Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report
Abstract Background Salbutamol is a selective β2-receptor agonist widely used to treat asthma in both emergency and outpatient settings. However, it has been associated with a broad spectrum of side effects. Lactic acidosis and diastolic hypotension are rarely reported together following intermitten...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-022-03357-z |
| _version_ | 1828347259211743232 |
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| author | Marco Colombo Anna Plebani Annalisa Bosco Massimo Agosti |
| author_facet | Marco Colombo Anna Plebani Annalisa Bosco Massimo Agosti |
| author_sort | Marco Colombo |
| collection | DOAJ |
| description | Abstract Background Salbutamol is a selective β2-receptor agonist widely used to treat asthma in both emergency and outpatient settings. However, it has been associated with a broad spectrum of side effects. Lactic acidosis and diastolic hypotension are rarely reported together following intermittent salbutamol nebulization in children, even less so at standard therapeutic doses. Case presentation We present the case of a 12-year-old Italian boy, 34 kg body weight, who experienced a serious drug reaction during a moderate asthma exacerbation with associated dehydration (blood urea nitrogen/creatinine 0.25), following intermittent inhaled (0.2 mg at 3-hour intervals—overall 1.4 mg in 24 hours before arrival) and nebulized treatment (3.25 mg at 20-minute intervals in 60 minutes, overall 11.25 mg in our emergency department). The patient developed hyperglycemia (peak concentration 222 mg/dL), hypokalemia (lowest concentration 2.6 mEq/L), electrocardiogram alterations (corrected QT interval 467 ms), long-lasting arterial hypotension despite fluid boluses (lowest value 87/33 mmHg), and elevated blood lactate levels (peak concentration 8.1 mmol/L), following the third nebulized dose. Infections, liver dysfunction, and toxicity following other medications were ruled out. The aforementioned alterations improved within 24 hours after discontinuation of salbutamol. Conclusions We reinforce the message that even the use of intermittent nebulized salbutamol for acute moderate asthma can lead to severe transient complications in children. Then, healthcare providers should pay attention not only in emergency settings, to achieve prompt recognition and proper management of this adverse reaction. Careful reassessment could prevent similar reactions. |
| first_indexed | 2024-04-14T00:37:29Z |
| format | Article |
| id | doaj.art-26510af4d9a04d8181b0a6fac598e5b1 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-14T00:37:29Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-26510af4d9a04d8181b0a6fac598e5b12022-12-22T02:22:19ZengBMCJournal of Medical Case Reports1752-19472022-04-011611610.1186/s13256-022-03357-zSevere lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case reportMarco Colombo0Anna Plebani1Annalisa Bosco2Massimo Agosti3Pediatric Emergency Department, ASST Sette LaghiPediatric Emergency Department, ASST Sette LaghiPediatric Emergency Department, ASST Sette LaghiDepartment of Neonatology and Pediatrics, ASST Sette LaghiAbstract Background Salbutamol is a selective β2-receptor agonist widely used to treat asthma in both emergency and outpatient settings. However, it has been associated with a broad spectrum of side effects. Lactic acidosis and diastolic hypotension are rarely reported together following intermittent salbutamol nebulization in children, even less so at standard therapeutic doses. Case presentation We present the case of a 12-year-old Italian boy, 34 kg body weight, who experienced a serious drug reaction during a moderate asthma exacerbation with associated dehydration (blood urea nitrogen/creatinine 0.25), following intermittent inhaled (0.2 mg at 3-hour intervals—overall 1.4 mg in 24 hours before arrival) and nebulized treatment (3.25 mg at 20-minute intervals in 60 minutes, overall 11.25 mg in our emergency department). The patient developed hyperglycemia (peak concentration 222 mg/dL), hypokalemia (lowest concentration 2.6 mEq/L), electrocardiogram alterations (corrected QT interval 467 ms), long-lasting arterial hypotension despite fluid boluses (lowest value 87/33 mmHg), and elevated blood lactate levels (peak concentration 8.1 mmol/L), following the third nebulized dose. Infections, liver dysfunction, and toxicity following other medications were ruled out. The aforementioned alterations improved within 24 hours after discontinuation of salbutamol. Conclusions We reinforce the message that even the use of intermittent nebulized salbutamol for acute moderate asthma can lead to severe transient complications in children. Then, healthcare providers should pay attention not only in emergency settings, to achieve prompt recognition and proper management of this adverse reaction. Careful reassessment could prevent similar reactions.https://doi.org/10.1186/s13256-022-03357-zAsthma exacerbationsSalbutamol adverse drug reactionLactic acidosisDiastolic hypotension |
| spellingShingle | Marco Colombo Anna Plebani Annalisa Bosco Massimo Agosti Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report Journal of Medical Case Reports Asthma exacerbations Salbutamol adverse drug reaction Lactic acidosis Diastolic hypotension |
| title | Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report |
| title_full | Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report |
| title_fullStr | Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report |
| title_full_unstemmed | Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report |
| title_short | Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report |
| title_sort | severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child a case report |
| topic | Asthma exacerbations Salbutamol adverse drug reaction Lactic acidosis Diastolic hypotension |
| url | https://doi.org/10.1186/s13256-022-03357-z |
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