Hyperventilation-related hyperlactataemia in a case of paroxysmal vocal cord dysfunction

Paroxysmal Vocal Cords Dysfunction(PVCD), also known as paradoxical vocal cord motion, is abnormal adduction of the vocal cords during inspiration. Like asthma, PCVD can be triggered by breathing in lung irritants, upper respiratory infection or exercise. However, unlike asthma, PCVD is not an immune system reaction and does not involve the lower airways. Treatment for the two conditions differs. Plasma lactate levels are usually associated with acidosis and an increased risk of poor outcome and are described in a number of disease states of circulatory and/or respiratory failure. In patients with psychogenic hyperventilation, high lactates are associated with hypocapnia and alkalosis and should not necessarily be considered as an adverse sign. We describe a case of a young patient with PCVD mimicking asthma with high plasma lactate and discuss the mechanisms involved.