PT - JOURNAL ARTICLE AU - Laurence Pearmain AU - Ravi Gupta AU - Rowland J Bright-Thomas TI - Lessons of the month 1: Salbutamol induced lactic acidosis: clinically recognised but often forgotten AID - 10.7861/clinmed.2019-0271 DP - 2020 Jan 01 TA - Clinical Medicine PG - 101--104 VI - 20 IP - 1 4099 - http://www.rcpjournals.org/content/20/1/101.short 4100 - http://www.rcpjournals.org/content/20/1/101.full SO - Clin Med2020 Jan 01; 20 AB - We present the case of an 83-year-old woman, with known asthma, admitted with increasing dyspnoea, wheeze and a productive cough. In addition to maintenance inhaled therapy, the patient was also on long-term mirtazapine and furosemide. Following acute treatment with nebulised salbutamol she became increasingly dyspnoeic and developed a metabolic acidosis with a significantly raised blood lactate level. After cessation of ß2-adrenergic medication, the patient's clinical condition improved with resolution of her lactic acidosis; salbutamol induced lactic acidosis was diagnosed. This clinical scenario is common but not well described. Here we discuss the mechanisms, investigation and management of raised serum lactate and lactic acidosis in the context of acute asthma and the possible interactions of polypharmacy and comorbidities in the acute medical setting.