Mechanism of lactic acidosis in children with acute severe asthma
- 1 January 2012
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Pediatric Critical Care Medicine
- Vol. 13 (1), 28-31
- https://doi.org/10.1097/pcc.0b013e3182196aa2
Abstract
Hyperlactatemia and lactic acidosis are common in adults with acute severe asthma however only a few cases have been reported in children. Type A lactic acidosis is associated with impaired oxygen delivery; type B occurs in the presence of normal oxygen delivery and has been described to occur with excessive adrenergic stimulation. Type A and B lactic acidosis can be distinguished by the blood lactate/pyruvate ratio. Our objectives are to 1) investigate the incidence of hyperlactatemia and lactic acidosis in children with acute severe asthma, and 2) determine whether lactate elevation is type A or B. Prospective observational study. University-affiliated tertiary care children's hospital. All children (n = 105) with acute severe asthma admitted to the pediatric intensive care unit between May 1, 2008 and November 30, 2009 were included. Blood lactate concentration was measured on a blood gas analyzer for all blood gas assessments obtained for clinical care. Hyperlactatemia was defined as lactate >2.2 mmol/L and lactic acidosis as lactate >5 mmol/L and pH 5 mmol/L, consent was requested for measuring blood lactate and pyruvate using enzymatic laboratory methods. Lactate/pyruvate ratio >25:1 indicated type A lactic acidosis. Eighty-seven (83%) children had lactate >2.2 mmol/L and 47 (45%) had lactate >5 mmol/L. Of those with lactate >5 mmol/L, 33 (70%) had corresponding blood pH 25 in one; and indeterminate in one. Lactic acidosis is common in children with acute severe asthma and is primarily type B occurring in the presence of normal oxygen delivery.Keywords
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