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Acid-base disturbances in acute asthma.

R D Mountain1, J E Heffner, N C Brackett

  • 1Department of Medicine, University of Colorado Health Sciences Center, Denver.

Chest
|September 1, 1990
PubMed
Summary

Metabolic acidosis is common in severe asthma attacks, affecting 28% of patients. This condition correlates with more severe airflow obstruction and hypoxemia, suggesting multifactorial causes in acute asthma management.

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Area of Science:

  • Pulmonary Medicine
  • Critical Care Medicine
  • Nephrology

Background:

  • Acute asthma exacerbations can lead to complex physiological disturbances.
  • Acid-base balance is crucial in assessing asthma severity and patient outcomes.

Purpose of the Study:

  • To investigate the prevalence and characteristics of acid-base disturbances in hospitalized patients with acute asthma.
  • To determine the association between metabolic acidosis and asthma severity, airflow obstruction, and hypoxemia.

Main Methods:

  • Analysis of clinical features, arterial blood gases, and acid-base profiles in 229 asthma episodes.
  • Comparison of patient groups with and without metabolic acidosis.
  • Correlation analysis between anion gap, hypoxemia, and airflow obstruction.

Main Results:

  • Respiratory alkalosis was the most frequent disturbance (48%).
  • Metabolic acidosis occurred in 28% of episodes, often with respiratory acidosis.
  • Metabolic acidosis was linked to male sex, severe airflow obstruction, and increased hypoxemia (inverse correlation with anion gap).

Conclusions:

  • Metabolic acidosis is a frequent complication of acute, severe asthma.
  • Its pathogenesis is likely multifactorial, involving respiratory muscle lactate production, tissue hypoxia, and intracellular alkalosis.
  • Identifying metabolic acidosis is important for managing severe asthma exacerbations.

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