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This patient must have been panting for a while, so the overworked respiratory muscles would have generated some of this lactate. The acid base picture is not pure respiratory alakalosis, but that of a mixed respiratory alkalosis and metabolic acidosis. What has made him tachypnoeic? thanks Mohammad Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath Consultant Chemical Pathologist ________________________________ From: "Galloway, Peter" <[log in to unmask]> To: [log in to unmask] Sent: Monday, March 25, 2013 10:46 AM Subject: advice in chronic respiratory alkalosis 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 **************************************************************************** NHSGG&C Disclaimer The information contained within this e-mail and in any attachment is confidential and may be privileged. If you are not the intended recipient, please destroy this message, delete any copies held on your systems and notify the sender immediately; you should not retain, copy or use this e-mail for any purpose, nor disclose all or any part of its content to any other person. All messages passing through this gateway are checked for viruses, but we strongly recommend that you check for viruses using your own virus scanner as NHS Greater Glasgow & Clyde will not take responsibility for any damage caused as a result of virus infection. ************************************************************************** ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/