Improving Outcomes, Improving Throughput, Mythbusting

Albuterol: Sepsis Mimic

In today’s day and age of overtesting, some providers will not send home a patient with an abnormal lactic acid at all, regardless of etiology. So let’s examine what can possibly cause abnormalities of the current apple of our sepsis eye.

Here, 28 healthy subjects were randomized to placebo or 10 mg of nebulized albuterol over an hour. This is what many of us would consider “an hour long treatment” – or about 4 of those plastic neb vials. Serum lactate (and serum potassium as well) was measured prior to treatment, and at 30 minutes and 70 minutes after the start of treatment.

In the 14 patients receiving albuterol, their lactate went up on average 0.77 mmol/L vs a decrease of 0.15 mmol/L for the placebo group, while serum potassium levels went down by 0.5 mEq/L in the treatment arm vs no change in the placebo arm.

In our current overdiagnosis induced sepsis frenzy, if you must order a lactic acid, do it before giving albuterol, or better yet, if there is clearly some other reason for dyspnea aside from an infectious etiology (asthma or COPD that require immediate albuterol) – don’t order a lactic at all and document that an infectious etiology is not the cause of today’s abnormal vital signs.