Hyperventilation

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Hyperventilation
ICD-10 R06.4
ICD-9 786.01
Tachypnea
ICD-10 R06.0
ICD-9 786.06

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Jyostna Chouturi, M.B.B.S [2]


Overview

In medicine, hyperventilation (or overbreathing) is the state of breathing faster and/or deeper than necessary, thereby reducing the carbon dioxide concentration of the blood below normal.[1].Stress or anxiety commonly are causes of hyperventilation; this is known as hyperventilation syndrome. Hyperventilation can also be brought about voluntarily, by taking many deep breaths.

This is in contrast to hyperpnea, where the increased breathing is required to meet demand, as during and following exercise or when the body lacks oxygen (hypoxia), for instance in high altitude or as a result of anaemia. Hyperpnea may also occur as a result of sepsis, and is usually a sign of the beginning of refractory sepsis.

Hyperventilation can, but does not necessarily cause symptoms such as numbness or tingling in the hands, feet and lips, lightheadedness, dizziness, headache, chest pain, slurred speech and sometimes fainting, particularly when accompanied by the Valsalva maneuver. Sometimes hyperventilation is induced for these same effects. Hyperventilation can sometimes be self induced for moments of needed focus and adrenaline.

The related symptom tachypnea (or "tachypnoea") (Greek: "rapid breathing") is characterized by rapid breathing and is not identical with hyperventilation - tachypnea may be necessary for a sufficient gas-exchange of the body, for example after exercise, in which case it is not hyperventilation.

Lastly, in the case of metabolic acidosis, the body uses hyperventilation to counter the increased acidity of the blood; this is known as Kussmaul breathing.

Causes

Life-Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular Cheyne-stokes respirations, congestive cardiac failure,pulmonary embolism, stroke
Chemical/Poisoning Ammonium chloride ,camphor ,glycol ether ,inhalation of irritants,methanol ,Salicylate poisoning,
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Aminophylline, aspirin, coffee abuse, pralidoxime, tiagabine
Ear Nose Throat No underlying causes
Endocrine Diabetic ketoacidosis, renal disease
Environmental Acute stress disorder
Gastroenterologic Abdominal surgery, acute liver failure, acute porphyria, end stage liver failure , hepatic cirrhosis, intestinal fistula, pyloric stenosis
Genetic Acute porphyria, arginosuccinic aciduria, carbamoylphosphate synthetase 1 deficiency disease, carbonic anhydrase va deficiency, hereditary fructose-1,6-bisphosphatase deficiency, Pitt-hopkins syndrome
Hematologic Acute porphyria
Iatrogenic No underlying causes
Infectious Disease CNS infection, fever
Musculoskeletal/Orthopedic Hip cancer
Neurologic Altitude sickness, acute, brain trauma, central neurogenic hyperventilation, cerebrovascular accident, CNS infection, cree leukoencephalopathy , damaged respiratory pathways, epilepsy, epileptic encephalopathy, early infantile, 2, head injury, intracranial space-occupying lesion, meningoencephalitis, pain, Pitt-hopkins syndrome, raised intracranial pressure, stroke, Vasovagal attacks
Nutritional/Metabolic Diabetic ketoacidosis, hereditary fructose-1,6-bisphosphatase deficiency, heat stroke, lactic acidosis
Obstetric/Gynecologic No underlying causes
Oncologic Bronchial neoplasm, rib tumor
Ophthalmologic No underlying causes
Overdose/Toxicity Biguanide intolerance
Psychiatric Acute stress disorder , adult panic-anxiety syndrome, agoraphobia, anxiety , Briquet's syndrome, combat stress reaction , cree leukoencephalopathy , crying or severe distress, Da costa syndrome, depression, distress, excitement, fear, functional disorders, grief, hypochondriasis, hysteria, malingering, pain, panic attack , phobia, primary habit disorder, Rett's syndrome, schizophrenia, stress, strong emotions
Pulmonary Acute altitude sickness, apneustic respirations, asthma, ataxic respiration, biot's respiration, central neurogenic hyperventilation, Cheyne-stokes respirations, damaged respiratory pathways, diffuse pulmonary fibrosis, emphysema , hyperventilation syndrome, inhalation of irritants, lung damage, metabolic acidosis , persistent hypoxemia, pleural effusion, pneumonia, pneumothorax, pulmonary embolism, pulmonary oedema
Renal/Electrolyte Acid-base imbalance , metabolic acidosis , phaeochromocytoma, renal disease
Rheumatology/Immunology/Allergy Asthma, pseudoallergic reactions
Sexual No underlying causes
Trauma Brain trauma, head injury, lung damage, raised intracranial pressure, sponatneous pneumothorax, stroke, surgical relocation of ureters in ileum or colon
Urologic Surgical relocation of ureters in ileum or colon
Miscellaneous Abdominal surgery, adulation, childbirth, fever

Causes in Alphabetical Order


Mechanism

In normal breathing, both the depth and frequency of breaths is varied by the neural system primarily in order to maintain normal amounts of carbon dioxide but also to supply appropriate levels of oxygen to the body's tissues. This is mainly done by measuring the carbon dioxide content of the blood; normally, a high carbon dioxide concentration signals a low oxygen concentration, as we breathe in oxygen and breathe out carbon dioxide at the same time, and the body's cells use oxygen to burn fuel molecules to carbon dioxide.

The gases in the alveoli of the lungs are nearly in equilibrium with the gases in the blood. Normally, less than 10% of the gas in the alveoli is replaced each breath. Deeper or quicker breaths exchange more of the alveolar gas with air and have the net effect of drawing more carbon dioxide out of the body, since the carbon dioxide concentration in normal air is very low.

The resulting low concentration of carbon dioxide in the blood is known as hypocapnia. Since carbon dioxide is held in the blood mostly in the form of carbonic acid, hypocapnia results in the blood becoming alkaline, i.e. the blood pH value rises. (In the normal person, this alkalosis would automatically be countered by reduced breathing, but for various reasons this doesn't happen when the neural control is not present.)

If carbon dioxide levels are high, the body assumes that oxygen levels are low, and accordingly the brain's blood vessels dilate, to assure sufficient blood flow and supply of oxygen. Conversely, low carbon dioxide levels (e.g. from hyperventilation) cause the brain's blood vessels to constrict, resulting in reduced blood flow to the brain and lightheadedness. Thus, though it seems counterintuitive, breathing too much can result in a decrease in the oxygen supply to the brain. Doctors sometimes artificially induce hyperventilation after head injury to reduce the pressure in the skull, though the treatment has potential risks.[2]

The high pH value resulting from hyperventilation also reduces the level of available calcium (hypocalcemia), which affects the nerves and causes the numbness or tingling of the hands. This occurs because alkalinisation of the plasma proteins (mainly albumin) increases their calcium affinity.

References

  1. Kenneth Baillie and Alistair Simpson. [ttp://www.altitude.org/calculators/oxygencalculator/oxygencalculator.htm "Hyperventilation calculator"]. Apex (Altitude Physiology EXpeditions). Retrieved 2006-08-10.  - Online interactive oxygen delivery calculator that mimicks hyperventilation
  2. Stocchetti N, Maas AI, Chieregato A, van der Plas AA (2005). "Hyperventilation in head injury: a review". Chest. 127 (5): 1812–27. PMID 15888864. doi:10.1378/chest.127.5.1812. 

See also


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