Management of Pediatric Salbutamol Overdose

Initial Assessment and Management

The American Society of Anesthesiologists recommends an ABC approach (Airway, Breathing, Circulation) with team-based care to accomplish multiple tasks simultaneously, and to remove any remaining medication and maintain airway patency, in pediatric patients with salbutamol overdose 1
High-flow oxygen should be administered if respiratory distress is present in pediatric patients with salbutamol overdose, as recommended by the Thorax society 2, 3
Baseline vital signs should be obtained with continuous cardiac monitoring, and intravenous access should be established for fluid administration and medication if needed, in pediatric patients with salbutamol overdose 1

The Anaesthesia society recommends monitoring vital signs frequently, with particular attention to heart rate and blood pressure, and elevating the patient's legs if hypotension develops, in pediatric patients with salbutamol overdose 1

The Thorax society recommends considering ipratropium bromide 250-500 μg via nebulizer for bronchospasm in pediatric patients with salbutamol overdose 3, 4
In severe cases with persistent bronchospasm, the Anaesthesia society recommends considering IV magnesium sulfate in pediatric patients with salbutamol overdose 1

The Thorax society recommends follow-up with a primary care provider within one week, and reviewing the asthma management plan if the overdose occurred in the context of poor symptom control, although the latter is also recommended by Praxis Medical Insights, the former is preferred 2, 6