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Hyperventilation syndrome

Richard M Schwartzstein, MD
Jeremy Richards, MD, MA
Jonathan A Edlow, MD, FACEP
Section Editors
Mark D Aronson, MD
Robert S Hockberger, MD, FACEP
Deputy Editor
Daniel J Sullivan, MD, MPH


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 with or without agoraphobia in adults" and "Psychotherapy for panic disorder with or without agoraphobia 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 CO2 production and alveolar ventilation (PaCO2 = VCO2/VA).

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Literature review current through: Nov 2017. | This topic last updated: Apr 04, 2017.
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