[Metabolic acidosis in a context of acute severe asthma].
In a context of asthma, lactic acidosis may occur during beta2-agonist therapy. Several cases have been reported during its administration by intravenous and/or inhaled route. This side-effect seems rather unknown and the mechanism for compensation of metabolic acidosis by hyperventilation may worsen dyspnoea and mislead clinicians. Other causes of lactic acidosis such as a major hypoxemia, a cardiovascular collapse or sepsis may also be experienced in this context and must be ruled out before attributing the lactic acidosis to beta2-agonist treatment. We report the case of a 50-year-old man hospitalized for an acute major asthma, who received a salbutamol continuous infusion associated with inhaled terbutaline. A serum lactate level of 13 mmol/l was noted eight hours after the introduction of the bronchodilator treatment. After reducing doses of beta2-agonists, the evolution was favourable, regarding both respiratory and metabolic aspects, with a rapid decrease of the serum lactate level, which finally returned to normal level after 32 hours of hospitalization.
Chaulier
K
K
Département d'anesthésie-réanimation, pavillon P réanimation, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France. kevinchaulier@yahoo.fr
Chalumeau
S
S
Ber
C-E
CE
Bret
M
M
Rimmelé
T
T
D000140:Acidosis, Lactic / Q000139:chemically induced*; D000208:Acute Disease; D000420:Albuterol / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D013726:Terbutaline / Q000009:adverse effects* / Q000627:therapeutic use
D001993:Bronchodilator Agents; D013726:Terbutaline; D000420:Albuterol