Lactate: panicking doctor or panicking patient?

Abstract

We report a case of a 51-year-old man with a first panic attack associated with high serum lactate due to hyperventilation induced alkalosis. Hyperlactataemia may trigger somatically oriented tests and divert attention from diagnosing panic disorder (PD). Factors associated with underdiagnosis of PD as well as pathophysiology of hyperlactataemia will be discussed.

Hypoxemia in the presence or absence of systemic inflammation does not increase blood lactate levels in healthy volunteers

“…to tightly regulate pH. Therefore, lactic acid levels rise with high intracellular pH, as observed in patients with respiratory alkalosis [6]. In the present work, we demonstrate either very weak or absent correlations between oxygenation parameters and lactate, and a stronger correlation between PaCO 2 and lactate.…”

“…If compensatory mechanisms are sufficient, an increase in cardiac output is likely to maintain adequate delivery of oxygen to the tissues, despite a lower oxygen content. In addition, hypoxemia induces hyperventilation with respiratory alkalosis, which by itself may result in elevated lactate levels through decreased glycolysis [6].…”

Unusual Triggers of the Depression and Anxiety Episodes

“…In the second case, we presume the toxic influence of lactate as the cause of provocation of panic attacks after several calm years. This connection is known from the beginning of existence of panic disease diagnosis [5][6][7]. There are not hypoglycemia's after overdose but the rise of serum lactic acid as the major side effect of higher doses of metformin [8].…”

Lactate: The Fallacy of Oversimplification

“…Apart from adrenergic stimuli, a pH elevation also spins the wheels of glycolysis; therefore, respiratory alkalosis causes lactate elevation. This fact can be observed in panic attacks [24], as well as in the case of salicylate toxicity, with direct central stimulation of ventilation [25] combined with cell-metabolism disturbances.…”