Metabolic Acidosis in Status Asthmaticus

Aj, Roncoroni; Adrogué, H.J.A.; Obrutsky, Clara W. de; Marchisio, Maria L.; Herrera, Mariana

doi:10.1159/000193721

Cited by 55 publications

(22 citation statements)

References 23 publications

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“…In the report of McFadden and Lyons [1], metabolic acidosis was documented in 20.8 % of 24 episodes. Roncoroni and co-workers [10] found that simple or combined metabolic acidosis occurred in 37.9% of 103 episodes of acute asthma. In the latter study, arterial lactate levels were measured only in 27 patients with simple or combined metabolic acidosis and were always found to be elevated with a mean value of 4.16 mEq/1.…”

Section: Discussionmentioning

confidence: 99%

“…An increase in arterial blood lactate has been noticed either on admission or during the course of acute severe asthma (ASA) [8][9][10][11]. Hyperlactatemia has been suggested to be a marker of severity of ASA, predicting respiratory failure and the requirement for mechanical ventilation [9].…”

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%

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Hyperlactatemia during acute severe asthma

et al. 1998

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hyperlactatemia during acute severe asthma

et al. 1998

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“…In a prospective study7 of 18 patients with acute exacerbation of asthma, attending the emergency department, the change in lactate levels after administering 1200 µg of inhaled salbutamol over 120 min was assessed. Fifty per cent of patients had increased lactate levels of over 2.5 mmol/L, and were over 4 mmol/L in four of these.…”

Section: Discussionmentioning

confidence: 99%

Conundrum in an asthma exacerbation

et al. 2016

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A 66-year-old man, an asthmatic, presented with symptoms suggestive of an acute exacerbation of asthma. His arterial blood gas revealed type 1 respiratory failure (PaO2 <8 kPa or 60 mm Hg with normal or low PaCO2) with a compensated lactic acidosis. He was treated for an asthma exacerbation and sepsis. Despite treatment, his respiratory rate remained elevated although his hypoxaemia improved. There was progressive worsening of the lactic acidosis. Treatment for sepsis was augmented. Peak flow measurements were not used to assess the severity of his exacerbation nor his response to treatment. An alternate diagnosis of acute coronary syndrome with acute pulmonary oedema was made and his asthma treatment was stopped. This coincided with a decline in his serum lactate. A diagnosis of salbutamol-induced lactic acidosis (SILA) was made. SILA is a relatively common complication of salbutamol therapy in moderate/severe asthma exacerbations. It is caused by a mechanism different from the lactataemia that is associated with septic shock and life-threatening asthma.

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“…[1][2][3][4] A prevalence of 16-40% has been reported. 2 3 However, the condition has been infrequently studied in patients attending the emergency department (ED).…”

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confidence: 99%

Elevated plasma lactate level associated with high dose inhaled albuterol therapy in acute severe asthma

Rodrigo

Rodrigo²

2005

Emergency Medicine Journal

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Background: Lactic acidosis is a recognised event in adult patients with status asthmaticus, particularly in the setting of intensive care. However, it has been infrequently studied in patients attending the emergency departments (ED). Methods: We conducted a prospective and descriptive study to assess levels of lactate and effects on bronchodilator response in adult patients with acute severe asthma treated with high doses of albuterol in the ED. In total, 18 subjects (mean (SD) age 42.9 (2.7) years, FEV 1 = 32.2 (10.9)% of predicted) who presented to an emergency department were enrolled in the study. All patients were treated with albuterol; four puffs (100 mg/puff) at 10 minute intervals, delivered by a pressurised metered dose inhaler into a spacer device over a 2 hour period. Results: At the end of treatment, mean (SD) plasma lactate level (2.94 (2.1) mmol/l) was significantly higher (p = 0.001) than baseline. Of the 18 patients, nine (50%) showed lactate levels >2.5 mmol/l (four patients presented values .4 mmol/l); these patients had a shorter duration of attack prior to ED presentation (p = 0.01), a higher pretreatment heart rate (p = 0.005), a lower pretreatment SpO 2 (p = 0.03), a lower pretreatment PO 2 (p = 0.009), a higher pretreatment PCO 2 , and a lower pretreatment serum potassium (p = 0.005). However, there were no significant differences in the airway response between groups. Conclusions: This study confirmed previous observations that high lactate concentrations can develop during the first hours of inhaled beta agonist treatment. The presence of a previous hyperadrenergic state may predispose to the development of this condition. A significant improvement in lung function was associated with elevated lactate levels.

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Metabolic Acidosis in Status Asthmaticus

Cited by 55 publications

References 23 publications

Hyperlactatemia during acute severe asthma

Hyperlactatemia during acute severe asthma

Conundrum in an asthma exacerbation

Elevated plasma lactate level associated with high dose inhaled albuterol therapy in acute severe asthma

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