from ventolin to acid lactate???

Treated a patient last week with back to back ventolin and back to back and back to back.... Well actully she was transfert to me after many treatment. An ABG was done. Her lactate was 8. The RT said it was porbably induce by the ventolin. 2 questions:

1) Any data or study that support the use of back to back ventolin?

2) what is the physiology of the production of lactate from ventolin neb?

Yeah, the RT was actually right on this one. A couple of studies have been done that show this. Elevated PaCO2 and increased amounts of circulating epi and norepi are thought to be a major contributor to the increased lactate. Once the bronchospasm resolves, the lactate will go down. Here is a link to one study.

Rodrigo, G. J. & Rodrigo, C. (2005). Elevated plasma

lactate level associated with high dose inhaled albuterol therapy in acute severe asthma. Emergency Medical Journal. 22, 404-408.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15911945&dopt=Abstract

thanks alot!!