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Open AccessArticle

Selective ß2-Adrenoceptor Agonists and Relevant Hyperlactatemia: Systematic Review and Meta-Analysis

Department of Internal Medicine, Ente Ospedaliero Cantonale, 6600 Locarno, Switzerland
Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, 1010 Lausanne, Switzerland
Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
Faculty of Biology and Medicine, University of Lausanne, 1000 Lausanne, Switzerland
Author to whom correspondence should be addressed.
These authors equally contributed to this work.
J. Clin. Med. 2020, 9(1), 71;
Received: 5 November 2019 / Revised: 20 December 2019 / Accepted: 22 December 2019 / Published: 27 December 2019
(This article belongs to the Section Pharmacology)
Selective ß2-agonists have been imputed as potential cause of l-hyperlactatemia since the 1970s. To document the prevalence of hyperlactatemia associated with selective ß2-agonists and to investigate the predisposing factors, we searched for published articles until April 2019 pertaining to the interplay of administration of selective ß2-agonists and circulating l-lactic acid in the Excerpta Medica, Web of Science, and the U.S. National Library of Medicine databases. Out of the 1834 initially retrieved records, 56 articles were included: 42 papers reporting individual cases, 2 observational studies, and 12 clinical trials. Forty-seven individual patients receiving a selective ß2-agonist were found to have l-lactatemia ≥5.0 mmol/L, which decreased by ≥3.0 mmol/L or to ≤2.5 mmol/L after discontinuing (N = 24), reducing (N = 17) or without modifying the dosage of the selective ß2-agonist (N = 6). Clinical trials found that l-lactic acid significantly increased in healthy volunteers administered a ß2-agonist. l-lactatemia ≥5.0 mmol/L was observed in 103 (24%) out of 426 patients with asthma or preterm labor managed with a selective ß2-agonist and was more common in patients with asthma (30%) than in premature labor (5.9%). A significant relationship was also noted between l-lactate level and intravenous albuterol dose or its circulating level. In conclusion, relevant l-hyperlactatemia is common on high dose treatment with a selective ß2-agonist. View Full-Text
Keywords: acidosis; Kussmaul breathing; lactate; lactic acid; ß2-adrenoceptor agonist acidosis; Kussmaul breathing; lactate; lactic acid; ß2-adrenoceptor agonist
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Liedtke, A.G.; Lava, S.A.G.; Milani, G.P.; Agostoni, C.; Gilardi, V.; Bianchetti, M.G.; Treglia, G.; Faré, P.B. Selective ß2-Adrenoceptor Agonists and Relevant Hyperlactatemia: Systematic Review and Meta-Analysis. J. Clin. Med. 2020, 9, 71.

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