title: Inhaled β-agonist therapy and respiratory muscle fatigue as under-recognised causes of lactic acidosis.
abstract: A 49-year-old man with chronic obstructive pulmonary disease (COPD) presented with significant tachypnoea, fevers, productive cough and increased work of breathing for the previous 4 days. Laboratory data showed elevated lactate of 3.2 mEq/L. Continuous inhaled ipratropium and albuterol nebuliser treatments were administered. Lactate levels increased to 5.5 and 3.9 mEq/L, at 6 and 12 h, respectively. No infectious source was found and the lactic acidosis cleared as the patient improved. The lactic acidosis was determined to be secondary to respiratory muscle fatigue and inhaled β-agonist therapy, two under-recognised causes of lactic acidosis in patients presenting with respiratory distress. Lactic acidosis is commonly used as a clinical marker for sepsis and shock, but in the absence of tissue hypoperfusion and severe hypoxia, alternative aetiologies for elevated levels should be sought to avoid unnecessary and potentially harmful medical interventions.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Lau
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Mazer
authors.forename: Gerardo
authors.initials: G
authors.lastname: Carino
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology*; D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000420:Albuterol / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D018763:Muscle Fatigue / Q000187:drug effects / Q000528:radiation effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000503:physiopathology; D012132:Respiratory Muscles / Q000503:physiopathology
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000420:Albuterol