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Mechanism of lactic acidosis in children with acute severe asthma

Kathleen L Meert1, LaTasha McCaulley, Ashok P Sarnaik

  • 1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA. kmeert@med.wayne.edu

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 5, 2011
PubMed

Insights

Lactic acidosis is common in children with severe asthma, predominantly type B, indicating normal oxygen delivery. This study investigated its incidence and type in pediatric patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Emergency Medicine

Background:

  • Hyperlactatemia and lactic acidosis are frequent in adults with acute severe asthma.
  • Cases in children are less commonly reported, necessitating further investigation.

Purpose of the Study:

  • To determine the incidence of hyperlactatemia and lactic acidosis in children with acute severe asthma.
  • To differentiate between type A (impaired oxygen delivery) and type B (excessive adrenergic stimulation) lactic acidosis in this pediatric population.

Main Methods:

  • Prospective observational study including 105 children with acute severe asthma admitted to a pediatric intensive care unit.
  • Blood lactate levels were measured; hyperlactatemia defined as lactate >2.2 mmol/L, lactic acidosis as lactate >5 mmol/L and pH <7.35.
  • Lactate/pyruvate ratio was used to distinguish between type A and type B lactic acidosis.

Main Results:

  • 83% of children exhibited hyperlactatemia (lactate >2.2 mmol/L), and 45% had lactic acidosis (lactate >5 mmol/L).
  • Of those with lactic acidosis, 70% had a pH <7.35.
  • Lactate/pyruvate ratios indicated predominantly type B lactic acidosis.

Conclusions:

  • Lactic acidosis is a common complication in children experiencing acute severe asthma.
  • The findings suggest that type B lactic acidosis is the primary form observed, occurring despite normal oxygen delivery.
Abstract

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