Minimal dose inhaled salbutamol leading to diastolic hypotension (rare presentation) and significant lactic acidosis mimicking shock, a case report from tertiary care hospital in Ajman, UAE

Salbutamol is a selective β2-receptor agonist widely used to treat asthma in both emergency and outpatient settings. It has been associated with a various side effects ranging from mild to severe in presentation. Lactic acidosis and diastolic hypotension are rarely reported together following intermittent salbutamol nebulization in children, even less so at standard therapeutic doses. We present the case of an 11-year-old Emirati male child, known asthmatic but not on any preventive therapy, who experienced a serious drug reaction during an asthma exacerbation following inhaled salbutamol (5 mg back to back, overall 5 to 10 mg. while he was receiving the second dose of salbutamol nebulization in our emergency department, he developed persistent hypotension (lowest 70/45) despite fluid boluses, also he had elevated blood lactate levels (peak concentration 9 mmol/l), following the hyperglycemia (peak concentration 18 mmol/l), hypokalemia (lowest concentration 3.3 mEq/l).The aforementioned alterations improved within 24 hours after discontinuation of salbutamol and without any further fluid boluses which has been initiated initially at the causality based on the presentation that was mimicking shock status. We reinforce the message that even the use of intermittent nebulized salbutamol for acute moderate asthma can lead to severe transient complications in children. Then, healthcare providers should pay attention not only in emergency settings, to achieve prompt recognition and proper management of this adverse reaction. Careful reassessment could prevent similar reactions and further serious complications.