Peskind E R, Jensen C F, Pascualy M, Tsuang D, Cowley D, Martin D C, Wilkinson C W, Raskind M A
Mental Health Service, Mental Illness Research, Education and Clinical Center, University of Washington School of Medicine, Seattle, USA.
Biol Psychiatry. 1998 Nov 15;44(10):1007-16. doi: 10.1016/s0006-3223(98)00053-5.
Although experimental induction of panic by infusion of 0.5 mol/L sodium lactate in persons with panic disorder was described three decades ago, the mechanism underlying this observation remains unclear. Here we asked if the rapid administration of the large sodium load contained in the 0.5-mol/L sodium lactate infusion might be involved in panic induction.
We compared in panic disorder and healthy subjects behavioral, electrolyte, endocrine, and acid-base responses to three double-blind randomly ordered equal volume 20-min infusions: 0.5 mol/L sodium lactate, hypertonic saline (3% sodium chloride), and normal saline placebo.
Sodium lactate (0.5 mol/L) and hypertonic saline produced the same high incidence of panic and equivalent increases in panic symptoms, serum sodium, and plasma vasopressin in the panic disorder subjects. Neither hypertonic infusion increased cortisol or adrenocorticotropin. No normal subject experienced panic in any condition. The 0.5-mol/L sodium lactate infusion induced alkalosis, whereas hypertonic saline and normal saline induced a mild acidosis.
Hypertonic sodium solution containing either chloride or lactate anion induces panic in panic disorder. The large sodium loads delivered by hypertonic saline and 0.5 mol/L sodium lactate may be involved in the mechanism of panic induction.
尽管三十年前就已描述通过向惊恐障碍患者输注0.5摩尔/升乳酸钠来实验性诱发惊恐，但这一观察结果背后的机制仍不清楚。在此，我们探讨0.5摩尔/升乳酸钠输注中所含大量钠负荷的快速给药是否与惊恐诱发有关。
我们比较了惊恐障碍患者和健康受试者对三种双盲、随机排序、等体积的20分钟输注的行为、电解质、内分泌和酸碱反应：0.5摩尔/升乳酸钠、高渗盐水（3%氯化钠）和生理盐水安慰剂。
在惊恐障碍患者中，乳酸钠（0.5摩尔/升）和高渗盐水诱发惊恐的发生率相同，且惊恐症状、血清钠和血浆血管加压素的增加程度相当。两种高渗输注均未增加皮质醇或促肾上腺皮质激素。在任何情况下，正常受试者均未出现惊恐。0.5摩尔/升乳酸钠输注诱发碱中毒，而高渗盐水和生理盐水诱发轻度酸中毒。
含有氯离子或乳酸根阴离子的高渗钠溶液可诱发惊恐障碍患者的惊恐发作。高渗盐水和0.5摩尔/升乳酸钠所带来的大量钠负荷可能参与了惊恐诱发机制。
