- Richard M Schwartzstein, MD
Richard M Schwartzstein, MD
- Professor of Medicine
- Harvard Medical School
- Jeremy Richards, MD, MA
Jeremy Richards, MD, MA
- Assistant Professor of Medicine
- Medical University of South Carolina
- Jonathan A Edlow, MD, FACEP
Jonathan A Edlow, MD, FACEP
- Professor of Medicine and Emergency Medicine
- Harvard Medical School
- Section Editors
- Mark D Aronson, MD
Mark D Aronson, MD
- Editor-in-Chief — Primary Care (Adult); Hospital Medicine
- Section Editor — General Medicine
- Professor of Medicine
- Harvard Medical School
- Robert S Hockberger, MD, FACEP
Robert S Hockberger, MD, FACEP
- Section Editor — Adult Signs and Symptoms
- Emeritus Professor of Medicine
- David Geffen School of Medicine at UCLA
The hyperventilation syndrome describes a condition in which an inappropriate increase in minute ventilation beyond metabolic needs (ie, a respiratory alkalosis) is associated with a wide range of symptoms without a clear organic precipitant. As with other medical "syndromes," there is controversy about the etiology, diagnosis, and treatment of this condition.
This topic will discuss the pathophysiology, clinical presentation, diagnosis, and treatment of patients presenting with hyperventilation syndrome. Detailed discussions of associated disorders are presented separately. (See "Panic disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for panic disorder and agoraphobia in adults" and "Psychotherapy for panic disorder in adults" and "Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Evaluation of the adult with dyspnea in the emergency department".)
Hyperventilation — Alveolar hyperventilation is present when the arterial tension of carbon dioxide (PaCO2) decreases below the normal range <36 mmHg (<4.8 kPa).
Hyperpnea — Increase in the depth and rate of respiration leading to an increase in the minute volume of ventilation, which is the product of tidal volume per breath multiplied by respiratory rate, and consistent with an increase in metabolism as reflected by CO2 production. Thus, the PaCO2 is normal in a patient with hyperpnea (an example of hyperpnea is the increase in ventilation that occurs during moderate exercise).
Tachypnea — Increased respiratory rate >20 breaths per minute. The PaCO2 cannot be predicted by tachypnea alone since PaCO2 reflects the relationship between carbon dioxide production and alveolar ventilation (PaCO2 = VCO2/VA).
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- Hyperventilation syndrome
- PREVALENCE AND EPIDEMIOLOGY
- CLINICAL PRESENTATION
- Somatic symptoms
- Psychological symptoms
- Physical examination
- DIFFERENTIAL DIAGNOSIS
- Initial evaluation
- - Bedside assessment
- - Point-of-care testing
- - Caution about breathing into paper bag
- Further evaluation
- Follow-up testing
- Evaluation of recurrent episodes
- Specialist referral
- Ancillary diagnostic testing
- Acute management
- Treatment to prevent recurrent episodes
- SUMMARY AND RECOMMENDATIONS