SHM Converge Scientific Abstract ePoster Gallery-An Unexpected Case of Type B Lactic Acidosis: Frequent Nebulizer Use Causes Stark Increase in Lactic Acid Within Hours of Administration

An Unexpected Case of Type B Lactic Acidosis: Frequent Nebulizer Use Causes Stark Increase in Lactic Acid Within Hours of Administration

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This case report describes a 63-year-old woman with severe COPD and chronic home oxygen use who presented with acute-on-chronic hypoxic respiratory failure during a presumed COPD exacerbation. She was treated with BiPAP and repeated ipratropium-albuterol nebulizers, including three treatments within 20 minutes, totaling 12.5 mg of albuterol.<br /><br />Although her respiratory status improved, her lactate rose from 5.9 to 11.5 mmol/L. On reevaluation, she appeared comfortable on 5 L nasal cannula and showed no evidence of hypoperfusion or shock, making type A lactic acidosis unlikely. Chart review suggested the elevated lactate was caused by frequent inhaled beta-adrenergic agonist use, leading to type B lactic acidosis. Once the beta agonists were discontinued, the lactate level decreased without further intervention or fluid resuscitation.<br /><br />The report highlights that type B lactic acidosis can occur not only with intravenous epinephrine but also with frequent inhaled beta-agonist nebulizer therapy. Recognizing this medication-induced cause is important, especially in patients with respiratory disease and heart failure risk, because an elevated lactate may prompt unnecessary fluid administration and potential fluid overload.<br /><br />The authors emphasize the need to interpret laboratory data in the context of the full clinical picture rather than reacting to lactate levels alone. They also note that further research is needed to identify which COPD and asthma patients are most susceptible to this complication.

Asset Subtitle

Faiqa Amin

Meta Tag

Author List Danielle Uibel, Faiqa Amin, Martin Banks, Modupe Oluya

Category Clinical Vignettes

Concept Beta-Adrenergic Agonist

Concept Type B Lactic Acidosis

Concept Albuterol

Concept Type A Lactic Acidosis

Concept Lactate

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center - - Dover, DE

Presenting Author Faiqa Amin

Track Adult

Keywords

COPD

type B lactic acidosis

beta-agonist nebulizers

albuterol

hypoxic respiratory failure

BiPAP

ipratropium-albuterol

elevated lactate

beta-adrenergic agonist

medication-induced lactic acidosis

Beta-Adrenergic Agonist

Type B Lactic Acidosis

Albuterol

Type A Lactic Acidosis

Lactate