Epinephrine Causes Severe Lactic Acidosis in a Patient With Shellfish-Induced Anaphylaxis

Xue, Ji-ke; Mannem, Seetharam; jandeel, A Al; Ruvo, a; Levi, Daniela

doi:10.1016/j.chest.2020.05.008

Cited by 3 publications

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“…This adrenergic drive is probably the cause of hyperlactatemia in early phases of shock, when organism stress reactions and endogenous catecholamine release compensate for hypotension. In line with this theory, lactate elevation has been repeatedly observed after exogenous epinephrine administration [19,20]. Therefore, hyperlactatemia may be perceived mainly as a valuable marker of cellular stress response and an early warning sign of compensated shock, similar to sinus tachycardia.…”

Section: Main Textmentioning

confidence: 90%

Lactate: The Fallacy of Oversimplification

Müller,

Radej,

Horak

et al. 2023

Biomedicines

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Almost a quarter of a millennium after the discovery of an acidic substance in sour milk by Swedish chemist Carl Wilhelm Scheele and more than 100 years after the demonstration of a tight connection between this lactic acid and tissue hypoxia in shock, we are still surrounded by false beliefs and misunderstandings regarding this fascinating molecule. Common perceptions of lactate, the conjugate base of lactic acid, as a plain waste product of anaerobic metabolism and a marker of cellular distress could not be further from the truth. Lactate is formed and utilized continuously by our cells, even under fully aerobic conditions, in large quantities, and although marked hyperlactatemia is always a red flag in our patients, not all these conditions are life-threatening and vice versa—not all critically ill patients have hyperlactatemia. Lactate also does not promote acidosis by itself; it is not toxic, nor is it a metabolic renegade. On the contrary, it has many beneficial properties, and an interpretation of hyperlactatemia might be trickier than we tend to think. The aim of this article is to debunk some of the deeply rooted myths regarding this fascinating molecule.

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Section: Main Textmentioning

confidence: 90%

Lactate: The Fallacy of Oversimplification

Müller,

Radej,

Horak

et al. 2023

Biomedicines

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“…The immediate administration of epinephrine is essential, aiming to prevent potentially fatal delays. [6][7][8] Epinephrine activated adrenergic receptors, promoting vasoconstriction, improved cardiac output, and bronchodilation. [9] In cases of severe anaphylaxis with persistent hypotension, continuous epinephrine infusion may be necessary.…”

Section: Discussionmentioning

confidence: 99%

Epinephrine induced lactic acidosis during the management of anaphylactic shock: a case report

Oh,

Chung,

Park

et al. 2024

Clin Exp Emerg Med

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In a case of contrast media-induced anaphylactic shock managed with epinephrine, a 57-year-old male developed lactic acidosis without cardiogenic shock or global hypoperfusion, highlighting epinephrine's potential to trigger lactic acidosis. Despite previous management of similar reactions with antihistamines and corticosteroids, this case required intensive care unit admission and emergency intervention, with lactate levels peaking alarmingly. The rapid resolution of acidosis following epinephrine discontinuation underscores the need for careful monitoring and the consideration of alternative vasopressor strategies in severe anaphylaxis, illustrating the complex relationship between epinephrine's metabolic effects and anaphylaxis-induced tissue hypoperfusion.

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Epinephrine

2020

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Epinephrine Causes Severe Lactic Acidosis in a Patient With Shellfish-Induced Anaphylaxis

Cited by 3 publications

References 0 publications

Lactate: The Fallacy of Oversimplification

Lactate: The Fallacy of Oversimplification

Epinephrine induced lactic acidosis during the management of anaphylactic shock: a case report

Epinephrine

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