Lactic acidosis in children with acute exacerbation of severe asthma

Abstract

This is a retrospective case series reporting lactic acidosis in four pediatric patients with acute severe asthma treated with nebulized beta2-agonists in a pediatric intensive care unit of a tertiary care teaching facility. During treatment with beta2-agonists, these patients developed lactic acidosis with a peak concentration of 5.2 to 13 mmol/l. Lactic acidosis improved within 24 h after discontinuation or decrease in the dosage of beta2-agonists. We conclude that the intensive use of beta2-agonists for acute severe asthma in children may be the primary and significant cause of lactic acidosis.

Takotsubo cardiomyopathy

“…Beta-agonists, including salbutamol, are known to raise serum lactate levels. This is well described beyond the reports cited by the authors [2][3][4][5][6]. In septic shock, hyperglycaemia and hyperlactaemia are common, due, in part, to sympathomimetic agents.…”

“…These more detailed data might provide some explanations for any significant differences in outcome between ICUs. [2]. It should also be mentioned that not only is there a significantly greater incidence in women, but that the vast majority of these women are postmenopausal, as was the patient in Bennett and colleagues' article.…”

“…Of the survivors, 62 (85.7%) returned to their normal residence. We have previously published data on outcomes for these patients up until 2004 [2]. A recent study from Canada reported that 537 (36.4%) of 1474 patients admitted to ICU after out-ofhospital cardiac arrest survived to hospital discharge [3].…”

Cardiotoxicodynamics

“…Metabolic acidosis can be observed in both methylxanthines and b 2 -agonist toxicity and can occur without hypoxia, shock, or seizures. 46,[67][68][69] Increased muscular activity, seizures, and increased basal metabolic rate may result in hyperthermia, rhabdomyolysis, and renal failure. 70,71 Hyperglycemia and leukocytosis are also common but rarely of consequence.…”

The Importance of the Ionic Product for Water to Understand the Physiology of the Acid-Base Balance in Humans

“…Unlike patients with chronic pulmonary disorders, patients with acute respiratory failure tend to display more acidic plasma pH in some studies [96], but plasma acidosis in these patients is likely related to metabolic causes of acidosis, such as L-lactic acidosis due to β 2 -adrenergic agonists and the increasing rate and depth of breathing in patients with acute respiratory failure may represent compensatory hyperventilation to metabolic acidosis rather than worsening airway obstruction [97, 98]. …”