Albuterol Nebulization: Unraveling the Risk of Lactic Acidosis in Continuous Therapy

Abstract Lactic acidosis (LA) is a significant metabolic disturbance marked by the increased accumulation of lactic acid due to either increased production or decreased clearance. It is distinguishable into two forms: type A, which results from tissue hypoperfusion or hypoxia, and type B, which arises from various other causes unrelated to hypoperfusion. While type A LA is the most common, the incidence of type B LA is rising as more causes are identified. This presentation focuses on a patient with Albuterol-induced type B LA. A 64-year-old woman with morbid obesity, severe persistent asthma, environmental allergies and obstructive sleep apnea is maintained on inhaled steroids and long-acting beta-2-agonists with good clinical control. However, her asthma symptoms worsened after exposure to the Canadian wildfires in 2023. In January 2024, she contracted COVID-19 and required hospitalization for asthma exacerbation. As a result, Montelukast was added. One month later, she presented with a one day history of shortness of breath and wheezing after exposure to automobile exhaust at home. She was subsequently admitted to the ICU and required BiPAP therapy in addition to albuterol nebulizer, magnesium, and steroids. The initial ABG was with a pH of 7.27 and a CO2 49 mEq/L. At this time, her bicarbonate was 22 mEq/L. Two hours later, a repeat blood gas revealed improvement in CO2 to 40 mEq/L but reduction in the bicarbonate to 18 mEq/L. After another two hours, her bicarbonate was at 14 mEq/L. One hour later, there was development of an increased anion gap of 22 mEq/L and a lactic acid level of 9 mmol/L. Upon chart review, the patient had received a one time Albuterol/Ipratropium bromide nebulization in the ER and an additional 20 mg of Albuterol, continuous nebulizer before the lactic acid was checked. After discontinuation of Albuterol, lactic acid was serially checked and returned to normal the next morning. This case illustrates the potential for severe LA with the use of Albuterol and the importance of a complete history and chart review. In addition, it highlights the various causes of lactic acidosis in the absence of hypoperfusion and how critical it is for healthcare providers to determine the primary cause so that treatment can be individualized. Given the potential severity, obtaining laboratory data can be an important screening tool that can be used to closely monitor and potentially prevent the development of LA.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.