{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:39:49Z","timestamp":1760132389084,"version":"3.40.4"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,4,25]]},"abstract":"<jats:p>A 66-year-old man, an asthmatic, presented with symptoms suggestive of an acute exacerbation of asthma. His arterial blood gas revealed type 1 respiratory failure (PaO<jats:sub>2<\/jats:sub>&lt;8\u2005kPa or 60\u2005mm\u2005Hg with normal or low PaCO<jats:sub>2<\/jats:sub>) with a compensated lactic acidosis. He was treated for an asthma exacerbation and sepsis. Despite treatment, his respiratory rate remained elevated although his hypoxaemia improved. There was progressive worsening of the lactic acidosis. Treatment for sepsis was augmented. Peak flow measurements were not used to assess the severity of his exacerbation nor his response to treatment. An alternate diagnosis of acute coronary syndrome with acute pulmonary oedema was made and his asthma treatment was stopped. This coincided with a decline in his serum lactate. A diagnosis of salbutamol-induced lactic acidosis (SILA) was made. SILA is a relatively common complication of salbutamol therapy in moderate\/severe asthma exacerbations. It is caused by a mechanism different from the lactataemia that is associated with septic shock and life-threatening asthma.<\/jats:p>","DOI":"10.1136\/bcr-2016-214360","type":"journal-article","created":{"date-parts":[[2016,5,10]],"date-time":"2016-05-10T16:11:18Z","timestamp":1462896678000},"page":"bcr2016214360","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Conundrum in an asthma exacerbation"],"prefix":"10.1136","volume":"2016","author":[{"given":"Barney Thomas Jesudason","family":"Isaac","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"McLellan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnson","family":"Samuel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard","family":"Yung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,5,10]]},"reference":[{"key":"2025042703215800000_2016.may10_1.bcr2016214360.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1309483"},{"key":"2025042703215800000_2016.may10_1.bcr2016214360.2","doi-asserted-by":"crossref","first-page":"pii: bcr2013201015","DOI":"10.1136\/bcr-2013-201015","article-title":"Inhaled \u03b2-agonist therapy and respiratory muscle fatigue as under-recognised causes of lactic acidosis","volume":"2013","author":"Lau","year":"2013","journal-title":"BMJ Case Rep"},{"key":"2025042703215800000_2016.may10_1.bcr2016214360.3","first-page":"a420","article-title":"An unusual case of lactic acidosis","volume":"4","author":"Ganaie","year":"2011","journal-title":"BJMP"},{"key":"2025042703215800000_2016.may10_1.bcr2016214360.4","doi-asserted-by":"crossref","first-page":"378","DOI":"10.2310\/8000.2012.110581","article-title":"Lactic acidosis following intentional overdose by inhalation of salmeterol and fluticasone","volume":"14","author":"Manara","year":"2012","journal-title":"CJEM"},{"key":"2025042703215800000_2016.may10_1.bcr2016214360.5","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2003.012039"},{"issue":"1","key":"2025042703215800000_2016.may10_1.bcr2016214360.6","first-page":"i1","article-title":"British guideline on the management of asthma","volume":"69","author":"British Thoracic Society","year":"2014","journal-title":"Thorax"},{"key":"2025042703215800000_2016.may10_1.bcr2016214360.7","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1159\/000193721","article-title":"Metabolic acidosis in status asthmaticus","volume":"33","author":"Roncoroni","year":"1976","journal-title":"Respiration"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-214360","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T10:22:02Z","timestamp":1745749322000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-214360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,10]]},"references-count":7,"alternative-id":["10.1136\/bcr-2016-214360"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-214360","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2016,5,10]]}}}