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We all have sent labs that we may regret having sent, or "inherit" labs
that we need to deal with (or have been in the situation in which we
"shotgun" labs for a critically ill patient).

Here's a mnemonic for the causes of an elevated lactate I like to use for
the trainees that may be helpful --

[image:
http://pemplaybook.org/podcast/big-labs-little-people-troponin-bnp-d-dimer-and-lactate/]
<http://pemplaybook.org/podcast/big-labs-little-people-troponin-bnp-d-dimer-and-lactate/>

(* "Can't Breathe" refers to anaerobic metabolism from increased WOB)

More pediatric lab work philosophy and practicality:

http://pemplaybook.org/podcast/big-labs-little-people-troponin-bnp-d-dimer-and-lactate/

Feel free to share -- thanks for the discussion --

2016-07-07 8:07 GMT-07:00 TP-A <[log in to unmask]>:

> Continuous Albuterol can cause beta toxicity. They can get vasodilation,
> wide pulse pressure and hypotensive which can mimick sepsis.
>
> While we don't get gases routinely we do get them on our sicker asthmatics
> i.e. Those on nippv/ terb/ etc.
>
> ToniPetrillo,MD
> Emory
>
> On Thursday, July 7, 2016, trzim29 <
> [log in to unmask]> wrote:
>
> > Original email says continuous Albuterol drip...type o or do I have to
> > start reading more...A kid with status asthmaticus huffing and puffing,
> > hypermetabolic from the disease process and the meds, I would not be
> > surprised if elevated. Maybe use like a crp in these particular asthmatic
> > kids, meaning if elevated in conjunction with other specific
> > parameters...Not sure it registers on my Careometer, at this point. Did
> get
> > me thinking...Todd ZGo GreenGo KnicksAnd for laughs, my wife made me get
> a
> > teacup maltese named Chanel...I am now one of them! Don't hate.
> >
> >
> > Sent from my Verizon, Samsung Galaxy smartphone
> > -------- Original message --------From: Gill Winnik <
> > [log in to unmask] <javascript:;>> Date: 7/6/16  9:34 PM
> > (GMT-05:00) To: [log in to unmask] <javascript:;> Subject: Re:
> > Lactic Acidosis and status asthmaticus
> > Most VBG/ABG samples come back with the lactate as well, so we get to see
> > it whether we ordered it or not....
> > Giora
> >
> > Sent from my iPad
> >
> > > On Jul 6, 2016, at 8:00 PM, Rebecca Reamy <[log in to unmask]
> > <javascript:;>> wrote:
> > >
> > > I agree. Why would you check?
> > >
> > >> On Wed, Jul 6, 2016 at 4:56 PM, Simon P. Ros <[log in to unmask]
> > <javascript:;>> wrote:
> > >>
> > >> My question is - how would I know that my asthmatic patient has lactic
> > >> acidosis ? I usually do not send any lab tests on my asthmatic
> patients.
> > >>
> > >> Sent from my iPhone
> > >>
> > >>> On Jul 6, 2016, at 3:51 PM, Tim Horeczko <[log in to unmask]
> > <javascript:;>> wrote:
> > >>>
> > >>> Great discussion item!
> > >>>
> > >>> Albuterol itself can cause a rise in lactate level:
> > >>>
> > >>>
> >
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pubmed_26857949&d=CwIBaQ&c=djx4x_Lu5jS1_mKMB7WBGhXdIwpne1KOnJAaisGB74Q&r=exvi3q-J52PR7GzZVteuwfhRX2j70zxRa9Sp7tvqwdc&m=23S1mr2CN1xAeok00NonfLFLpWwLHh43jfisU3yfo2U&s=LKYAp1gVK_EoNAyoEmJAT85fMF3ai2jq2srdH0OCMz4&e=
> > >>>
> > >>>
> >
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pubmed_26744665&d=CwIBaQ&c=djx4x_Lu5jS1_mKMB7WBGhXdIwpne1KOnJAaisGB74Q&r=exvi3q-J52PR7GzZVteuwfhRX2j70zxRa9Sp7tvqwdc&m=23S1mr2CN1xAeok00NonfLFLpWwLHh43jfisU3yfo2U&s=MhtiWsqGFt7hk_cc66qDGagt_cacQ39WXI-h96QWfRc&e=
> > >>>
> > >>>
> >
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ncbi.nlm.nih.gov_pubmed_24394811&d=CwIBaQ&c=djx4x_Lu5jS1_mKMB7WBGhXdIwpne1KOnJAaisGB74Q&r=exvi3q-J52PR7GzZVteuwfhRX2j70zxRa9Sp7tvqwdc&m=23S1mr2CN1xAeok00NonfLFLpWwLHh43jfisU3yfo2U&s=2AnHUZZXMHJzVSL5WlN2qDaIWvqKcLC2z3bYU5fFgGU&e=
> > >>>
> > >>> The picture can be muddied if there is concomitant infection; also
> > >>> albuterol overdose can cause diastolic hypotension...
> > >>>
> > >>> I think this is a good reminder for us that not all hyperlactatemia
> is
> > >>> sepsis.
> > >>>
> > >>> Interested in others' experience -- thanks!
> > >>>
> > >>> 2016-07-06 12:52 GMT-07:00 Gill Winnik <[log in to unmask]
> > <javascript:;>>:
> > >>>
> > >>>> A recent discussion in our group was the management of child in
> status
> > >>>> asthmaticus and continuous albuterol drip who develops lactic
> > acidosis (
> > >>>> but is does not have any other obvious signs of sepsis).
> > >>>> Can members of the list comment on their experience?
> > >>>>
> > >>>> Giora Winnik MD
> > >>>> Maimonides/Brooklyn
> > >>>>
> > >>>> For more information, send mail to [log in to unmask]
> > <javascript:;> with the
> > >>>> message: info PED-EM-L
> > >>>> The URL for the PED-EM-L Web Page is:
> > >>>>
> >
> https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=CwIBaQ&c=djx4x_Lu5jS1_mKMB7WBGhXdIwpne1KOnJAaisGB74Q&r=exvi3q-J52PR7GzZVteuwfhRX2j70zxRa9Sp7tvqwdc&m=23S1mr2CN1xAeok00NonfLFLpWwLHh43jfisU3yfo2U&s=azZFRUrNhrMyPGB5XhyJjmc57s-1_o5OYuHrOxx7GIg&e=
> > >>>
> > >>> For more information, send mail to [log in to unmask]
> > <javascript:;> with the
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> > >>> The URL for the PED-EM-L Web Page is:
> > >>>
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> > >>
> > >> Confidentiality Notice:
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> > >
> > > For more information, send mail to [log in to unmask]
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> >
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> >
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> >
> >
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> >
>
>
> --
> ~T
>
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> The URL for the PED-EM-L Web Page is:
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>

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