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Acute Hyperventilation


Presentation

  • Misattribution of the presenting complaints to a cardiac or other life-threatening disorder was reported in 20 patients (87%) and was the main reason for their presentation to the hospital.[ncbi.nlm.nih.gov]
  • Additionally, you may go back to previous EM:RAP episodes and redeem CME (any episode Jan 2015 to the present, 6 hours per month). On EM:RAP we try to make make the process simple and the question sets are quite reasonable.[emrap.org]
  • Patients with chronic HVS present with similar symptoms, including recurrent chest pain, dyspnea, and neurologic deficits, and usually have had many similar presentations in the past.[emedicine.medscape.com]
  • All patients presenting to the ED with the primary diagnosis of primary hyperventilation during the study period were eligible for study inclusion.[journals.plos.org]
  • Overview Hyperventilation syndrome is one of the most common causes of dizziness and paresthesias presenting to neurologists, and yet, it is underdiagnosed.[medlink.com]
Crying
Tachypnea
  • The symptoms of acute hyperventilation are mainly caused by the hypocalcemia. 4 Symptoms Tachypnea Muscle spasms Paresthesia Dizziness Anxiety Spasms of the muscles of the lower arm and hands ( hyperventilation tetany ) can lead to the characteristic[flexikon.doccheck.com]
  • CONSUMERS: Click here for the Consumer Version Topic Resources Hyperventilation syndrome is anxiety-related dyspnea and tachypnea often accompanied by systemic symptoms.[merckmanuals.com]
  • Acute hyperventilation with obvious tachypnea accounts for about 1% of all cases of hyperventilation ( Lum 1975 ).[medlink.com]
  • Acute hyperventilation Patients often present dramatically, with agitation, hyperpnea and tachypnea, chest pain, dyspnea, wheezing, dizziness, palpitations, tetanic cramps (eg, carpopedal spasm), paresthesias, generalized weakness, and syncope.[emedicine.medscape.com]
  • […] breathing R06.02 Shortness of breath R06.03 Acute respiratory distress R06.09 Other forms of dyspnea R06.3 Periodic breathing R06.4 Hyperventilation R06.5 Mouth breathing R06.8 Other abnormalities of breathing R06.81 Apnea, not elsewhere classified R06.82 Tachypnea[icd10data.com]
Hyperpnea
  • Abstract The hyperventilation syndrome is generally considered an acute, transitory episode characterized by gross hyperpnea and culminating in frank tetany.[annals.org]
  • Acute hyperventilation Patients often present dramatically, with agitation, hyperpnea and tachypnea, chest pain, dyspnea, wheezing, dizziness, palpitations, tetanic cramps (eg, carpopedal spasm), paresthesias, generalized weakness, and syncope.[emedicine.medscape.com]
  • R29.0 ICD-10-CM Diagnosis Code R29.0 Tetany 2016 2017 2018 2019 Billable/Specific Code Applicable To Carpopedal spasm Type 1 Excludes hysterical tetany ( F44.5 ) neonatal tetany ( P71.3 ) parathyroid tetany ( E20.9 ) post-thyroidectomy tetany ( E89.2 ) hyperpnea[icd10data.com]
Prolonged Expiration
  • Sampling was started by an operator three seconds after the beginning of a prolonged expiration lasting 16 seconds or more.[bmcpulmmed.biomedcentral.com]
Carpopedal Spasm
  • The diagnosis of HVS should be considered in young patients without cardiac risk factors who present with chest pain, particularly if the pain is associated with paresthesias and carpopedal spasm.[emedicine.medscape.com]
  • Hyperventilation syndrome related to anxiety can cause alkalosis severe enough to cause carpopedal spasm. A mild fairly well compensated respiratory alkalosis is the usual finding in pregnancy.[anaesthesiamcq.com]
  • Before neuraxial analgesia had been established, however, and after a period of hyperventilation, the patient was found lying supine with both arms and legs extended, and both wrists in extreme flexion (carpopedal spasm), looking upwards and breathing[academic.oup.com]
  • spasm Type 1 Excludes hysterical tetany ( F44.5 ) neonatal tetany ( P71.3 ) parathyroid tetany ( E20.9 ) post-thyroidectomy tetany ( E89.2 ) hyperpnea R06.4 hyperventilation R06.4 - see also Hyperventilation ICD-10-CM Codes Adjacent To R06.4 R06 Abnormalities[icd10data.com]
  • Trousseau's sign (also called 'main d'accoucheur' or carpopedal spasm) is muscle spasm in the hands, with the tips of the fingers and thumb apposed and the fingers straight. It results from hypocalcaemia.[patient.info]
Muscle Twitch
  • Acute secondary hypocalcemia can result in carpopedal spasm, muscle twitching, a prolonged QT interval, and positive Chvostek and Trousseau signs. Hypokalemia tends to be less pronounced than hypocalcemia but can produce generalized weakness.[emedicine.medscape.com]
  • , twitching and cramps, tension and panicky feelings, depression and anxiety.[familydoctor.co.nz]
  • Muscle twitching, spasms, and weakness may be noted. Seizures, irregular heart beats, and tetany (muscle spasms so severe that the muscle locks in a rigid position) can result from severe respiratory alkalosis.[medical-dictionary.thefreedictionary.com]
Leg Cramp
  • Cramps: - How to get rid of cramps : How to get rid of cramps breathing exercise - Leg cramps at night : Two easy solutions (Earthing and reduced breathing exercise).[normalbreathing.com]
Chvostek Sign
  • Chvostek's sign is also due to hypocalcaemia. Flick behind the ear, just in front of the mastoid bone where the facial nerve emerges. The hypersensitive facial nerve makes the muscles of the face twitch.[patient.info]
Emotional Outbursts
Dizziness
  • Presenting complaints were dyspnea (61%), paresthesia (35%), chest pain or tightness (43%), muscle spasm (9%), dizziness (13%), palpitations (13%), and panic (30%). Similar previous episodes were reported in 74%.[ncbi.nlm.nih.gov]
  • Overview Hyperventilation syndrome is one of the most common causes of dizziness and paresthesias presenting to neurologists, and yet, it is underdiagnosed.[medlink.com]
  • Most commonly, the history is one of sudden onset of dyspnea, chest pain, or neurologic symptoms (eg, dizziness, weakness, paresthesias, or near-syncope) after a stressful event.[emedicine.medscape.com]
  • The symptoms typically associated with chronic HVS include faintness, dizziness, and visual disturbances. Chronic HVS is due to exaggerated upper thoracic movement as the diaphragm is not engaged.[ndhealthfacts.org]
Agitation
  • Patients with acute hyperventilation syndrome (HVS) may present with agitation and anxiety.[emedicine.medscape.com]
  • Symptoms of Acute HVS are often more dramatic than Chronic HVS and may include breathlessness or the inability to catch one’s breath, agitation, rapid and/or deep breathing, chest pain, dizziness, heart palpitations and loss of consciousness.[ndhealthfacts.org]
  • It is accompanied by agitation and a sense of terror or by symptoms of chest pain, paresthesias (peripheral and perioral), peripheral tetany (eg, stiffness of fingers or arms), and presyncope or syncope or sometimes by a combination of all of these findings[merckmanuals.com]
  • ACUTE ATTACK - agitation, rapid upper chest breathing and heart-rate, chest pains, shortness of breath, nausea, tingling dizziness, clammy hands, dilated pupils, perhaps fainting and general weakness.[familydoctor.co.nz]
  • The person with ARDS may initially appear agitated as a result of breathing difficulty (rapid breathing or shortness of breath), but later may become lethargic and or even comatose.[rarediseases.org]

Workup

Hypocapnia
  • Abstract Acute hypocapnia decreases CBF, increases hemoglobin affinity for oxygen and causes cerebral tissue hypoxia. This tissue hypoxia is reversed with inhalation of 100% O2 in dogs.[ncbi.nlm.nih.gov]
  • Symptoms of hypocapnia due to the (pre-)intervention as well as any adverse events will be reported and analysed.[clinicaltrials.gov]
  • In reality, they have about the same oxygenation in the arterial blood (normal values are about 98% for hemoglobin saturation) and too little carbon dioxide ( hypocapnia ) in their blood and other tissues.[en.wikipedia.org]
  • Granholm L, Siesjö BK (1969) The effects of hypercapnia and hypocapnia upon cerebrospinal fluid lactate and pyruvate concentrations and upon the lactate, pyruvate, ATP, ADP, phosphocreatine and creatine concentrations of cat brain tissues.[link.springer.com]
  • The U-B PCO2 decreased from a control of 22 /-1 mm Hg (mean /-SEM) to 11 /-2 mm Hg (mean /-SEM) with hypocapnia, and rose again to its control value when the blood PCO2 returned to prehyperventilation values.[jci.org]

Treatment

  • Treatment Group 1 (TG1, n 36) : Mean Age 28yr; Gender: Male 27, Female 9; Mean GCS 5.6. Treatment Group 2 (TG2, n 36) : Mean Age 34yr; Gender: Male 22, Female 14; Mean GCS 5.6.[abiebr.com]
  • Although no patients presented with clinical features of asthma, 7 (30%) were known asthmatics receiving treatment and another 10 (44%) had a history and investigation results suggestive of asthma.[ncbi.nlm.nih.gov]
  • Both treatment programs were equally effective in reducing symptoms, said Meuret. But CART was the only treatment to physiologically alter panic symptoms by actively reversing hyperventilation in the patients.[sciencedaily.com]
  • Supportive counseling Sometimes psychiatric or psychologic treatment Treatment is reassurance. Some physicians advocate teaching the patient maximal exhalation and diaphragmatic breathing.[merckmanuals.com]
  • Treatment for hyperventilation depends on the cause. Home treatment is usually all that is needed for mild hyperventilation symptoms.[osmc.net]

Prognosis

  • Prognosis Prognosis is generally good but will depend on the underlying cause and comorbidity. [ 12 ] Management of associated disorders (such as agoraphobia) will alter the course of the hyperventilation.[patient.info]
  • Pneumothorax (Symptoms, Causes, Types, and Prognosis) A pneumothorax is free air in the chest outside the lung, that causes the lung to collapse (collapsed lung). There are two types...[medicinenet.com]
  • Without the complete withdrawal of medication on long term, a definite healing is impossible Nevertheless that the patient has the subjective feeling of despair about the possibility of healing, the prognosis with the right treatment is good.[15minutes4me.com]
  • Severe prognosis in a large family with hypokalemic periodic paralysis. Muscle Nerve 2003 ; 27 : 165 –9 8 Geffner I, Murgatroyd J. Tetany. A case induced by hysterical hyperventilation. Br Dent J 1980 ; 148 : 264 9 Day JW, Parry GJ.[academic.oup.com]
  • Prognosis If the underlying condition that caused the respiratory alkalosis is treated and corrected, there may be no long-term effects.[medical-dictionary.thefreedictionary.com]

Etiology

  • Because of its bizarre manifestations and its basic etiology, it is seen by everyone regardless of the limitation of one's practice. Too many of us have been lulled into a sense of false security by medical school teachings.[aafp.org]
  • Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'.[icd10data.com]
  • The patient benefits from explanations of laboratory tests and treatment. respiratory alkalosis Metabolism A condition characterized by pH due to excess CO 2 excretion Etiology Hyperventilation–eg, due to anxiety, pain, panic attacks, psychosis, CVA,[medical-dictionary.thefreedictionary.com]

Epidemiology

  • Epidemiology It is quite common but precise prevalence is unknown.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • […] from Greek: ὑπέρ ("iper") - over and Latin: ventilare - breathe German : Hyperventilation Contents 1 Definition 2 Forms 3 Pathophysiology 4 Symptoms 5 Therapy 1 Definition Hyperventilation is defined as unphysiological deeper and/or faster breathing that[flexikon.doccheck.com]
  • Lewis contended that acute and chronic hyperventilation syndrome occurred frequently and described the common and atypical presentations, pathophysiology, and therapy ( Lewis 1953 ).[medlink.com]
  • The pathophysiology of hyperventilation disorders. Chest 1996 ; 109 : 516 –34 3 Contreras G, Gutierrez M, Beroiza T, et al. Ventilatory drive and respiratory muscle function in pregnancy. Am Rev Respir Dis 1991 ; 144 : 837 –41 4 Moore EW.[academic.oup.com]
  • Nasal congestion, rhinitis, and related conditions: - Nasal congestion : Its causes, mechanism, and treatment - Sinusitis : Causes, pathophysiology, and treatment - How to get rid of a stuffy nose : a very easy breathing exercise - Runny nose : Causes[normalbreathing.com]
  • The pathophysiology of hyperventilation disorders. Chest. 1996;109:516–34. ... 2. Saisch SG, Wessely S, Gardner WN. Patients with acute hyperventilation presenting to an inner-city emergency department. Chest. 1996;110:952–7. 3. Singer EF.[aafp.org]

Prevention

  • This means that if you can stop hyperventilating, you can potentially reduce the severity of your panic attacks and perhaps prevent them altogether.[calmclinic.com]
  • 21:01:24 Hello - just a quick comment, I kept having episodes a while ago where I wasnt ble to breathe, went clammy etc etc (turned out they were to do with what I ate and stress) the results of whch were an asthma type reaction - dr gave me both a preventative[mumsnet.com]
  • You, your friends, and family can learn techniques to stop it from happening and prevent future attacks. If you start hyperventilating, the goal is to raise the carbon dioxide level in your blood. This will end most of your symptoms.[medlineplus.gov]
  • Examples of medications for hyperventilation include: alprazolam (Xanax) doxepin paroxetine (Paxil) You can learn breathing and relaxation techniques to help prevent hyperventilation.[healthline.com]
  • Prevention of parturient paresis by a low-calcium diet prepartum: a field study. J Dairy Sci 1975 ; 58 : 430 –1 6 Lesser, RP. Psychogenic seizures. Neurology 1996 ; 46 : 1499 –507 7 Caciotti A, Morrone A, Domenici R, Donati MA, Zammarchi E.[academic.oup.com]

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