Lactatemia during treatment of status asthmaticus in children

Background: Transient increase of lactate levels with or without metabolic acidosis has been seldom reported as a complication of beta2-adrenergic therapy administered during asthma attacks in children

Objective: The study is aimed to investigate the frequency of lactatemia in children with acute asthma treated with nebulized beta2-agonists, and to delineate its causes and effects on prognosis

Methods: We studied 32 asthmatic children; 68.8% had intermittent asthma, and 31.2% had mild persistent asthma. Their ages ranged from 6 to 8 years with a mean of 6.48 +/- 0.68 years. Patients were enrolled during acute asthma exacerbation [62.5% had severe and 37.5% had moderate attacks] from the Cairo University Children's Hospital. Patients underwent clinical evaluation, and routine investigations [CBC, PEFR, and total serum IgE] then received nebulized salbutamol at 0.1 mg/kg/dose [minimum 2.5 mg] every 20 min for three doses together with O2. Plasma lactate was determined before, 1 h after, and 24 h following the inhalation therapy. Blood gases were also evaluated before and after the beta2-agonist treatment

Results: At 1 h post-treatment, all patients had appreciable lactatemia [4.44 +/- 0.78 mmol/L, p<0.001] compared to the pre-treatment level with a rise of 257 +/- 121.5%. Patients with severe attacks demonstrated a higher mean value compared to those with moderate attacks [4.69 +/- 0.8 mmol/L versus 4.02 +/- 0.6 mmol/L, p<0.05]. At 24 h post-treatment, lactate levels returned to the normal values in most patients [1.91 +/- 0.59 mmol/L, p<0.001] as compared to the 1 h post-treatment level. None of our patients developed metabolic acidosis and all of them showed significant clinical improvement. Our results strongly accuse nebulized salbutamol as the possible pathogenetic factor for lactatemia during therapy of acute asthma attacks, while overworked respiratory muscles and hypoxemia have been excluded as contributing factors

Conclusion: Transient lactatemia is not uncommon during beta2-agonist therapy in asthmatic children with acute exacerbation, and is harmless in most cases. Prediction of lactic acidosis prevents inappropriate intensification of therapy especially in patients with more severe attacks or impending respiratory failure

Alpha-one antitrypsin phenotypes in chest diseases in infants and children

In the present work, 92 infants and children were studied [52 males and 40 females] suffering from 5 common chest diseases: chronic broncho-pneumonia [15 patients], bronchiectasis [12 patients], bronchial asthma [20 patients], broncho-pneumonia [15 patients] and pulmonary TB [20 patients]. Bronchial asthma patients were subdivided into atopic [14 cases] and non atopic [6 cases] according to the results of IgE and allergic skin test, 30 normal children were taken as controls. All patients and controls were subjected to chest radiographs. CBS ESR, quantitative determination of serum ALAT by radial immunodiffusion methods and ALAT phenotyping by immunofixation electrophoresis. A second serum ALAT determination after 3 weeks of treatment was carried in chronic bronchitis, broncho- pnemonia and bronchial asthma group. It was done after 6 months in tuberculous patients. Serum ALAT in all patient groups, with the exception of bronchial asthma, was significantly higher than control at the initial estimation. As ALAT is one of the acute phase reactants it rises in active chest diseases. After treatment these high levels dropped to normal. In asthmatic patients, there is significant decrease of serum ALAT, both in atopic and non atopic cases. But the level was higher in patients with associated chest infection than in those without. As regards ALAT phenotyping the MM phenotype was the commonest. It was found in all controls, in 85% of TB. In asthmatics other pi variants [MS, MZ, SS], known to be ALAT phenotype variants than PiM were heterozygous deficient in ALAT and presented as recurrent chest infections or bronchial asthma

Heat-labile alkaline phosphatase

Fifty Egyptian infants and children [28 males and 22 females] aged 4 months to 15 years were enrolled in this study. All were subjected to thorough clinical evaluation, to exclude any medical problems that may affect growth; together with anthropometric measurments [Height, weight and skull circumference for those who were less than 3 years old]. Serum alkaline phosphatase [ALP]. Total activity and the bony isoenzyme level were measured for all of them. Statistical analysis of our data showed no significant correlation between ALP bony isoenzyme and the crude anthropometric measures. However, higher levels of bony ALP were detected in age groups with high growth velocity [infancy and adolescence] and lower level were found in the low growth velocity age group [2-10 years], which confirms the presence of a significant direct relationship between bony and growth velocity. This may signifies the validity of using bony ALP isoenzyme as an index of growth velocity in normal Egyptians infants and children

Study of the clinical and haematological pictures of sickle cell anaemia in Saudi Arabia

Fifty children with sickle cell anaemia with ages ranging from 8 months to 13 years were chosen for this study. Their results were compared with those of 22 children with sickle cell trait with a comparable age [2 months to 13 years] as well as 10 normal controls of the same age group. Vaso- occclusive crises were the main presenting symptom recorded in 74% of patients, anaemia in 66%, splenomegaly in 32% and hepatomegaly in only 8% of cases. G6PD was deficient in 34% of patients with sickle cell disease as well as in 57% of patients with the trait. A significant decrease in Hb level with significant increase in both HbF and reticulocytic count were detected