Pulmonary Physiology: Fellow Case Report Poster - Pulmonary Physiology |

Severe Lactic Acidosis in an Asthmatic Receiving Extended Beta Agonist Therapy FREE TO VIEW

John Kern, DO; Yuriy Takhalov, MD; Corinne Kern, PA-C; Andrew Berman, MD
Author and Funding Information

Rutgers University - NJMS, Oceanport, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1110A. doi:10.1016/j.chest.2016.08.1218
Text Size: A A A
Published online

SESSION TITLE: Fellow Case Report Poster - Pulmonary Physiology

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Asthma attacks are potentially life threatening medical emergencies requiring aggressive care including the use of beta-2 agonists, which in rare cases have been associated with a type B lactic acidosis.

CASE PRESENTATION: A 37 year old African American woman with a past medical history of asthma presented with a two day history of shortness of breath, fevers and productive cough. On physical examination she was found to be in moderate respiratory distress with diffuse bilateral expiratory wheezes and tachypnea. Treatment with non-invasive positive pressure ventilation was initiated and the patient was given a combination of nebulized albuterol and ipratropium followed by prednisone. Following initial treatment she remained tachypneic and was subsequently administered 13 additional treatments. Despite intervention she remained tachypneic. An arterial blood gas demonstrated a worsening metabolic acidosis with a corresponding lactate of 11.4 mEq/L. Given that the lactic acidosis appeared following initiation of beta agonist therapy further nebulizer treatments were discontinued. Following discontinuation patient’s tachypnea improved and the lactic acidosis trended down to normal over the next 12 hours.

DISCUSSION: Beta agonist therapy has long been a standard therapeutic intervention for acute asthma exacerbations. In severe cases multiple beta agonist treatments may be required, increasing the potential of inducing a type B lactic acidosis[1,2]. The mechanism for the lactic acidosis is attributed to an increase in pyruvate production as well as inhibition of pyruvate oxidation leading to increased lactate production[1]. Several reports have also attributed a component of the lactic acidosis to smooth muscle contraction and diaphragmatic fatigue[2]. The increasing metabolic derangement results in worsening tachypnea as a compensatory mechanism. This creates a diagnostic challenge as tachypnea can be a sign of worsening asthma exacerbation potentially prompting clinicians to pursue further beta agonist therapy. Most of the cases reviewed demonstrated the development of lactic acidosis in patients who have received prolonged or multiple nebulized beta agonist treatments. The acidosis generally resolves within 24-48 hours, and in many cases within as little as 3 hours, of cessation of beta agonist therapy[1,2].

CONCLUSIONS: As metabolic derangements are often present in severe asthma exacerbation, patients with increased tachypnea despite beta agonist therapy often present a diagnostic challenge. It is important, therefore, to recognize Type B lactic acidosis from beta agonist therapy as a possible source of worsening tachypnea and metabolic acidosis.

Reference #1: Moustafa F et al. Lactic acidosis after inhaled beta-2 agonists: about 2 cases. Ann Fr Anesth Reanim. 2014 Jan;33(1):49-51.

Reference #2: Bohn D. Metabolic acidosis in severe asthma: Is it the disease or is it the doctor? Pediatr Crit Care Med. 2007 Nov;8(6):582-3.

DISCLOSURE: The following authors have nothing to disclose: John Kern, Yuriy Takhalov, Corinne Kern, Andrew Berman

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543