Salbutamol
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Salbutamol Exacerbation of asthma, acid-base disorders and respiratory failure: case report
A 42-year-old man developed exacerbation of asthma, lactic acidosis, hyperlactataemia, tachypnoea and respiratory failure during treatment with salbutamol for acute asthma [not all dosages stated]. The man was admitted with respiratory distress and wheezing. Over the last 3 days, he exhibited a runny nose, shortness of breath, dry cough and audible wheezing. Despite the use of increased doses of inhaled salbutamol at home, he continued to have tightness in chest and trouble breathing. He was asthmatic since childhood. On admission, he was unable to speak in complete sentences, with marked accessory muscles of respiration use. He was afebrile, conscious and agitated. Investigation revealed pulse rate 130 beats/min, respiratory rate 45 breaths/min, oxygen saturation 91% on room air and BP 140/75mm Hg. Chest auscultation revealed bilateral expiratory wheeze. Arterial blood gas showed a severe acidosis. A chest X-ray demonstrated enlargement of the intercostal spaces with horizontalisation of the ribs. He developed exacerbation of asthma. The man received supplement oxygen with seven doses of nebulised salbutamol (35mg in total as 5mg every 20min) along with ipratropium bromide [ipratropium], and methylprednisolone for stress ulcer prophylaxis and concurrent deep venous thrombosis. After 2h, he became less responsive to the medical treatment. Therefore, a bolus dose of sulfate magnesium 2g was administered, without any clinical improvement: oxygen saturation was 87% on high-flow oxygen with worsening of dyspnoea, limited inspiratory flow and decreased wheeze. A second arterial blood gas showed severe mixed acidosis, without any signs of hypoperfusion or sepsis. He was intubated, and was mechanically ventilated at the following settings. The airways pressures were high, and peak pressure was at 45cm H2O. Salbutamol was tapered off, and the dose of corticosteroids were reduced to 60mg daily. Inhaled sevoflurane was administred for 1h twice a day, resulting in clinical improvement with further decreased wheezes and respiratory pressures. Of note, the systemic lactic acidosis persisted during the initial 12h post-intubation, but then resolved slowly over the next 48h, coinciding with tapering of salbutamol. He was extubated on day 2, and was transferred on day 3 with a normal acid–base status [times to reactions onsets not stated]. Najout H, et al. Salbutamol-induced severe lactic acidosis in acute asthma. SAGE Open Medical Case Reports 8: 2020. Available from: URL: http:// doi.org/10.1177/2050313X20969027
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Reactions 21 Nov 2020 No. 1831
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