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Asthma is one of the most prevalent chronic respiratory diseases, characterized by bronchial hyper-responsiveness and intermittent airflow obstruction. Short-acting β 2  agonists (SABA) remain the cornerstone of acute asthma management due to its properties in smooth muscle relaxation and bronchodilatation. Rarely, these drugs might be associated with adverse effects, including the development of metabolic and hydro-electrolytic imbalances. We report a case of lactic acidosis secondary to β 2  agonists in a young female patient admitted with severe acute asthma. After initial management and significant improvement of the respiratory distress with nebulized and subcutaneous salbutamol, the patient developed high anion gap metabolic acidosis due to hyperlactacidemia and hypokalemia. Alternative causes of lactic acidosis were discarded, such as severe hypoxemia, systemic hypoperfusion, sepsis, and organ dysfunction, and SABA-related lactic acidosis was suspected. This treatment was halted, and tachypnea, metabolic acidosis, and lactate levels rapidly resolved. The remainder of the hospital stay was uneventful, and the patient was discharged after a period of five days. Although rare, the development of unexplained lactic acidosis in a SABA-treated patient should alert the treating physician to this β2 agonist side-effect., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Miranda et al.)