P538 Increased serum lactate levels associated with beta-2 agonist use in paediatric patients with acute respiratory conditions. (June 2019)

• Record Type: Journal Article
• Authors: Travers, John; Elnazir, Basil
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 3
• Page Start: A368
• Page End: A369
• Publication Date: 2019-06
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-epa.872
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Introduction: Beta-2 agonist use has been hypothesised to lead to increased lactate by the following mechanism: Increased lipolysis and free fatty acids from beta-adrenergic receptor stimulation inhibit Kreb's cycle conversion of pyruvate. Resultant elevated pyruvate is metabolised by anaerobic glycolysis, increasing lactate. 1 There are few case reports of raised lactate from beta-2 agonist treatment. We set out to identify any association of beta-2 agonist use and serum lactate levels in paediatric patients treated for acute respiratory conditions. Methods: We recorded the frequency of administering 2.5 mg nebulised salbutamol and subsequent serum lactate levels for paediatric patients who presented to a hospital emergency department with respiratory distress and were referred to the respiratory specialist team over a 4 week period. Lactate levels were measured by arterial blood gas analysis within 2 hours of treatment. We also recorded age, gender and diagnosis. Results: 27 patients were admitted under respiratory team care following initial management, including salbutamol treatment, during the 4 week period. Mean age was 16 months and 46% were female. Conditions were diagnosed as bronchiolitis, lower respiratory tract infections, viral induced wheeze or exacerbations of asthma. 27% of patients had received three doses back-to-back, 65% had received single doses at 2 hour intervals and 8% had received single doses at 4 hour intervals. Lactate levels were elevated for all patients. Mean lactate was 2.2 mmol/l. We did not identify any correlation between increasing frequency of administration and lactate level nor did we find any correlation between type of condition and lactate level. A review of patients showed that raised lactate was not as a result of other potential causes, such as tissue hypoxia, acute liver injury, diabetic ketoacidosis, ethanol toxicity, drug toxicity (including metformin, salicylates) or seizures. The raised lactate had no clear prognostic implication. Conclusions: We identified raised lactate levels in all paediatric patients that had been treated with nebulised salbutamol. This finding may be useful to clinicians to help avoid unnecessary use of salbutamol and to explain lactate findings when use of salbutamol is appropriately indicated. Reference: Sharif Z, Al-Alawi M. Beware of beta! A case of salbutamol induced lactic acidosis in severe asthma. Case reports 2018;2018:bcr-2017–224090