The false suffocation alarm hypothesis was proposed by Klein1 in light of his and his colleagues' earlier finding
that D-lactate infusion was almost as effective as L-lactate in inducing panic
attacks.2 This hypothesis has now become
widely accepted, but in our view, it is fundamentally flawed.
Klein's assumption was that D-lactate could not be metabolized by humans,
and he drew the conclusion from his findings that theories of lactate-induced
panic requiring metabolism of the lactate were invalid. There was at the time
a considerable literature demonstrating that D-lactate is metabolized by humans,3- 5
and this has grown6 with the confirmation
that enzymes required for this are present in humans.7
Additionally, the data presented by the Columbia Group2
are indicative that D-lactate was being metabolized by their subjects. Specifically,
changes in venous bicarbonate, pH, PCO2, and plasma phosphate induced
by infusions of D-lactate and DL-lactate, were statistically indistinguishable,
indicating that both were undergoing similar metabolic fates and producing
similar physiological effects in blood chemistry.
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