Abstract

Asthma is a chronic inflammatory condition of the airways characterized by airflow obstruction, caused by bronchoconstriction, airway edema, acute inflammation and increased secretions, most commonly treated with albuterol. Albuterol functions by activating beta-2-adrenergic receptors on airway smooth muscles stimulating adenyl cyclase and increasing production of C-AMP causing relaxation of the smooth muscle and bronchodilation. It has been our observation that lactic acid levels tend to increase with the use of continuous albuterol treatments in pediatric patients. This phenomenon is important to recognize as a possible complication of albuterol treatment in patients with status asthmaticus. Not recognizing this association may lead to an escalation of therapy, by misinterpreting the condition as worsening respiratory distress, hypoxemia or volume depletion. Progression of therapy may ultimately lead to prolonged hospitalizations, mechanical ventilation and further increase in morbidity and mortality. In this case report, we discuss three pediatric patients in status asthmaticus, admitted to Florida Hospital Tampa-PICU and placed on continuous albuterol treatments, who in-spite of improvement of airflow exchange, bronchospasm and general condition and in the absence of clinical hypoxemia or hypovolemic shock, went on to develop metabolic acidosis with rising lactic acid levels. We graphed their lactic acid levels throughout their hospital course as a function of continuous albuterol treatments. We observed that weaning the patients off continuous albuterol treatments resulted in quick resolution of acidosis and continued clinical improvement of the patients, resulting in a timely discharge.

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