To the Editor:
Levalbuterol, the R-isomer of racemic albuterol, is a more effective bronchodilator with fewer side-effects than racemic albuterol 1–3. We present a paediatric patient in status asthmaticus who received twelve times the prescribed dose of levalbuterol and manifested only mild systemic side-effects.
This 4-yr-old African-American male was admitted to the Pediatric Intensive Care Unit (Portsmouth, VA, USA) where continuous nebulised levalbuterol was ordered at 0.63 mg·h−1. The nebuliser chamber was erroneously filled with twelve 0.63 mg unit-dose ampoules, delivering 7.56 mg·h−1 of levalbuterol. This dosing regimen was continued for twelve hours before it was discovered.
On the morning rounds, the child was noted to be tachypneic …