beta agonist usage can lead to lactic acidosis in asthma

• related: lactic acidosis types
• tags: #literature #icu

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In some patients with asthma, adrenergic therapy can produce type B lactic acidosis. β2-adrenergic receptor activation directly impacts glycolysis, gluconeogenesis, pyruvate metabolism, and free fatty acid production, leading to elevated lactic acid and pyruvate levels. β-agonist-induced lactic acidosis is well-described in asthma treatment but has also been seen when ritodrine (a β2-agonist) is infused to prevent premature labor. Although pyruvate levels are not often measured clinically (being reserved for research studies), they provide insight into biochemical mechanisms.

Patients with status asthmaticus are also at risk of experiencing type A lactic acidosis related to hypoxemia, circulatory compromise (due to autoPEEP, barotrauma, or other), hepatic congestion (due to autoPEEP), or excessive respiratory muscle activity. This patient’s hemodynamic values, normal oxygenation level, modest autoPEEP, and therapeutic paralysis argue against type A lactic acidosis.¹²³⁴

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• lactic acidosis types
  • beta agonist usage can lead to lactic acidosis in asthma

Footnotes

1. SEEK Questionnaires ↩

2. Dodda VR, Spiro P. Can albuterol be blamed for lactic acidosis? Respir Care. 2012;57(12):2115-2118. PubMed ↩

3. Haffner CA, Kendall MJ. Metabolic effects of beta 2-agonists. J Clin Pharm Ther. 1992;17(3):155-164. PubMed ↩

4. Nowadly CD, Liao SY, Rose JS. Effects of continuous albuterol inhalation on serum metabolome in healthy subjects: more than just lactic acid. J Clin Pharmacol. 2021;61(5):649-655. PubMed

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