9-39: Hyperventilation Syndromes

Hyperventilation is an increase in alveolar minute ventilation that leads to hypocapnia. It may be caused by a variety of conditions, such as pregnancy, hypoxemia, obstructive and infiltrative lung diseases, sepsis, liver dysfunction, fever, and pain. Functional hyperventilation may be acute or chronic. Acute hyperventilation presents with hyperpnea, anxiety, paresthesias, carpopedal spasm, and tetany. Chronic hyperventilation may present with various nonspecific symptoms, including fatigue, dyspnea, anxiety, palpitations, and dizziness. The diagnosis of chronic hyperventilation syndrome is established if symptoms are reproduced during voluntary hyperventilation. Once organic causes of hyperventilation have been excluded, treatment of acute hyperventilation consists of breathing through pursed lips or through the nose with one nostril pinched or rebreathing expired gas from a paper bag held over the face to decrease respiratory alkalemia and its associated symptoms. Anxiolytic drugs may also be useful. Central neurogenic hyperventilation denotes a monotonous, sustained pattern of rapid and deep breathing seen in comatose patients with brainstem injury of multiple causes.