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

Ueda, Yoshiyasu; Aizawa, Masayo; Takahashi, Atsushi; Fujii, Masamitsu; Isaka, Yoshitaka

doi:10.1093/ndt/gfn585

Cited by 14 publications

(16 citation statements)

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“…Increased lactate serum concentration changes other parameters of acid-base status, particularly the consumption of bicarbonates with the consequent increase in base deficit ( 19 ). Higher base deficit in patients with hemodynamically stable PE in our study was a result of increased lactate level and the presence of metabolic lactic acidosis with the respiratory disorder.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of lactates in relation to gas analysis and acid-base status in patients with pulmonary embolism

et al. 2018

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AimTo assess the prognostic value of lactate level for mortality in patients with pulmonary embolism (PE) and Pulmonary Embolism Severity Index (PESI) I-III and its independence of gas-analysis parameters and acid-base status.MethodsThis prospective observational study was conducted at the University Clinical Hospital Mostar from 2013 to 2017. On the first day after PE diagnosis, 1.5 mL of arterial blood was collected from 103 patients with PE. Partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, blood pH value, concentration of bicarbonates in arterial blood (HCO3-), base deficit, and oxygen saturation were analyzed. Lactate levels were assessed using blood samples taken from the cubital vein. Logistic regression analysis was used to assess the predictive value of gas-analysis variables, lactate level, PESI score, age, and sex for in-hospital death due to PE.ResultsThe mortality in the group of PE patients was 19.1% (18 of 103 patients). Lactate level was an independent predictor of mortality (P = 0.002, odds ratio 0.06). HCO3- was also found to be a significant predictor (P = 0.022, odds ratio 2.4). Lactates were independent of other variables. Other gas-analysis parameters were not significant predictors of mortality.ConclusionIn PE patients at low-intermediate risk of mortality (PESI I-III), lactate level was associated with a short-term mortality, independently of other gas-analytic parameters.Oxford Centre for Evidence-based Medicine level of evidence: 2.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of lactates in relation to gas analysis and acid-base status in patients with pulmonary embolism

et al. 2018

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“…16, 21 In addition, neuroimaging studies also raise the possibility of dysregulated acid–base buffering and increased plasma and brain lactate responses to metabolic challenges in PD. 22, 23, 24 There is also a high prevalence of hyperventilation and other respiratory abnormalities among patients with PD. 21, 25, 26 The link between panic attacks and pH disturbances also forms the basis of the false suffocation alarm theory of spontaneous panic, where CO 2 hypersensitivity may exist due to a malfunctioning suffocation alarm monitor.…”

Section: Acidosis An Interoceptive Trigger In Panic: Evidence For Rementioning

confidence: 99%

Acid–base dysregulation and chemosensory mechanisms in panic disorder: a translational update

2015

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Panic disorder (PD), a complex anxiety disorder characterized by recurrent panic attacks, represents a poorly understood psychiatric condition which is associated with significant morbidity and an increased risk of suicide attempts and completed suicide. Recently however, neuroimaging and panic provocation challenge studies have provided insights into the pathoetiology of panic phenomena and have begun to elucidate potential neural mechanisms that may underlie panic attacks. In this regard, accumulating evidence suggests that acidosis may be a contributing factor in induction of panic. Challenge studies in patients with PD reveal that panic attacks may be reliably provoked by agents that lead to acid–base dysbalance such as CO2 inhalation and sodium lactate infusion. Chemosensory mechanisms that translate pH into panic-relevant fear, autonomic, and respiratory responses are therefore of high relevance to the understanding of panic pathophysiology. Herein, we provide a current update on clinical and preclinical studies supporting how acid–base imbalance and diverse chemosensory mechanisms may be associated with PD and discuss future implications of these findings.

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“…Variables with dichotomous outcomes (e.g., sex) were evaluated using Fisher's exact test. As the previous study had shown that the correlation between PCO 2 and lactate was not linear, Spearman's rank correlation coefficient (ρ) was calculated to assess the associations between serum lactate level and pH, PCO 2 , or in each study group (ABG and VBG analysis) [2,4]. Using the same procedure, we conducted a sensitivity analysis using…”

Section: Discussionmentioning

confidence: 99%

“…Studies of arterial blood gas (ABG) analysis in patients with psychogenic hyperventilation have shown an inverse correlation between the arterial partial pressure of carbon dioxide (PaCO 2 ) and the serum lactate level [2,4].…”

Section: Hco −mentioning

confidence: 99%

Clinical Utility of Venous Blood Gas Analysis for the Evaluation of Psychogenic Hyperventilation in the Emergency Department

Urushidani¹,

Kuriyama²,

Matsumura³

2020

Cureus

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

Cited by 14 publications

References 10 publications

Prognostic value of lactates in relation to gas analysis and acid-base status in patients with pulmonary embolism

Prognostic value of lactates in relation to gas analysis and acid-base status in patients with pulmonary embolism

Acid–base dysregulation and chemosensory mechanisms in panic disorder: a translational update

Clinical Utility of Venous Blood Gas Analysis for the Evaluation of Psychogenic Hyperventilation in the Emergency Department

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