Najout Hamza, Moutawakil Mohamed, Elkoundi Abdelghafour, Doghmi Nawfal, Bekkali Hicham
Anesthesia and Critical Care Department, Mohamed V Military Training Hospital, Rabat, Morocco.
SAGE Open Med Case Rep. 2020 Oct 28;8:2050313X20969027. doi: 10.1177/2050313X20969027. eCollection 2020.
Selective beta-adrenoceptor agonists are worldwide prescribed to manage bronchial obstruction. However, they expose to a potential risk of hyperlactatemia and lactic acidosis even with normal doses. The mechanism still poorly understood and suggested that salbutamol diverts the metabolism of pyruvate acid from Krebs cycle toward lactate formation. We report the case of a 42-year-old patient, admitted to intensive care unit for acute severe asthma. He presented a transient lactic acidosis over the first 48 h, following an excessive use of salbutamol. The metabolic acidosis caused tachypnea, as a compensatory mechanism, leading to respiratory failure. The diagnosis of salbutamol-induced lactic acidosis must be made by elimination and only accepted after deleting the other causes. The main clinical character is the worsening of dyspnea despite regression of bronchospasm. It is transient and usually normalizes within 24-48 h after stopping or decreasing doses of salbutamol.
选择性β-肾上腺素能受体激动剂在全球范围内被用于治疗支气管阻塞。然而，即使使用正常剂量，它们也存在高乳酸血症和乳酸酸中毒的潜在风险。其机制仍知之甚少，有人认为沙丁胺醇会使丙酮酸的代谢从 Krebs 循环转向乳酸生成。我们报告了一例 42 岁的患者，因急性重症哮喘入住重症监护病房。在过量使用沙丁胺醇后，他在最初的 48 小时内出现了短暂的乳酸酸中毒。代谢性酸中毒导致呼吸急促，作为一种代偿机制，进而导致呼吸衰竭。沙丁胺醇诱发的乳酸酸中毒必须通过排除法诊断，且只有在排除其他病因后才能确诊。主要临床特征是尽管支气管痉挛有所缓解，但呼吸困难仍加重。这种情况是短暂的，通常在停用或减少沙丁胺醇剂量后 24 - 48 小时内恢复正常。
