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1.02 Hyperventilation


Presentation

The patient is anxious and complains of shortness of breath and an inability to fill the lungs adequately. A patient may also have palpitations, chest or abdominal pain, and tingling or numbness around the mouth and fingers, or possibly even flexor spasm of the hands and feet. His respiratory volume is increased, which may be apparent by an increased respiratory rate, or only be an increased tidal volume or frequent sighing. The remainder of the physical examination is normal. The patient's history may reveal an obvious precipitating emotional cause (such as having been caught stealing or being in the midst of a family quarrel).

What to do:

What not to do:

Discussion

The acute metabolic alkalosis of hyperventilation causes transient imbalances of calcium, potassium, and perhaps other ions, with the net effect of increasing the irritability and spontaneous depolarization of excitable muscles and nerves. First-time victims of the hyperventilation syndrome are the most apt to visit the ED, and this is an excellent time to educate them about its pathophysiology and the prevention of recurrence. Repeat visitors may be overly excitable or may have emotional problems and need counseling.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD