Aubuchon, Kristen

House, Stacey

Lewis, Lawrence

Matsuda, Kazuko

Schneider, John

Digital Commons@Becker

Washington University School of MedicineDigital Commons@BeckerConference Abstracts and Posters Division of Emergency Medicine/Emergency CareResearch Section2012Increased serum albuterol concentrations may beassociated with elevations of serum lactate insubjects with acute asthma exacerbationsKristen AubuchonWashington University School of Medicine in St. LouisKazuko MatsudaWashington University School of Medicine in St. LouisStacey HouseWashington University School of Medicine in St. LouisJohn SchneiderWashington University School of Medicine in St. LouisLawrence LewisWashington University School of Medicine in St. LouisFollow this and additional works at: http://digitalcommons.wustl.edu/em_confThis Presentation Poster is brought to you for free and open access by the Division of Emergency Medicine/Emergency Care Research Section atDigital Commons@Becker. It has been accepted for inclusion in Conference Abstracts and Posters by an authorized administrator of DigitalCommons@Becker. For more information, please contact engeszer@wustl.edu.Recommended CitationAubuchon, Kristen; Matsuda, Kazuko; House, Stacey; Ferguson, Ian; Schneider, John; Lewis, Lawrence, “Increased serum albuterolconcentrations may be associated with elevations of serum lactate in subjects with acute asthma exacerbations” (2012). ConferenceAbstracts and Posters. Paper 9. http://digitalcommons.wustl.edu/em_conf/9BACKGROUND         We have previously described increased serum lactate concentrations in subjects with acute asthma exacerbations.  It is not clear if this is due to increased work of breathing or a possible side effect of treatment (in particular beta-adrenergic agonist therapy).   OBJECTIVES          1) Determine if a significant correlation exists between treatment lactate or ∆ lactate, and serum albuterol concentrations after adjusting for dyspnea score.   2) Determine if elevated treatment lactate concentrations or ∆ lactate concentrations are associated with increased hospital admissions.   METHODS          •Interim, subgroup analysis of a prospective, interventional, double-blind, placebo controlled trial of an IV beta-adrenergic agonist in ED patients with acute asthma exacerbations.  •FEV1 < 50% predicted 30 minutes following initiation of “standard care” (includes a minimum of 2.5 mg nebulized albuterol; 0.5 mg nebulized ipratropium; and 50 mg of a corticosteroid).  ED physicians, unaware of study objectives, administered all treatments.   •Subjects were randomized in a 1:1 ratio to either placebo or  an investigational intravenous beta agonist arm.  Blood was obtained at 1 and 1.25 hours after the start of the hour long infusion for determination of albuterol , electrolytes, and lactate concentrations; and a Modified Borg Dyspnea Score (DS) was calculated for all patients.  •Treatment lactate and ∆ lactate were correlated with 1 hr serum albuterol concentrations and hospital admission, using partial Pearson correlations to adjust for DS.   Increased Serum Albuterol Concentrations May Be Associated With Elevations  Of Serum Lactate In Subjects With Acute Asthma Exacerbations Kristen Aubuchon1, Kazuko Matsuda2, Stacey L. House1, Ian Ferguson1, John Schneider1, Lawrence Lewis1  1Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri; 2Medicinova, Inc., San Diego, CA RESULTS          •42 subjects were enrolled to date, 20 with complete data.   •The mean baseline serum lactate level was 19.3 mg/dL (SD ±9.5).  This increased to 32.6 mg/dL (SD ±15.8) at 1.25 hrs.   •The mean 1 hr DS was 3.85+ 2.0.   •The correlation between treatment lactate, ∆ lactate, 1 hr serum albuterol concentrations (R, S and total) and admission to hospital are shown (see table below). Both treatment and ∆ lactate were highly correlated with total serum albuterol, R albuterol, and S albuterol.      R Albuterol S Albuterol Total Albuterol Admit Treatment Lactate Correlation Coefficient 0.505 0.497 0.674 -0.018 Significance (2 tailed) 0.028 0.030 0.002 0.910 Delta Lactata Correlation Coefficient 0.519 0.525 0.605 -0.075 Significance (2 tailed) 0.023 0.021 0.006 0.643 RESULTS (cont.)         •There was no correlation between treatment lactate or ∆ lactate and hospital admission.  There was also no significant difference in mean lactate levels in admitted vs. non-admitted  subjects (32.8 mg/dL vs. 32.1 mg/dL, p=0.9).    •There was a trend in twenty-four hour DS in patients with markedly elevated lactate (≥ 30 mg/dL) compared to those with lactate < 30 mg/dL (3.19 vs. 1.88, p=0.08)  DISCUSSION         Lactic acidosis  may be caused by increased production (Type A)  or decreased utilization  (metabolism) (Type B). 1  Type B  lactic acidosis may be  caused by alcohol or drugs.  There have been several reports of increased lactate associated with beta agonists. 2  A  recent study in children  treated for acute severe asthma, showed that  the mechanism of lactic acidosis was most often Type B. 3  CONCLUSION         Lactate and ∆ lactate concentrations correlate with albuterol concentrations in patients presenting with acute asthma exacerbations after adjusting for dyspnea score, but do not correlate with hospital admission.  REFERENCES         1. Luft FC.  Lactic acidosis update for critical care clinicians.  JASN 2001 2. Creagh-Brown BC. An under-recognized complication of treatment of acute        severe asthma. Amer J Emerg Med 2008 3.   Meert KL, et al.  Mechanism  of lactic acidosis in children with acute severe           asthma.  Ped Crit Care Med 2012   

Increased serum albuterol concentrations may be associated with elevations of serum lactate in subjects with acute asthma exacerbations

http://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=1006&context=em_conf

Increased serum albuterol concentrations may be associated with elevations of serum lactate in subjects with acute asthma exacerbations

Abstract

Similar works

Full text

Available Versions

Digital Commons@Becker