What is Hyperventilation Syndrome, Causes and Management

Hyperventilation syndrome is characterized by an increase in alveolar ventilation that leads to hypocapnia.
Central neurogenic hyperventilation occurs in brain stem injury presenting with a sustained pattern of rapid and deep breathing. Causes of hyperventilation may be organic or functional.

Organic causes of Hyperventilation syndrome.
Organic causes of Hyperventilation syndrome are pregnancy, hypoxemia, obstructive and infiltrative lung diseases, sepsis hepatic dysfunction, fever and pain Functional hyperventilation may be acute or chronic, usually due to anxiety.

In the acute form of Hyperventilation syndrome, patient (usually young females) present with rapid breathing, paresthesias, carpopedal spasm, tetany (due to unionization of calcium), chest pain or discomfort, choking sensation, sweating and anxiety.
In the chronic form of Hyperventilation syndrome, the patient presents with fatigue, dyspnea, anxiety, palpitation and dizziness.

Diagnosis of Hyperventilation Syndrome:

Rule out organic causes of Hyperventilation Syndrome
ABGs show low PC02 and increased pH (alkalosis)
Provocation test; voluntary over breathing for 2-3 min provokes similar symptoms.

Management of Hyperventilation syndrome:

Re-breathing into a closed paper bag to increase C02.
Explanation and reassurance.

Hyperventilation syndrome is a common emergency but the diagnosis is late if the emergency doctor is not much experienced. Chest pain, shortness of breath and twitching of hands due tetany are usual presentations. Consider possible organic causes such as sepsis and poisoning etc. and do not give oxygen. Perform ABGs and ask the attendant to bring a paper bag and ask the patient to breathe in this bag, gradually carbon dioxide increases in the blood, tetany disappears and the patient feels better.

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