Effect of lactate infusions on patients with myasthenia gravis

Abstract
Certain myasthenic patients may show that their skeletal muscles produce a substance during ischemic exercise that increases muscle weakness when released into the circulation. This phenomenon has been named after Mary Walker, the physician who popularized its demonstration. A new hypothesis explains the Mary Walker phenomenon as follows: Ischemic exercise produces lactic acid that binds calcium-reducing ionized and total serum calcium. The decreased calcium has an adverse effect on skeletal muscle function, especially in patients with myasthenia gravis, whose neuro muscular function is often so precarious it may be interrupted by weak inhibitors. To support this hypothesis we present evidence that infusions of lactate have a greater adverse effect on patients who have myasthenia gravis than on patients who have nonmyasthenic neuromuscular diseases.

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