Abstract
Objective To evaluate arterial lactate levels during treatment of acute severe asthma (ASA) and the prognostic value of arterial hyperlactatemia in ASA.
Design Prospective study.
Setting A respiratory intensive care unit (ICU) of a university hospital.
Patients 29 consecutive patients admitted to the ICU for ASA not intubated on admission and with a peak expiratory flow (PEF) < 150 l/min or an arterial carbondioxide tension (PaC02) > 40 mmHg. All patients received standardized treatment during the first 24 h including i. v. and nebulized salbutamol, i. v. theophylline, and dexamethasone.
Measurements and results Arterial lactate levels were serially measured by an enzymatic method during the first 24 h following admission. On admission, the mean arterial lactate level was 3.1 ± 0.38 mmol/l (range 1.1–10.4); 17 patients (59%) had arterial hyperlactatemia with a lactate level > 2 mmol/l. No difference was found in lactate levels between patients with progressively worsening asthma and those with an acute onset of severe asthma. No correlation was found between arterial lactate levels on admission, on the one hand, and respiratory rate (RR), heart rate, PEF, pH, PaC02, arterial oxygen tension, potassium, phosphorus, creatine kinase, or transaminase values on admission, on the other hand. All patients developed an important but transient increase in arterial lactate levels during treatment, with a peak at 7.72 ± 0.46 mmol/l and a mean elevation of 4.62 ± 0.45 mmol/l (range 0.4–12.1), from the initial admission value contrasting with a significant clinical improvement assessed by RR, PEF, and arterial blood gas parameters.
Conclusion This study suggests that, in ASA, arterial hyperlactatemia is frequently present on admission to the ICU. Delayed hyperlactatemia is a constant finding during treatment of ASA. Initial or delayed hyperlactatemia seems of no prognostic value because none of the patients required mechanical ventilation. The effects of therapy for acute asthma on lactate metabolism still need to be studied.
Similar content being viewed by others
References
McFadden ER, Lyons HA (1968) Arterial blood gas tension in asthma. N Engl J Med 278:1027–1032
Mountain RD, Heffner JE, Brackett NC, Sahn SA (1990) Acid-base disturbances in acute asthma. Chest 98: 651–655
Okrent DG, Tessler S, Twesky RA, Tashkin DP (1987) Metabolic acidosis not due to lactic acidosis in patients with severe acute asthma. Crit Care Med 15:1098–2002
Kruse JA (1996) Plasma lactate: diagnostic and prognostic value. Réan Urg 5:181–185
Vitek V, Cowley RA (1971) Blood lactate in the prognostic of various forms of shock. Ann Surg 173: 308–313
Kruse JA, Zaidi SA, Carlson RW (1987) Significance of blood lactate levels in critically ill patients with liver disease. Am J Med 83: 77–82
Broder G, Weilm MH (1964) Excess lactate: an index of irreversibility of septic shock. Science 143:1457–1459
Braden GL, Johnston S, Germain M, Fitzgibbons J, Dawson J (1985) Lactic acidosis associated with the therapy of acute bronchospasm. N Engl J Med 313:890–891
Appel D, Rubenstein R, Schräger K, Williams MH (1983) Lactic acidosis in severe asthma. Am J Med 75: 580–584
Roncoroni AJ, Adrogue HJA, De Obrutsky CW, Marcisio ML, Herrera MR (1976) Metabolic acidosis in status asthmaticus. Respiration 33: 85–87
Saint-Jean O, De Rohan-Chabot P, Thaler F, Loirat P (1987) Hyperlactatémie lors du traitement d’un bronchospasme aigü par du Salbutamol. Presse Med 16: 965–966
American Thoracic Society, Comittee on Diagnostic Standards for Nontuberculous Respiratory Disease (1982) Definitions and classifications of chronic bronchitis, asthma and pulmonary emphysema, statement by the committee on diagnostic standards for non tuberculosis respiratory diseases. Am J Respir Crit Care Med 85: 762–768
Gajdos P, Autret E, Castaing Y et al (1989) Conference de Consensus de la Société de Réanimation de Langue Française. Prise en charge des crises d’asthme aiguës graves de l’adulte. Rean Soins Intens Med Urg 5: 25–31
National Heart, Lung and Blood Institute, National Institutes of Health (1992) International consensus report on diagnosis and treatment of asthma. Eur Respir J 5: 601–641
British Thoracic Society (1993) Guidelines for the management of asthma. BMJ 306: 776–782
Laaban JP, Dupeyron JP, Guyon F, Lafay M, Drieu L, Rochemaure J et al (1986) Adjustment of intravenous theophylline dosage according to serum concentration on admission and total body clearance. Eur Respir J 69 [Suppl 146]: 571–579
Lissac J, Brulot N, Maubrey MC, Labrousse J, Coulaud JM (1991) Profil humoral actuel des asthmes aigus graves. Ann Med Interne 141: 668–673
Iberty TJ, Leibowitz AB, Papadakos PJ, Fischer EP (1990) Low sensitivity of the anion gap to detect hyperlactatemia in critically ill patients. Crit Care Med 18:275–277
Roussos C (1990) Respiratory muscle fatigue and ventilatory failure. Chest 97: 89S-95S
Brady HR, Ryan F, Cunningham J, Tormey W, Ryan MP (1989) Hypophosphatemia complicating bronchodilator therapy for acute severe asthma. Arch Intern Med 149: 2367–2368
Aubier M, Murciano D, Lecogguic Y et al (1985) Effect of hypophosphatemia on diaphragmatic contractility in patients with acute respiratory failure. N Engl J Med 313: 420–424
Lichtman MA, Miller DR, Cohen J, Waterhouse C (1971) Reduced red cell glycosis, 2,3-diphosphoglycerate and adenosine triphosphate concentration and increased hemoglobin-oxygen affinity caused by hypophosphatemia. Ann Intern Med 74: 562–568
Buda AJ, Pinsky MR, Ingels NB, Daugthers GT, Stinson EB, Aldermann EL (1979) Effect of intrathoracic pressure on left ventricular performance. N Engl J Med 301: 453–459
Jardin F, Dubourg O, Margairaz A, Bourdarias JP (1987) Inspiratory impairment in right ventricular performance during acute asthma. Chest 92: 789–795
Woll PJ, Record CO (1979) Lactate elimination in man: effects of lactate concentration and hepatic dysfunction. Eur J Clin Invest 9: 397–404
Villard J, Magnenat JL, Jolliet P, Chevrolet JC (1993) Acidose métabolique et augmentation de la creatinine kinase dans l’asthme aigu sévère. Rôle possible des muscles respiratoires. Réan Urg 2: 259–266
Haffner CA, Kendall MJ (1992) Metabolic effects of B2-agonists. J Clin Pharm Ther 17:155–164
Reverte M, Garcia-Barrado MJ, Moratinos J (1991) Changes in plasma glucose and lactate evoked by alpha and beta2-adrenoreceptor stimulation in conscious fasted rabbits. Fundam Clin Pharmacol 5: 663–671
Richards SR, Chang EE, Stempel LE (1983) Hyperlactacidemia associated with acute ritodrine infusion. Am J Obstet Gynecol 146:1–5
Barnes PJ, Pauwels RA (1994) Theophylline in the management of asthma: time for reappraisal. Eur Respir J 7: 579–591
Svedmyr N (1990) Action of corticosteroids on beta-adrenergic receptors. Am J Respir Crit Care Med 141: S32-S38
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rabbat, A., Laaban, J.P., Boussairi, A. et al. Hyperlactatemia during acute severe asthma. Intensive Care Med 24, 304–312 (1998). https://doi.org/10.1007/s001340050572
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s001340050572