A case of life-threatening lactic acidosis after smoke inhalation - interference between beta-adrenergic agents and ethanol?
A 49-year-old male developed bronchospasm and severe lactic acidosis after exposition to fire smoke. The correction of lactic acidosis following beta-adrenergic agents withdrawal, and the transitory increase in lactate after salbutamol reintroduction are consistent with hypersensitivity to salbutamol. However, the plasma lactate concentration (32.6 mmol/l) that we observed 9.5 h after admission is far above those currently seen after administration of beta-adrenergic agents. We searched for causes able to potentiate the adverse effects of these drugs and we noticed that our patient had a high plasma ethanol level (2.4 g/l). Alcohol metabolism in the liver results in generation of high NADH/NAD+ ratios, thus reducing lactate liver clearance. This observation suggests that plasma lactate levels should be monitored closely in alcoholic patients treated with beta-mimetic agents.
Taboulet
P
P
Hopital Fernand Widal, Reanimation Toxicologique, Universite Paris, France.
Clemessy
J L
JL
Freminet
A
A
Baud
F J
FJ
D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced*; D000318:Adrenergic beta-Agonists / Q000009:adverse effects*; D000420:Albuterol / Q000009:adverse effects*; D000435:Alcoholic Intoxication / Q000097:blood / Q000150:complications*; D000437:Alcoholism / Q000097:blood / Q000150:complications; D001986:Bronchial Spasm / Q000188:drug therapy* / Q000209:etiology; D001993:Bronchodilator Agents / Q000494:pharmacology; D004357:Drug Synergism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015208:Smoke Inhalation Injury / Q000150:complications* / Q000628:therapy; D013806:Theophylline / Q000494:pharmacology
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D013806:Theophylline; D000420:Albuterol