Hyperventilation Episode 1
Primary hyperventilation is defined as a state of alveolar ventilation in excess of metabolic requirements, leading to decreased arterial partial pressure of carbon dioxide. The primary aim of this study was to characterise patients diagnosed with primary hyperventilation in the ED.
Hyperventilation Episode 1
Hyperventilation is a diagnostic chimera with a wide spectrum of symptoms. Patients predominantly are of young age, female sex and often have psychiatric comorbidities. The severity of symptoms accompanied with primary hyperventilation most often needs further work-up to rule out other diagnosis in a mostly young population. In the future, further prospective multicentre studies are needed to evaluate and establish clear diagnostic criteria for primary hyperventilation and possible screening instruments.
Hyperventilation is respiration that exceeds metabolic demands [1,2] and according to Malmberg et al hyperventilaton is defined as a state of alveolar ventilation in excess of metabolic requirements, leading to a decreased arterial partial pressure of carbon dioxide [3,4] sometimes resulting in respiratory alkalosis and an increase in pH [3]. Wheter changes in carbon dioxid always occur comittant with hyperventilation is controversially discussed [3,5].
Hyperventilation syndrome is a disorder with no widely accepted diagnostic criteria [5,7]. Therefore its diagnosis widely relies on the physician's experience and medical education. Possible diagnostic tools include blood gas analysis or a hyperventilation provocation test [1]. Several studies have indicated that hyperventilation syndrome is widely common [1,6], with a study by Jones et al estimating a prevalence of 9.5% in the general adult population [4]. Despite this, exact data on the prevalence of hyperventilation in EDs is not available.
Although hyperventilation is a widely recognized medical condition, there have been few studies on the population presenting with primary hyperventilation syndrome to the ED. Therefore, the primary aim of this study was to characterise patients diagnosed with primary hyperventilation at our ED.
Primary hyperventilation was defined according to Ter Avest et al[5]. It was presumed to be present when an increased respiratory rate (>20 min) was documented at or before the ED visit and when somatic causes explaining the hyperventilation were absent [5].
All statistical analyses were performed with SPSS 20.0 Statistical Analysis program (SPSS Inc; Chicago, IL). The data were summarised using descriptive statistics (means, standard deviations, percentages, medians, quartiles and Ns). The differences in patient characteristics were compared using χ2tests for categorical variables, and t tests and ANOVA for continuous variables. Multivariable logistic regression was used to identify predictors for diagnosis of hyperventilation without laboratory analysis, with the model including gender, age groups, admission time, type of referral, psychiatric comorbidities and past hyperventilation episodes. All p values were two tailed and at a level of significance of 0.05.
In the present study on more than 600 patients who received the primary diagnosis of hyperventilation in the ED of a large university hospital, we demonstrate that the syndrome is often associated with fear, paraesthesisas and dizziness.
In our study, the most common symptom of hyperventilation syndrome was fear, followed by paraesthesias and dizziness. These symptoms are widely recognized in the medical literature [4,6,8,11]. Fear in particular seems to be a core component of hyperventilation syndrome [2]. Nevertheless, almost thirty percent of our study population presented with thoracic pain/chest tightness. According to Gardner et al, chest tightness is not a symptom of hyperventilation per se [12]. It is therefore important to evaluate these patients for cardiac or other pulmonary causes of thoracic pain, such as pulmonary embolism.
Our study is limited by its retrospective, single centre design. As information in our medical history database is presented in a narrative comment, no guarantee of complete or correct reporting can be given and bias is possible. Additionally, we did not assess precipitating factors for hyperventilations syndrome, such as palpitations, drug abuse etc. and therefore cannot report on these. Furthermore we did not assess whether patients visited our ED again after 7 days which would indicate that the original diagnosis was mistaken. And it is also possible that our patients were admitted to another hospital in the surrounding area or went to a family physician and received another diagnosis there.
Apart from the retrospecitve design the major draw back of the present study is that the diagnosis of In hyperventilation was only based on clinical examination and in some cases on blood gas analysis if any diagnostic evaluation was performed at all. As this was a retrospective describtive study we did not use the hyperventilation provocation test or the Nijmegen questionnaire by van Dixhoorn et al.
Hyperventilation is a diagnostic chimera with a wide spectrum of symptoms. Patients predominantly are younger fifty, female sex and often have psychiatric comorbidities. The severity of symptoms accompanied with primary hyperventilation most often needs further work-up to rule out other diagnosis in a mostly young population.
Hyperventilation is one of the most commonly overlooked diagnoses in all of clinical medicine [1,2], occurring most often in young or middle aged subjects, and is estimated to constitute approximately 5%-10% of all general medical patients. Moreover, its manifestations may be chronically disabling, for in my personal experience in evaluating applicants for permanent disability status, I have estimated a frequency of as high as 15% or more. Despite its high prevalence, however, this diagnosis regularly eludes family practitioners, internists, and also several specialty groups as well, notably neurologists, cardiologists and psychiatrists. Although associated panic with extreme anxiety is usually obvious during the episodes, the somatic manifestations such as dizziness, weakness, chest pain, dry mouth, numbness and tingling often divert attention from the causative breathing disorder. Obscuring recognition even further, the syndrome can acquire a more subtle chronic and recurring pattern [1]. In most instances, patients describe a feeling of shortness of breath, but they may be totally unaware of such rapid respiration. Once this diagnosis is suspected, simple measures can confirm its presence and allow for control of all the disagreeable bodily sensations, and, at the same time, reduce the underlying anxiety itself.
Background: Primary hyperventilation is defined as a state of alveolar ventilation in excess of metabolic requirements, leading to decreased arterial partial pressure of carbon dioxide. The primary aim of this study was to characterise patients diagnosed with primary hyperventilation in the ED.
Conclusion: Hyperventilation is a diagnostic chimera with a wide spectrum of symptoms. Patients predominantly are of young age, female sex and often have psychiatric comorbidities. The severity of symptoms accompanied with primary hyperventilation most often needs further work-up to rule out other diagnosis in a mostly young population. In the future, further prospective multicentre studies are needed to evaluate and establish clear diagnostic criteria for primary hyperventilation and possible screening instruments.
We studied the link between chronic fatigue syndrome (CFS) and hyperventilation in 31 consecutive attenders at a chronic fatigue clinic (19 females, 12 males) who fulfilled criteria for CFS based on both Oxford and Joint CDC/NIH criteria. All experienced profound fatigue and fatigability associated with minimal exertion, in 66% developing after an infective episode. Alternative causes of fatigue were excluded. Hyperventilation was studied during a 43-min protocol in which end-tidal PCO2 (PETCO2) was measured non-invasively by capnograph or mass spectrometer via a fine catheter taped in a nostril at rest, during and after exercise (10-50 W) and for 10 min during recovery from voluntary overbreathing to approximately 2.7 kPa (20 mmHg). PETCO2 041b061a72