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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e3182196aa2
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Mechanism of lactic acidosis in children with acute severe asthma

Meert, Kathleen L. MD, FCCM; McCaulley, LaTasha MD; Sarnaik, Ashok P. MD, FCCM

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Objective: Hyperlactatemia and lactic acidosis are common in adults with acute severe asthma however only a few cases have been reported in children. Type A lactic acidosis is associated with impaired oxygen delivery; type B occurs in the presence of normal oxygen delivery and has been described to occur with excessive adrenergic stimulation. Type A and B lactic acidosis can be distinguished by the blood lactate/pyruvate ratio. Our objectives are to 1) investigate the incidence of hyperlactatemia and lactic acidosis in children with acute severe asthma, and 2) determine whether lactate elevation is type A or B.

Design: Prospective observational study.

Setting: University-affiliated tertiary care children's hospital.

Patients: All children (n = 105) with acute severe asthma admitted to the pediatric intensive care unit between May 1, 2008 and November 30, 2009 were included.

Interventions: Blood lactate concentration was measured on a blood gas analyzer for all blood gas assessments obtained for clinical care. Hyperlactatemia was defined as lactate >2.2 mmol/L and lactic acidosis as lactate >5 mmol/L and pH <7.35. If lactate concentration was >5 mmol/L, consent was requested for measuring blood lactate and pyruvate using enzymatic laboratory methods. Lactate/pyruvate ratio >25:1 indicated type A lactic acidosis.

Measurements and Main Results: Eighty-seven (83%) children had lactate >2.2 mmol/L and 47 (45%) had lactate >5 mmol/L. Of those with lactate >5 mmol/L, 33 (70%) had corresponding blood pH <7.35. Lactate/pyruvate ratios were obtained for 16 patients. Of these, lactate/pyruvate ratio was <10 in three patients; 10–25 in 11; >25 in one; and indeterminate in one.

Conclusions: Lactic acidosis is common in children with acute severe asthma and is primarily type B occurring in the presence of normal oxygen delivery.

©2012The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies


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