As our sepsis overlords entrenched new \u201cquality measures\u201d and other protocol-driven resuscitation requirements in our Emergency Departments, this article serves as a lovely reminder of the importance of staying cognitively engaged.<\/p>\n
Lactate levels can be elevated by metabolic and microcirculatory derangements related to the spectrum of sepsis \u2013 but also other, non-infectious causes. These include hepatic disease, multiple toxodromes, and multiple medications \u2013 one of the most commonly used being beta-agonist therapy for obstructive airways. This very simple study examines the physiologic changes in healthy volunteers receiving 10mg of nebulized albuterol, as compared with nebulized saline. Placebo volunteers had no change in lactate or placebo. Albuterol receiving volunteers had an average increase in lactate of 0.77 mmol\/L and an average decrease in potassium of 0.5 mEq\/L. Lactate increases, however, were highly variable \u2013 ranging from 0.04 to 2.02 mmol\/L.<\/p>\n
These data aren\u2019t perfectly generalizable to the critically or pseudo-critically ill, but they\u2019re a reasonable starting point for a gross estimate. They\u2019re also justification for reconsideration of potentially inappropriate therapies for an intermediate-range lactate that obstinately refuses to clear \u2013 in the context of receiving multiple rounds of nebulizers.<\/p>\n
At the very least, it\u2019s a reminder of the various exceptions to our protocols we need to consider to prevent costly and avoidable harms.<\/p>\n
\u201cThe Effect of Nebulized Albuterol on Serum Lactate and Potassium in Healthy Subjects\u201d As our sepsis overlords entrenched new \u201cquality measures\u201d and other protocol-driven resuscitation requirements in our Emergency Departments, this article serves as a lovely reminder of the importance of staying cognitively engaged. Lactate levels can be elevated by metabolic and microcirculatory derangements related to the spectrum of sepsis \u2013 but also other, non-infectious causes. These include … Continue reading “Severe Sepsis \u2026 or \u00df-Agonist”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[11,12,25],"tags":[],"class_list":["post-3142","post","type-post","status-publish","format-standard","hentry","category-quality","category-sepsis","category-toxicology"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7KesJ-OG","_links":{"self":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/3142","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3142"}],"version-history":[{"count":0,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/3142\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3142"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3142"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3142"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26857949<\/a><\/p>\n\n