser product.
Seek urgent emergency care now if
- Severe breathlessness, inability to speak full sentences, cyanosis, drowsiness/confusion
- Chest pain, fainting, marked palpitations
- No improvement after prescribed reliever treatment, or worsening soon after using it
Before giving a dose, verify the exact product label: inhaler, nebule, or 5 mg/mL respirator solution. The dilution is different for each.
[25/09, 12:07 pm] Salman Soub: Methyl [25/09, 12:07 pm] Salman Soub: Prednisolone [25/09, 12:07 pm] Salman Soub: Mechanism indications contraindications how to give how munch dilute dose
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systemic corticosteroids asthma exacerbation
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methylprednisolone sodium succinate prescribing information reconstitution dilution prednisolone dose asthma exacerbation
“Methyl” usually means methylprednisolone. Both methylprednisolone and prednisolone are systemic corticosteroids. They are not rescue bronchodilators like salbutamol. In acute asthma or COPD exacerbation, they reduce airway inflammation and relapse risk, but their effect takes several hours.
Mechanism
They enter cells and bind glucocorticoid receptors, altering gene transcription. This:
- Reduces inflammatory-cell activity and cytokines
- Decreases mucosal oedema and mucus production
- Improves responsiveness to beta-2 agonists such as salbutamol
Main indications
- Moderate to severe asthma exacerbation
- COPD exacerbation
- Severe allergic/inflammatory conditions
- Autoimmune disorders, depending on the regimen
- Some neurologic, renal, rheumatologic, and haematologic indications
Contraindications and cautions
There are few absolute contraindications when treating a life-threatening asthma attack, but use cautiously in:
- Untreated systemic fungal infection
- Known serious hypersensitivity to the product
- Active or suspected untreated tuberculosis, strongyloides infection, or varicella exposure
- Diabetes or uncontrolled hyperglycaemia
- Peptic ulcer disease or gastrointestinal bleeding
- Severe hypertension, heart failure
- Acute psychosis or severe mood disorder
- Concurrent live vaccines with immunosuppressive doses
Monitor blood glucose, blood pressure, mental status, infection signs, and potassium where clinically relevant. Avoid abruptly stopping a prolonged course due to adrenal suppression. A short burst of under about 1 week usually does not need tapering.
1. Prednisolone
Route
Usually oral tablet or oral liquid.
Acute asthma dose
Adults: prednisolone 40-50 mg orally once daily, generally for 5-7 days.
Children: 1-2 mg/kg/day orally, maximum often 40 mg/day depending on local protocol, generally for 3-5 days.
Give with food, preferably in the morning.
Dilution
- Tablets: do not dilute. Swallow with water.
- Oral liquid: usually ready to use. Do not dilute unless the product label or pharmacy directs it.
- Prednisolone should not be confused with injectable methylprednisolone.
2. Methylprednisolone
Route and formulation
- Oral tablets: methylprednisolone tablets
- IV or IM: use methylprednisolone sodium succinate such as Solu-Medrol
- Do not give methylprednisolone acetate suspension, such as Depo-Medrol, IV.
Acute asthma dose
If the patient cannot take oral prednisolone or has severe asthma:
Adult: methylprednisolone 40-80 mg IV per day, as a single dose or divided doses, based on local emergency protocol.
Child: 1-2 mg/kg/day IV/IM, usually divided, maximum commonly 60 mg/day for standard acute asthma treatment. Severe status asthmaticus protocols may differ and need senior/ICU oversight.
For an acute asthma attack, oral prednisolone is usually preferred if the person can swallow and absorb it. IV methylprednisolone is not routinely “stronger” than a suitable oral steroid dose.
Reconstitution and dilution of IV methylprednisolone sodium succinate
Check the vial label first. Reconstitution volumes vary by manufacturer and vial strength.
Common examples after reconstitution:
- 40 mg vial: often yields 40 mg/mL
- 125 mg vial: often yields 125 mg in 2 mL = 62.5 mg/mL
- 500 mg vial: label-specific concentration after adding the supplied/recommended diluent
Use sterile water for injection or the supplied diluent for reconstitution exactly as stated on that vial. For IV infusion, the reconstituted medicine may be further diluted in a compatible IV fluid, commonly 0.9% sodium chloride or 5% dextrose, according to hospital policy.
For a standard low-dose IV administration, many protocols allow slow IV injection over several minutes. Large doses should be infused, not pushed rapidly. The DailyMed product information lists formulation-specific reconstitution details, and the CHEO IV monograph gives examples of infusion concentrations and administration times.
Important practical point
Do not calculate an injection volume from the drug name alone. First confirm:
- Patient age and weight
- Diagnosis and intended steroid dose
- Exact vial strength and final concentration after reconstitution
- IV versus IM route
- Local hospital dilution and infusion policy
For asthma, systemic steroids should be given early alongside salbutamol, but they do not replace oxygen, inhaled bronchodilator treatment, monitoring, or escalation for severe respiratory distress.
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