Background: Previously excessive K+ increase upon exercise has been described in myotonic dystrophy, but not in non-dystrophic myotonias or other muscular dystrophies. However, at that time the differentiation into myotonic dystrophy type 1 (DM1) or type 2 (DM2) was not yet possible. Objective: Resting venous and interstitial (intramuscular) lactate and K+ levels were measured in patients with genetically defined DM1 (n=6) and DM2 (n=6). Control groups included mitochondrial disorders (n=9) and healthy volunteers (n=9). In all individuals venous and interstitial lactate and K+ were analysed upon standardized forearm exercise using both an ischemic and nonischemic protocol. Results: There was no difference in resting venous and interstitial lactate and K+ levels between DM1, DM2, and both control groups. Maximal contraction force (MCF), workload, venous and interstitial lactate increase were significantly lower in DM1 than in the other groups. Patients with DM2 and mitochondrial disorders exhibited intermediate values. Venous and interstitial K+ increases were not different between DM1, DM2, and both control groups. Venous K+ increase related to workload (specific K+ production) was significantly higher in both protocols in patients with DM1, but not in those with DM2 compared to both control groups. In contrast venous lactate increase related to workload (specific lactate production) was not different in all four groups. Due to the used temporal resolution the interstitial increases were less pronounced than in venous blood. Conclusion: An abnormally high increase of venous K+ upon exercise seems to be specific for DM1 but could not be observed in DM2. Even if a higher K+ production upon exercise might be related to myotonia in DM1, other mechanisms seems to be responsible in DM2. For example, altered splicing has been shown for the small conductance Ca 2+-activiated K+-channel (apamin receptor) mRNA and might contribute to increased K+ release and subsequently to myotonic phenomenon in DM1.