Lactic acidosis is a frequent laboratory finding in patients with severe ex
acerbations of asthma. The pathogenesis of lactic acidosis in asthma is not
well understood, but it has been presumed, by some, to be generated by fat
iguing respiratory muscles. We herein report the cases of three patients wi
th status asthmaticus and lactic acidosis despite pharmacologic muscle rela
xation. No common etiologies were found for lactic acidosis that abated aft
er bronchospasm improved and the intensity of pharmacologic therapies was r
educed. We review the literature describing lactic acidosis with asthma and
discuss mechanisms by which lactic acidosis may occur in patients with sta
tus asthmaticus.