Letters to the Editor |

D-Lactate and the False Suffocation Alarm

D. R. Davies, MD; D. D. Davies, MD
Arch Gen Psychiatry. 2002;59(3):287. doi:10.1001/archpsyc.59.3.287.
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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,35 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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