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Pediatric Asthma


Tuesday, November 3, 2009

12:45 PM - 2:00 PM

METABOLIC ACIDOSIS IS ASSOCIATED WITH HIGH-DOSE INHALED ALBUTEROL THERAPY IN ACUTE SEVERE ASTHMA

Muhammad A. Rishi, MD, Saleha Z. Chaudhry, MD*, Bimi Sidhu, MD, Christina Blot, MD, Fredrick Ramos, MD, Marylou Gaeta, MD and Yaw Amoateng-Adjepong, MD

Bridgeport Hospital, Yale School of Medicine, Bridgeport, CT

PURPOSE: In this study, we test whether there is a dose related relationship between inhaled albuterol therapy and metabolic acidosis.

METHODS: Retrospective analysis of historical, demographic and physiologic data of all pediatric patients ( < 18yrs) admitted to pediatric intensive care unit (PICU) with diagnosis of severe acute asthma between Jan 1st 2007 and Dec 31st, 2008.

RESULTS: 201 patients with asthma were admitted to the PICU during the study period. 42 patients (median age 7+/–2.67, 76.2 % male) had blood gases done during the admission and were included in the analysis. 30 patients (71.4%) were on high dose ( > 10 mg/h) continuous inhaled albuterol. There was no difference between age, gender, duration of symptoms before presentation, pediatric risk of mortality score between patient on high dose and low dose ( < 10 mg/h) albuterol. Heart rate and respiratory rate was higher in patients on high dose albuterol (159+/–2.1 vs 132+/–4.3, p = 0.04 and 41+/–5.4 vs 32+/–8.6, p = 0.05). 14 patients (33%) developed metabolic acidosis. 13 (43.3 %) of the patients on high dose albuterol compared to 1 (8.3%) of the low dose inhaled albuterol patients developed metabolic acidosis (p = 0.03).

CONCLUSION: High dose inhaled albuterol use is associated with metabolic acidosis in patients with severe acute asthma.

CLINICAL IMPLICATIONS: Hyperventilation in treated asthma may be a sign of metabolic acidosis which should be treated with a taper of albulerol therapy.

DISCLOSURE: Saleha Chaudhry, No Financial Disclosure Information; No Product/Research Disclosure Information






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