EPINEPHRINE-INDUCED LACTIC-ACIDOSIS IN THE SETTING OF STATUS-ASTHMATICUS

A relationship between intravenous epinephrine infusion and the develo pment of lactic acidosis has been well described. We report a temporal association between the administration of subcutaneous epinephrine an d the development of lactic acidosis in the setting of status asthmati cus. A 20-year-old woman with a history of asthma came to the emergenc y service in acute respiratory distress and was treated with subcutane ous epinephrine. Six hours later, serial arterial blood gas studies re vealed the onset of a primary metabolic acidosis. Additional diagnosti c studies revealed a serum lactate level of 9.5 mu mol/L. The lactic a cidosis resolved within 15 hours. The patient never exhibited signs of hypotension, hypoxemia, or sepsis, and other potential etiologies for lactic acidosis were excluded. We believe the events of this case con stitute a new observation and theorize a mechanism of peripheral vasoc onstriction and transient tissue hypoperfusion mediated by the subcuta neous epinephrine.