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NDT Advance Access published online on October 21, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn585
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Exaggerated compensatory response to acute respiratory alkalosis in panic disorder is induced by increased lactic acid production

Yoshiyasu Ueda1, Masayo Aizawa2, Atsushi Takahashi2, Masamitsu Fujii2 and Yoshitaka Isaka1,3

1 Department of Nephrology, Osaka University Graduate School of Medicine, Suita 2 Osaka Kousei-Nenkin Hospital, Osaka 3 Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Suita, Japan

Correspondence and offprint requests to: Yoshitaka Isaka, Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. Tel: +81-6-6879-3746; Fax: +81-6-6879-3749; E-mail: isaka{at}att.med.osaka-u.ac.jp



  Abstract

Background. In acute respiratory alkalosis, the severity of alkalaemia is ameliorated by a decrease in plasma [HCO3–] of 0.2 mEq/L for each 1 mmHg decrease in PaCO2. Although hyperventilation in panic disorder patients is frequently encountered in outpatients, the drop in plasma [HCO3–] sometimes surpasses the expectation calculated from the above formula. The quantitative relationship between reduced PaCO2 and plasma [HCO3–] in acute respiratory alkalosis has not been studied in panic disorder patients. Our objective was to provide reference data for the compensatory metabolic changes in acute respiratory alkalosis in panic disorder patients.

Methods. In 34 panic disorder patients with hyperventilation attacks, we measured arterial pH, PaCO2, plasma [HCO3–] and lactate on arrival at the emergency room.

Results. For each decrease of 1 mmHg in PaCO2, plasma [HCO3–] decreased by 0.41 mEq/L. During hypocapnia, panic disorder patients exhibited larger increases in serum lactate levels (mean ± SD; 2.59 ± 1.50 mmol/L, range; 0.78–7.78 mmol/L) than previously reported in non-panic disorder subjects. Plasma lactate accumulation was correlated with PaCO2 (P < 0.001).

Conclusions. These results suggest that the compensatory metabolic response to acute respiratory alkalosis is exaggerated by increased lactic acid production in panic disorder patients. Here, we call attention to the diagnosis of acid–base derangements by means of plasma [HCO3–] and lactate concentration in panic disorder patients.

Keywords: lactic acid; panic disorder; respiratory alkalosis

Received for publication: 18. 7.08
Accepted in revised form: 24. 9.08


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