On admission to intensive care units, the acid-base profile in acute severe asthma appears to be more diverse than previously. Especially a mixed or less frequently metabolic acidosis is eventually observed, which is not always caused by elevated lactate.

On the other hand, hyperlactatemia is actually rather common, not necessarily accompanied by acidosis. This finding is as a rule related to massive doses of beta 2 adrenergic agents given parenterally: subsequent elevated lactate is in no way a marker of cellular hypoxia and has no pejorative meaning in this event.

Hypercapnia with severe respiratory acidosis implies less and less mechanical ventilation; however, when mandatory, it has to be carried out using permissive hypercapnia, giving more favorable outcome while lowering side-effects.

About the Authors

Lissac J. (1996) Acidosis in severe acute asthma. Presse Med. 1996 Oct 19;25(31):1411-4. Service de Reanimation et Medecine d'Urgence, Hopital Boucicaut, Paris.