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Yu Y, Fang B, Yang XD, Zheng Y. One stone two birds: anti-inflammatory bronchodilators as a potential pharmacological strategy for COVID-19. Front Pharmacol 2023; 14:1185076. [PMID: 37214443 PMCID: PMC10192734 DOI: 10.3389/fphar.2023.1185076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
The ongoing Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has imposed a huge threat to public health across the world. While vaccinations are essential for reducing virus transmission and attenuating disease severity, the nature of high mutation rate of SARS-CoV-2 renders vaccines less effective, urging quick development of effective therapies for COVID-19 disease. However, developing novel drugs remains extremely challenging due to the lengthy process and high cost. Alternatively, repurposing of existing drugs on the market represents a rapid and safe strategy for combating COVID-19 pandemic. Bronchodilators are first line drugs for inflammatory lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD). Compared to other anti-inflammatory drugs repurposed for COVID-19, bronchodilators are unique in that they have both anti-inflammatory and bronchodilating properties. Whether the dual properties of bronchodilators empower them greater potential to be repurposed for COVID-19 is worth exploring. In fact, clinical and preclinical studies have recently emerged to investigate the benefits of bronchodilators such assalbutamol, formoterol and theophylline in treating COVID-19, and many of them have shown encouraging efficacy on attenuating disease severity of pneumonia and other associated symptoms. To comprehensively understand the latest progress on COVID-19 intervention with bronchodilators, this review will summarize recent findings in this area and highlight the promising clinical benefits and possible adverse effects of bronchodilators as therapeutic options for COVID-19 with a focus on β2 receptor agonists, anticholinergic drugs and theophylline.
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Affiliation(s)
- Yuanyuan Yu
- The Research Center for Traditional Chinese Medicine, Shanghai Institute of Infectious Diseases and Biosecurity, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Center for Traditional Chinese Medicine and Immunology Research, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bangjiang Fang
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Dong Yang
- The Research Center for Traditional Chinese Medicine, Shanghai Institute of Infectious Diseases and Biosecurity, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Center for Traditional Chinese Medicine and Immunology Research, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuejuan Zheng
- The Research Center for Traditional Chinese Medicine, Shanghai Institute of Infectious Diseases and Biosecurity, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Center for Traditional Chinese Medicine and Immunology Research, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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2
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Glaser NS, Stoner MJ, Kwok MY, Quayle KS, Brown KM, Schunk JE, Trainor JL, McManemy JK, Tzimenatos L, Rewers A, Nigrovic LE, Bennett JE, Myers SR, Smith M, Casper TC, Kuppermann N. Relationships among biochemical measures in children with diabetic ketoacidosis. J Pediatr Endocrinol Metab 2023; 36:313-318. [PMID: 36637392 PMCID: PMC9986464 DOI: 10.1515/jpem-2022-0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Investigating empirical relationships among laboratory measures in children with diabetic ketoacidosis (DKA) can provide insights into physiological alterations occurring during DKA. We determined whether alterations in laboratory measures during DKA conform to theoretical predictions. METHODS We used Pearson correlation statistics and linear regression to investigate correlations between blood glucose, electrolytes, pH and PCO2 at emergency department presentation in 1,681 pediatric DKA episodes. Among children with repeat DKA episodes, we also assessed correlations between laboratory measures at the first vs. second episode. RESULTS pH and bicarbonate levels were strongly correlated (r=0.64), however, pH and PCO2 were only loosely correlated (r=0.17). Glucose levels were correlated with indicators of dehydration and kidney function (blood urea nitrogen (BUN), r=0.44; creatinine, r=0.42; glucose-corrected sodium, r=0.32). Among children with repeat DKA episodes, PCO2 levels tended to be similar at the first vs. second episode (r=0.34), although pH levels were only loosely correlated (r=0.19). CONCLUSIONS Elevated glucose levels at DKA presentation largely reflect alterations in glomerular filtration rate. pH and PCO2 are weakly correlated suggesting that respiratory responses to acidosis vary among individuals and may be influenced by pulmonary and central nervous system effects of DKA.
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Affiliation(s)
- Nicole S Glaser
- Department of Pediatrics, University of California, Davis Health, University of California Davis, School of Medicine, Sacramento, USA
| | - Michael J Stoner
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, USA
| | - Maria Y Kwok
- Division of Emergency Medicine, Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, USA
| | - Kimberly S Quayle
- Division of Emergency Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, Saint Louis, USA
| | - Kathleen M Brown
- Division of Emergency Medicine, Department of Pediatrics, Children's National Medical Center, The George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Jeff E Schunk
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - Jennifer L Trainor
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Julie K McManemy
- Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, USA
| | - Leah Tzimenatos
- Department of Emergency Medicine, University of California Davis Health, University of California Davis, School of Medicine, Sacramento, USA
| | - Arleta Rewers
- Division of Emergency Medicine, Department of Pediatrics, The Colorado Children's Hospital, University of Colorado-Denver School of Medicine, Denver, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Jonathan E Bennett
- Division of Emergency Medicine, Nemours/A.I. DuPont Hospital for Children, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Sage R Myers
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - McKenna Smith
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - T Charles Casper
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - Nathan Kuppermann
- Department of Pediatrics, University of California, Davis Health, University of California Davis, School of Medicine, Sacramento, USA.,Department of Emergency Medicine, University of California Davis Health, University of California Davis, School of Medicine, Sacramento, USA
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3
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Ma L, Russo C, Singaraju R. Albuterol, Acidosis, and Aneurysms. Fed Pract 2021; 38:209-211. [PMID: 34177229 DOI: 10.12788/fp.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient with a complicated medical history on admission for dyspnea was administered nebulizer therapy but after 72 hours developed asymptomatic acute kidney injury and anion-gap metabolic acidosis.
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Affiliation(s)
- Lucy Ma
- is a Resident, and is an Attending Physician, both at the National Capital Consortium in Bethesda. is a Medical Student at the Uniformed Services University of the Health Sciences in Bethesda, all in Maryland
| | - Christopher Russo
- is a Resident, and is an Attending Physician, both at the National Capital Consortium in Bethesda. is a Medical Student at the Uniformed Services University of the Health Sciences in Bethesda, all in Maryland
| | - Raj Singaraju
- is a Resident, and is an Attending Physician, both at the National Capital Consortium in Bethesda. is a Medical Student at the Uniformed Services University of the Health Sciences in Bethesda, all in Maryland
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4
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Bayrak O, Aksay E, Oray NC, Bayram B, Sakar S. Does salbutamol associated with increase in lactate levels in emergency department patients? J Crit Care 2020; 61:29-33. [PMID: 33070026 DOI: 10.1016/j.jcrc.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Ozlem Bayrak
- Dokuz Eylul Universitesi Tip Fakultesi, Izmir, Turkey
| | - Ersin Aksay
- Dokuz Eylul Universitesi Tip Fakultesi, Izmir, Turkey.
| | | | - Basak Bayram
- Dokuz Eylul Universitesi Tip Fakultesi, Izmir, Turkey
| | - Sebnem Sakar
- Dokuz Eylul Universitesi Tip Fakultesi, Izmir, Turkey
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5
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Meegada S, Muppidi V, Siddamreddy S, Challa T, Katta SK. Albuterol-Induced Type B Lactic Acidosis: Not an Uncommon Finding. Cureus 2020; 12:e8269. [PMID: 32494543 PMCID: PMC7263006 DOI: 10.7759/cureus.8269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lactic acidosis (LA) is usually a medical emergency diagnosed by laboratory evaluation in emergency rooms (ERs) and hospital settings in critically ill patients. LA is classified into two major types based on pathophysiology; type A results from tissue hypoxia and/or hypoperfusion and type B results from deranged metabolic activity in the cells in the absence of hypoxia/hypoperfusion. Prompt evaluation and treatment are essential to prevent morbidity and mortality, especially in patients with type A LA. Most cases of LA are due to type A (hypoperfusion/hypoxia). However, with increased testing of lactic acid levels in ERs and hospitals, we are encountering a few cases of type B LA as well. Diagnosing the exact type is crucial because of differences in management. We here describe a patient with albuterol-induced type B LA, which resolved after discontinuing the albuterol breathing treatments.
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Affiliation(s)
- Sreenath Meegada
- Internal Medicine, University of Texas Health Science Center/Christus Good Shepherd Medical Center, Longview, USA
| | | | | | - Tejo Challa
- Internal Medicine, University of Texas Health Science Center/Christus Good Shepherd Medical Center, Longview, USA
| | - Shravan K Katta
- Internal Medicine, Texas Health Arlington Memorial Hospital, Arlington, USA.,Internal Medicine, University of Texas, Arlington, USA
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Smith ZR, Horng M, Rech MA. Medication‐Induced Hyperlactatemia and Lactic Acidosis: A Systematic Review of the Literature. Pharmacotherapy 2019; 39:946-963. [DOI: 10.1002/phar.2316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Zachary R. Smith
- Department of Pharmacy Services Henry Ford Hospital Detroit Michigan
| | - Michelle Horng
- Department of Pharmacy Services The University of Texas MD Anderson Cancer Center Houston Texas
| | - Megan A. Rech
- Department of Pharmacy Loyola University Medical Center Maywood Illinois
- Department of Emergency Medicine Stritch School of Medicine Loyola University Chicago Chicago Illinois
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7
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[Hyperlactatemia induced by inhaled β2 agonists: An underrecognized side effect. Report of two cases]. Rev Med Interne 2018; 40:400-403. [PMID: 30541659 DOI: 10.1016/j.revmed.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/11/2018] [Accepted: 11/23/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repeated use of inhaled β2 agonists is common in asthma or COPD exacerbations. It can lead to hyperlactatemia. CASE REPORTS We report two asthmatic patients who presented in the emergency department for an asthma exacerbation. The first patient developed hyperlactatemia at 3.9 mmol/L and the second patient developed hyperlactatemia at 5.6 mmol/L after terbutaline treatment. Both patients had a favorable outcome after adjusting the aerosol dose to clinical parameters. DISCUSSION Lactic acidosis induced by the use of inhaled β2 agonists is not synonymous of clinical deterioration. However, this side effect may be complicated by a tachypnea compensating for metabolic acidosis and should be known to avoid unnecessary therapeutic escalation.
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8
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Tan LC, Yang WJ, Fu WP, Su P, Shu JK, Dai LM. 1H-NMR-based metabolic profiling of healthy individuals and high-resolution CT-classified phenotypes of COPD with treatment of tiotropium bromide. Int J Chron Obstruct Pulmon Dis 2018; 13:2985-2997. [PMID: 30310274 PMCID: PMC6166752 DOI: 10.2147/copd.s173264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Heterogeneity of COPD results in different therapeutic effects for different patients receiving the same treatment. COPD patients need to be individually treated according to their own characteristics. The purpose of this study was to explore the differences in different CT phenotypic COPD by molecular metabolites through the use of metabolomics. Methods According to the characteristics of CT imaging, 42 COPD patients were grouped into phenotype E (n=20) or phenotype M (n=24). Each COPD patient received tiotropium bromide powder for inhalation for a therapeutic period of 3 months. All subjects were assigned into phenotype E in pre-therapy (EB, n=20), phenotype E in post-therapy (EA, n=20), phenotype M in pre-therapy (MB, n=22), phenotype M in post-therapy (MA, n=22), or normal control (N, n=24). The method of metabolomics based on 1H nuclear magnetic resonance (1H-NMR) was used to compare the changes in serum metabolites between COPD patients and normal controls and between different phenotypes of COPD patients in pre- and post-therapy. Results Patients with COPD phenotype E responded better to tiotropium bromide than patients with COPD phenotype M in terms of pulmonary function and COPD assessment test scores. There were differences in metabolites in COPD patients vs normal control people. Differences were also observed between different COPD phenotypic patients receiving the treatment in comparison with those who did not receive treatment. The changes of metabolites involved lactate, phenylalanine, fructose, glycine, asparagine, citric acid, pyruvic acid, proline, acetone, ornithine, lipid, pyridoxine, maltose, betaine, lipoprotein, and so on. These identified metabolites covered the metabolic pathways of amino acids, carbohydrates, lipids, genetic materials, and vitamin. Conclusion The efficacy of tiotropium bromide on COPD phenotype E is better than that of phenotype M. Metabolites detected by 1H-NMR metabolomics have potentialities of differentiation of COPD and healthy people, discrimination of different COPD phenotypes, and giving insight into the individualized treatment of COPD.
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Affiliation(s)
- Li-Chuan Tan
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, People's Republic of China,
| | - Wen-Jie Yang
- Department of Respiratory, Baoshan People's Hospital, Baoshan 678000, People's Republic of China
| | - Wei-Ping Fu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, People's Republic of China,
| | - Ping Su
- Department of Respiratory, Baoshan People's Hospital, Baoshan 678000, People's Republic of China
| | - Jing-Kui Shu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, People's Republic of China,
| | - Lu-Ming Dai
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, People's Republic of China,
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9
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Septic shock without hyperlactatemia. Am J Emerg Med 2017; 35:934.e3-934.e4. [DOI: 10.1016/j.ajem.2016.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/11/2016] [Indexed: 11/20/2022] Open
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10
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Singh B, Jana SK, Ghosh N, Das SK, Joshi M, Bhattacharyya P, Chaudhury K. Metabolomic profiling of doxycycline treatment in chronic obstructive pulmonary disease. J Pharm Biomed Anal 2016; 132:103-108. [PMID: 27697570 DOI: 10.1016/j.jpba.2016.09.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/07/2016] [Accepted: 09/24/2016] [Indexed: 11/24/2022]
Abstract
Serum metabolic profiling can identify the metabolites responsible for discrimination between doxycycline treated and untreated chronic obstructive pulmonary disease (COPD) and explain the possible effect of doxycycline in improving the disease conditions. 1H nuclear magnetic resonance (NMR)-based metabolomics was used to obtain serum metabolic profiles of 60 add-on doxycycline treated COPD patients and 40 patients receiving standard therapy. The acquired data were analyzed using multivariate principal component analysis (PCA), partial least-squares-discriminant analysis (PLS-DA), and orthogonal projection to latent structure with discriminant analysis (OPLS-DA). A clear metabolic differentiation was apparent between the pre and post doxycycline treated group. The distinguishing metabolites lactate and fatty acids were significantly down-regulated and formate, citrate, imidazole and l-arginine upregulated. Lactate and folate are further validated biochemically. Metabolic changes, such as decreased lactate level, inhibited arginase activity and lowered fatty acid level observed in COPD patients in response to add-on doxycycline treatment, reflect the anti-inflammatory action of the drug. Doxycycline as a possible therapeutic option for COPD seems promising.
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Affiliation(s)
- Brajesh Singh
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, West Bengal 721302, India
| | - Saikat K Jana
- Department of Biotechnology, National Institute of Technology, Arunachal Pradesh, India
| | - Nilanjana Ghosh
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, West Bengal 721302, India
| | - Soumen K Das
- Institute of Pulmocare and Research, Kolkata, India
| | - Mamata Joshi
- National Facility for High-field NMR, Tata Institute of Fundamental Research, Mumbai Pin-400005, India
| | | | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, West Bengal 721302, India.
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Isaac BTJ, McLellan T, Samuel J, Yung B. Conundrum in an asthma exacerbation. BMJ Case Rep 2016; 2016:bcr2016214360. [PMID: 27166007 PMCID: PMC4885350 DOI: 10.1136/bcr-2016-214360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/04/2022] Open
Abstract
A 66-year-old man, an asthmatic, presented with symptoms suggestive of an acute exacerbation of asthma. His arterial blood gas revealed type 1 respiratory failure (PaO2 <8 kPa or 60 mm Hg with normal or low PaCO2) with a compensated lactic acidosis. He was treated for an asthma exacerbation and sepsis. Despite treatment, his respiratory rate remained elevated although his hypoxaemia improved. There was progressive worsening of the lactic acidosis. Treatment for sepsis was augmented. Peak flow measurements were not used to assess the severity of his exacerbation nor his response to treatment. An alternate diagnosis of acute coronary syndrome with acute pulmonary oedema was made and his asthma treatment was stopped. This coincided with a decline in his serum lactate. A diagnosis of salbutamol-induced lactic acidosis (SILA) was made. SILA is a relatively common complication of salbutamol therapy in moderate/severe asthma exacerbations. It is caused by a mechanism different from the lactataemia that is associated with septic shock and life-threatening asthma.
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Affiliation(s)
| | - Thomas McLellan
- Department of Respiratory Medicine, Basildon and Thurrock University Hospital, Basildon, Essex, UK
| | - Johnson Samuel
- Department of Respiratory Medicine, Basildon and Thurrock University Hospital, Basildon, Essex, UK
| | - Bernard Yung
- Department of Respiratory Medicine, Basildon and Thurrock University Hospital, Basildon, Essex, UK
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Pourmand A, Dorwart K, Mazer-Amirshahi M, Nasser S, Shokoohi H. β Agonist–induced lactic acidosis, an evidence-based approach to a critical question. Am J Emerg Med 2016; 34:666-8. [DOI: 10.1016/j.ajem.2015.12.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022] Open
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