We report a case of severe lactic acidosis in a patient undergoing thoracoscopic sympathectomy under general anesthesia who received repeated albuterol.
Lactic acidosis can occur in two different clinically distinguishable categories. The first (type A) occurs when oxygen delivery to the tissues is compromised. The second (type B) occurs when either lactate production is increased or lactate removal is decreased without obvious oxygen delivery problems. 7,8
β-2 Receptor activation produces excess glycogenolysis and lipolysis. 10 Increased glycogenolysis eventually leads to increased concentrations of pyruvate. Pyruvate is converted to acetyl CoA, which enters the citric acid cycle. If pyruvate does not enter this aerobic pathway, it is converted to lactate instead, thereby potentially causing lactic acidosis.
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