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Nebulised salbutamol tachycardia — GPhC CRA MCQ

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HardRespiratory TherapeuticsNebulised salbutamol tachycardiaGPhC CRA

During treatment of acute severe asthma, a patient receives repeated high-dose nebulised salbutamol. Wheeze and peak flow improve, but tachypnoea persists; lactate rises to 6 mmol/L with metabolic acidosis. What is the best interpretation?

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Correct answer: A — Suspect salbutamol-related lactic acidosis and reassess beta-2-agonist dosing

Explanation lettering: E = shown as A · A = shown as C · C = shown as D · D = shown as E

A risks a feedback loop: compensatory hyperventilation can mimic treatment failure despite improving airflow. B ignores a recognised high-dose nebulised salbutamol effect, though other causes including sepsis must still be assessed. C is over-absolute and could leave severe asthma untreated. D treats neither the cause nor the whole patient. E is correct: review clinical airflow measures, lactate and acid-base status and reduce inappropriate beta-2-agonist intensification while continuing guideline-based management of the exacerbation.

Reference: Salbutamol 2 mg/mL nebuliser solution SmPC. https://www.medicines.org.uk/emc/product/10257/smpc