Acid-Base Disturbances in Acute Asthma

Mountain, Richard D.; Heffner, John E.; Brackett, Newton C.; Sahn, Steven A.

doi:10.1378/chest.98.3.651

Cited by 82 publications

(40 citation statements)

References 17 publications

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“…58 Sicker patients often have a mixed respiratory and metabolic acidosis. 59 Lactic acidosis reflects a combination of excess production from respiratory muscles, tissue hypoxia (due to hypoxemia and decreased cardiac output), and dehydration (due to decreased intake and increased insensible losses). 60 The decision to intubate a child with severe acute asthma should be based on the child's clinical status and not simply the arterial blood gas values.…”

Section: Arterial Blood Gasmentioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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Section: Arterial Blood Gasmentioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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“…When airway obstruction is more severe or prolonged, respiratory acidosis may develop. Metabolic acidosis has been reported in acute severe asthma [2] and two types of metabolic acidosis have been described: renal loss of bicarbonate as a renal compensatory response to a preceding period of hypercapnia due to a prolonged period of hyperventilation and lactic acidosis [3].…”

Section: Introductionmentioning

confidence: 99%

“…Hyperlactatemia has been suggested to be a marker of severity of ASA, predicting respiratory failure and the requirement for mechanical ventilation [9]. However, hyperlactatemia in ASA has only been reported in retrospective studies [2,[8][9][10]. The incidence of arterial hyperlactatemia in ASA and its prognostic value are not well known.…”

Section: Introductionmentioning

confidence: 99%

Hyperlactatemia during acute severe asthma

et al. 1998

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“…The other common diagnoses included an exacerbation of COPD/asthma, ARF, AHF, malignancies, DKA, sepsis and PE. In cases of pneumonia and exacerbation of COPD/asthma, the most common causes of ABD included respiratory acidosis resulting from hypercarbia, metabolic acidosis due to other underlying pathologies, compensatory metabolic alkalosis that develops in response to respiratory acidosis, and MABD (particularly mixed MRAC) (20,(23)(24)(25)(26). ABDs, specifically metabolic acidosis and metabolic alkalosis secondary to hypoalbuminemia, are considered common in patients with ARF (14,27).…”

Section: Discussionmentioning

confidence: 99%

Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes

Köse¹,

Armağan²,

Öner³

et al. 2014

JAEM

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Objective: Acid-base disorders (ABDs) are usually correlated with high rates of morbidity and mortality. The objective of this study was to analyze the causes, outcomes, types and incidences of ABDs in patients presenting at the emergency department (ED). Material and Methods:We prospectively analyzed data from patients who presented between January 2011 and May 2011. Data on age, gender, chief complaint, and diagnosis in the ED were collected for ABD cases.Results: Of the 736 cases with an ABD, 173 patients (23.5%) had simple ABD and 563 patients (76.5%) had mixed ABD. The most common ABD was a mixed metabolic acidosis and respiratory alkalosis (MACRAL) (n=408, 55.4%). All ABD types were most commonly observed in patients over 65 years of age. Dyspnea was the most common complaint among ABD patients who presented at the ED (44.4%). In cases of ABD, pneumonia was the most common diagnosis (16.3%). Of the ABD cases, 379 patients (51.6%) were discharged, while 318 patients (43.2%) were hospitalized. Death was more commonly observed in cases with mixed metabolic and respiratory acidosis (MRAC) (n=6) and MACRAL (n=11). Conclusion:ABDs are quite common in patients presenting at the ED, especially among patients in a critical condition (71%). Mixed MACRAL was the most commonly noted ABD. Dyspnea and pneumonia were the most common diagnoses in ABD patients. Mortality was more common in cases with a mixed MRAC and MACRAL. This knowledge may provide important information concerning the diagnosis, treatment and early prognosis of patients. (JAEM 2014; 13: 4-9)

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Acid-Base Disturbances in Acute Asthma

Cited by 82 publications

References 17 publications

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Hyperlactatemia during acute severe asthma

Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes

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