Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

A case of life-threatening lactic acidosis after smoke inhalation — interference between β-adrenergic agents and ethanol?

  • 30 Accesses

  • 3 Citations


A 49-year-old male developed bronchospasm and severe lactic acidosis after exposition to fire smoke. The correction of lactic acidosis following β-adrenergic agents withdrawal, and the transitory increase in lactate after salbutamol reintroduction are consistent with hypersensitivity to salbutamol. However, the plasma lactate concentration (32.6 mmol/l) that we observed 9.5 h after admission is far above those currently seen after administration of β-adrenergic agents. We searched for causes able to potentiate the adverse effects of these drugs and we noticed that our patient had a high plasma ethanol level (2.4 g/l). Alcohol metabolism in the liver results in generation of high NADH/NAD+ ratios, thus reducing lactate liver clearance. This observation suggests that plasma lactate levels should be monitored closely in alcoholic patients treated with β-mimetic agents.

This is a preview of subscription content, log in to check access.


  1. 1.

    Roncoroni AJ, Adrogué HJA, De Obrutsky CW et al (1976) Metabolic acidosis in status asthmaticus. Respiration 33:85–94

  2. 2.

    Appel D, Rubenstein R, Schrager K et al (1983) Lactic acidosis in severe asthma. Am J Med 75:580–584

  3. 3.

    Braden GL, Johnston SS, Germain MJ et al (1985) Lactic acidosis associated with the therapy of acute bronchospasm. N Engl J Med 313:890–891

  4. 4.

    Assadi FK (1989) Therapy of acute bronchospasm complicated by lactic acidosis and hypokalemia. Clin Pediatr 28:258–260

  5. 5.

    Reed CE (1985) Adrenergic bronchodilators: pharmacology and toxicology. J Allergy Clin Immunol 76:335–341

  6. 6.

    Eldridge F, Salzer J (1967) Effect of respiratory alcalosis on blood lactate and pyruvate in humans. J Appl Physiol 22:461–468

  7. 7.

    Oliva PB (1970) Lactic acidosis. Am J Med 48:209–225

  8. 8.

    Baud FJ, Barriot P, Toffis V et al (1991) Elevated blood cyanide concentrations in fire victims. N Engl J Med 325: 1761–1766

  9. 9.

    Rall TW (1992) Drugs used in the treatment of asthma; the methylxanthines, cromolyn sodium and other agents. In: Goodman Gilman A, Rall TW, Nies AS, Taylor P (eds) The pharmacological basis of therapeutics. MacGraw-Hill, New York, pp 618–637

  10. 10.

    Cohen RD, Woods HF (1976) In: Cohen RD, Woods HF (eds) Clinical and biochemical aspects of lactic acidosis. Blackwell, Oxford

  11. 11.

    Kreisberg RA (1980) Lactate homeostasis and lactic acidosis. Ann Intern Med 92:227–237

  12. 12.

    Campbell CH (1984) The severe lactic acidosis of thiamine deficiency: acute pernicious or fulminating beriberi. Lancet II:446–449

  13. 13.

    Vestal RE, Eiriksson CE, Musser B et al (1983) Effect of intravenous aminophylline on plasma levels of catecholamines and related cardiovascular and metabolic responses in man. Circulation 67:162–171

  14. 14.

    Kelbaek H, Gjorup T, Brynjolf I et al (1985) Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise. Am J Cardiol 55:164–167

  15. 15.

    Stiles GL, Caron MG, Lefkowitz RJ (1984) β-Adrenergic receptors; biochemical mechanisms of physiological regulation. Physiol Rev 64:661–743

  16. 16.

    Massara F, Fassio V, Camanni F et al (1976) Some metabolic and hormonal effects of salbutamol in man. Acta Diabet Lat 13:146–153

  17. 17.

    Sawyer WT, Caravati EM, Ellison MJ et al (1985) Hypokalemia, hyperglycemia and acidosis after intentional theophylline overdose. Am J Emerg Med 3:408–411

  18. 18.

    Krebs HA, Freedland RA, Hems R et al (1969) Inhbition of hepatic gluconeogenesis by ethanol. Biochem J 112:117–120

  19. 19.

    Kreisberg RA, Owen WC, Siegal AM (1971) Ethanol-induced hyperlactacidemia: inhibition of lactate utilization. J Clin Invest 50:166–174

  20. 20.

    Greenway CV, Lautt WW (1990) Acute and chronic ethanol on hepatic oxygen ethanol and metabolism in cats. Am J Physiol 258:G411-G418

  21. 21.

    Zaleski J, Bryla J (1979) Ethanol-induced impairment of gluconeogenesis from lactate in rabbit hepatocytes: correlation with an increased reduction of mitochondrial NAD pool. Int J Biochem 11:237–242

Download references

Author information

Correspondence to P. Taboulet.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Taboulet, P., Clemessy, J.-., Fréminet, A. et al. A case of life-threatening lactic acidosis after smoke inhalation — interference between β-adrenergic agents and ethanol?. Intensive Care Med 21, 1039–1042 (1995).

Download citation

Key words

  • Smoke inhalation
  • Bronchospasm
  • Lactic acidosis
  • Salbutamol
  • Theophylline