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Updated 15 February 2016

Hyperventilation

Hyperventilation literally means to 'overbreathe' – both too deeply and/or too fast.

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Summary

  • There are many possible causes of hyperventilation, including excessive anxiety or excitement, central nervous system disorders, aspirin overdose, liver disorders, hypoxia, fever and overwhelming infections.
  • Rapid and deep breathing, heart palpitations, chest pains, tinnitus (runny nose), numbness and tingling around the mouth and muscle spasms are the most obvious symptoms of hyperventilation.
  • Where hyperventilation is caused by anxiety, most often it can be cured by placing a paper bag over someone's nose and mouth, thereby increasing the carbon dioxide levels in the lungs.
  • Psychiatric treatment may be necessary if anxiety causes regular hyperventilation.
  • Diabetic or renal complications may also underlie episodes of hyperventilation.
     

Definition

Hyperventilation literally means to 'overbreathe' – both too deeply and/or too fast. When someone hyperventilates, they breathe deeply and excessively to the point where noticeable symptoms develop.

This sustained deep breathing causes a reduction of carbon dioxide levels in the blood. This in turn reduces the acidity of the blood in other words the pH of the blood increases and the bicarbonate in the blood is reduced. The resulting lower calcium levels in the blood cause the sensation of 'pins and needles' in the lips and fingertips that sometimes makes the diagnosis of hyperventilation easy.

Someone who is hyperventilating could experience muscle spasms, tremors and sweating, often creating the impression that they are about to have a heart attack.

Causes and risk factors

Hyperventilation sometimes occurs in children during exercise, but is often an unconscious response to stress in both adults and children.

There are many possible causes of hyperventilation, including excessive anxiety or excitement, central nervous system disorders, aspirin overdose, liver disorders, hypoxia, fever and overwhelming infections.

Anxiety and overexcitement is most often the cause of hyperventilation, and it is often coupled with breathing difficulty in asthmatics and those suffering from emphysema. People who have high anxiety levels are more prone to episodes of hyperventilation.

Uncontrolled diabetes and kidney failure can also result in hyperventilation.

Signs and symptoms

The most common symptoms of hyperventilation are rapid breathing, gasping for air, shortness of breath, chest pain and numbness, or a sense of tingling (pins and needles) in the extremities or around the mouth. Sweating, nausea, palpitations, visual disturbances and muscle spasms in the hands and/or feet are also symptoms of hyperventilation.

Diagnosis of hyperventilation

Diagnosing hyperventilation is not difficult and health professionals will recognise the symptoms instantly. The difficulty often lies in calming the person down and convincing family members that the condition is not nearly as dramatic and serious as it seems to be.

The symptoms of hyperventilation can sometimes mimic the symptoms of more serious disorders, therefore it is advisable to seek professional treatment rather than assuming that the condition is not serious.

Treatment and prevention

Immediate treatment of hyperventilation consists in getting the person to rebreathe exhaled carbon dioxide by breathing into a paper sack. If the hyperventilation is anxiety-induced, a tranquilizer of some sort may be administered.

As the carbon dioxide levels in the paper bag rise, so will the carbon dioxide levels in the bloodstream. Normal acidity and normal blood calcium levels will be restored and the imbalance of oxygen and carbon monoxide levels will return to its usual levels. Within a few minutes, all other symptoms will disappear.

If high anxiety levels, panic attacks or extreme nervousness precede regular episodes of hyperventilation, treatment of these conditions by a psychiatrist or psychotherapist may be required. The underlying reasons for the hyperventilation must be determined, rather than merely treating the symptoms of this condition.

In the case of diabetic or renal patients, hyperventilation is an effort by the body to rectify acidosis by getting rid of excess carbon dioxide. Doctors need to treat diabetic ketoacidosis or uraemia in these cases.

When to see a doctor

There are many possible causes of hyperventilation, including excessive anxiety or excitement, central nervous system disorders, aspirin overdose, liver disorders, hypoxia, fever and overwhelming infections.

All of these are potentially serious medical conditions, and hyperventilation may be caused by any of the above conditions. If someone hyperventilates, it is always a good idea to get the person to a doctor, so that he/she can get the treatment that might be needed.

Reviewed by Dr B. van Niekerk (MBChB) (MPraxMed)

 
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