Transient lactic acidosis as a side effect of inhaled salbutamol therapy in asthmatic children

ABSTRACT

In spite of the effectiveness of inhaled beta-2 agonists as bronchodilator therapy in bronchial asthma management in children; they produce a number of biochemical changes. The clinical relevance of these biochemical changes is not clearly defined. One of these observed changes is the transient lactatemia. The aim of this study is to evaluate the presence of lactic acidosis as a transient side effect of inhaled salbutamol therapy during the management of asthmatic attacks. Thirty-six asthmatic children presenting in acute asthma, 20 males and 16 females with age range between 6 and 10 years [mean +/- SD 7.47 +/- 1.13 years], were included in this study. All of them were subjected to full history taking, thorough clinical examination and lab evaluation including Serum lactate levels before salbutamol inhalation therapy, one hour after start of inhalation therapy and 24 hours later. Blood gas analysis before and after inhalation therapy were also done. Salbutamol inhalation therapy was given to all patients in the form of 3-successive doses, 20 minutes apart, in a dose of 0.15 mg/kg/dose, thereafter intensive management was continued. A statistically highly significant increase in the early post treatment serum lactate level was found in comparison to both pre treatment and 24 hours post treatment levels. In spite of the return of serum lactate levels to normal limits, the difference between the 24-hour post treatment and pre treatment levels was also statistically highly significant. The results of this study confirm that transient lactic acidosis occurs as a side effect of inhaled salbutamol. Physicians should be aware of this side effect of bronchodilators, which might prove of clinical significance in the more severe cases where other causes of metabolic acidosis coexist. Abbreviation S.I.T. = salbutamol inhalation therapy