[Effect of therapeutic hyperventilation on blood lactate concentration]

The increase of blood lactate is a well known side effect of active and passive hyperventilation. In 22 patients who underwent controlled respiration after head injury or elective neurosurgical operations, we measured lactate, pyruvate, pH, and bicarbonate in central venous blood and investigated their interference by hypocapnia. The level of ventilation was between pCO2 equal 25 mmHg and pCO2 equal 45 mmHg, measured in the central venous blood. With decreasing pCO2, pH showed an increasing (from 7.40 +/- 0.015 to 7.50 +/- 0.068) and bicarbonate a decreasing tendency (from 25.46 +/- 1.32 mMol/l to 23.28 +/- 3.76 mMol/l). Lactate and pyruvate remained within the normal range down to a central venous pCO2 of 31 mmHg. But then with increasing hypocapnia both increased significantly (lactate 2.001 +/- 1.08 mMol/l, 0.098 +/- 0.068 mMol/l). At a pCO2-range of 25-27 mmHg (central venous) lactate continued increasing to 2.212 +/- 0.995 mMol/l whereas pyruvate dropped to 0.087 +/- 0.05 mMol/l. Therefore the possibility of hypocapnia-induced lacticemia seems to arise at a ventilation level less than 30 mmHg (pCO2 central venous). Production of excess-lactate may begin at a central venous pCO2 of 27 mmHg.