Colleagues,
Could anyone
help with the physiology –
From the
history provided by others: 50 year old gentleman
with longstanding exertional pains in his muscles
of uncertain aetiology, felt
increasingly tired, lightheaded with tingling in
his arms and legs. He was
sweaty and felt he was going to pass out.
On admission
to A+E, his blood gases showed pH 7.59,
pCO2 2.25, pO2 17.4, Bic 16.1 mmol/l, BE -3 with
lactate 6.1 mmol/l. This was
repeated at 6.5 mmol/l. (K 4, adj Ca 2.12, creat
87, normal LFTs)
I assume he
has a partially compensated acute respiratory
alkalosis. From the Oxford Textbook, the
suggestion is that alkalosis has an
effect on phosphofructokinase stimulating
glycolysis. The more pyruvate formed
the more lactate. Given that alkalosis, will stop
NH3 release and stimulate
bicarbonate loss, the effect will be to inhibit
lactate renal excretion. The Oxford textbook
suggests
that mild increase in lactate would occur unless
there was liver dysfunction –
not evident in above case.
Tietz (3rd
edition) suggests that with chronic respiratory
alkalosis, lactate may increase to 2-4 mmol/l from
enhanced glycolysis and
lactate with levels probably ‘owning to a
decrease in hepatic blood flow’.
At review
his lactate was 0.8 mmol/l. Repeat Gases weren’t
undertaken or a bicarbonate requested.
Is anyone
willing to speculate whether the lactate could
rise to 6.5 mmol/l in someone with normal BPand
pulse during this scenario?
Thank you
for your help
Peter
Galloway
Glasgow
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