Treatment

Intensive care treatment of the poorly responsive asthmatic patient should include high concentrations of inspired oxygen, continuous nebulisation of b agonists, intravenous corticosteroids, and respiratory support.27-29 Clinicians must be aware of the need to optimise oxygenation and avoid dehydration and hypokalaemia. Unrestricted high concentrations of oxygen (60-100%) must be administered to abolish hypoxaemia,27 30 unlike the patient with chronic obstructive lung disease where controlled limited oxygen is indicated.

Hypokalaemia is common and may be exaggerated by fluid resuscitation and the administration of b agonist bronchodila-tors. Repeated infusions of potassium chloride may be required with careful monitoring of serum levels and continuous ECG monitoring.

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