Prevalence and risk factors of lactic acidosis in children with acute moderate and severe asthma, a prospective observat
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ORIGINAL ARTICLE
Prevalence and risk factors of lactic acidosis in children with acute moderate and severe asthma, a prospective observational study Marta Ruman 1
&
Isabelle Rochat Guignard 2 & Ermindo R. Di Paolo 3 & Mario Gehri 1 & Jean-Yves Pauchard 1
Received: 27 August 2020 / Revised: 28 September 2020 / Accepted: 9 October 2020 # The Author(s) 2020
Abstract Lactic acidosis is a common complication of status asthmaticus in adults. However, data is sparse in children. The aim of this study was to describe the prevalence and risk factors for lactic acidosis in children hospitalised for acute moderate or severe asthma. A total of 154 children 2–17 years of age were enrolled in a prospective observational study conducted in a tertiary hospital. All had capillary blood gas assessment 4 h after the first dose of salbutamol in hospital. The primary endpoint was the prevalence of lactic acidosis. Potential contributing factors such as age, sex, BMI, initial degree of asthma severity, type of salbutamol administration (nebuliser or inhaler), steroids, ipratropium bromide, and glucose-containing maintenance fluid represented secondary endpoints. All in all, 87% of patients had hyperlactatemia (lactate concentration > 2.2 mmol/l). Lactic acidosis (lactate concentration > 5 mmol/l and anion gap ≥ 16 mmol/l) was observed in 26%. In multivariate analysis, age more than 6 years (OR = 2.8, 95% CI 1.2–6.6), glycemia above 11 mmol/l (OR = 3.2 95% CI 1.4–7.4), and salbutamol administered by nebuliser (OR = 10, 95% CI 2.7–47) were identified as risk factors for lactic acidosis in children with moderate or severe asthma. Conclusion: Lactic acidosis is a frequent and early complication of acute moderate or severe asthma in children. What is Known: • Lactic acidosis during acute asthma is associated with b2-mimetics administration. • Salbutamol-related lactic acidosis is self-limited but important to recognise, as compensatory hyperventilation of lactic acidosis can be mistaken for respiratory worsening and lead to inappropriate supplemental bronchodilator administration. What is New: • Lactic acidosis is a frequent complication of acute asthma in the paediatric population. • Age older than 6 years, hyperglycaemia, and nebulised salbutamol are risk factors for lactic acidosis during asthma.
Keywords Lactic acidosis . Salbutamol . Asthma . Paediatrics
Communicated by Peter de Winter * Jean-Yves Pauchard [email protected] Marta Ruman [email protected] Isabelle Rochat Guignard [email protected] Ermindo R. Di Paolo [email protected] Mario Gehri [email protected]
1
Children’s Hospital, Service of Paediatrics, Department of Woman, Mother, Child, Lausanne University Hospital, University of Lausanne, Chemin de Montétan 16, 1004 Lausanne, Switzerland
2
Respiratory Unit, Service of Paediatrics, Department of Woman, Mother, Child, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
3
Service of Pharmacy, Lausanne University Hospital, University of Lausanne
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