The diagnosis of chronic hyperventilation missed

This article was written by Ph. D. B. Snitslaar, neurologist, in the 80’s associated with the Phobias project of the Department of Personality Studies of the sub faculty of Psychology at the University of Amsterdam. Later he was employed by the Common Medical Service, Research and Development department, Research section. Although many medical terms are used in this article, it can still provide good background information. Even if you are not a medical doctor and are interested in more accurate information about chronic hyperventilation syndrome, the medical articles on this site may be of interest to you.

There are a number of symptoms that often lead the physician astray in the recognition of the syndrome of chronic hyperventilation. Because of this, the diagnosis chronic hyperventilation is often missed.

Referrals to a cardiologist

• occurring anxiety feelings.
• Pain on the thorax (with or without radiation to one or both arms)
• Heart pounding and fear of dying
• Anomalies on the ECG 

Referral to a gastro-enterologist

• A full and tense feeling in the upper abdomen
• belching and flatulence
• Constipation or diarrhea

Alleged hyperthyroidism with referal to an internist

• Extreme fatigue
• Excitement
• Clammy skin
• Rapid pulse
• Sleep disorders
• Anxiety feelings
• Emotional instability
• Tremors

Referal to a neurologist

• Blurred vision and / or spots, followed by (often from the neck) rising headache.
• Hypersensitivity to stimuli with sometimes nausea arouses the suspicion of a migraine.
• Special features on the EEG as they occur in many chronic hyperventilating patients also point to migraine. The patient is then treated as such.

Symptoms that indicate temporal epilepsy, for which the patient is then treated

• Depersonalization with a feeling of imminent loss of consciousness.
• An unpleasant feeling, often experienced as heat flows, from the legs or lower body and unrest and / or emotional discharges.
• Certain configurations on the electroencephalogram.

A concise explanation of the phenomenon of chronic hyperventilation

The following substances are released during the energy supply of our organs: water and carbon dioxide (CO₂). Partly the CO₂ is exhaled via the lungs, while a remainder plays an essential role in maintaining an optimal acidity in the body. The more CO₂ accumulates in the body, the more acidic the organism becomes and the more active the respiratory center becomes in the central nervous system. This increases the ventilation and more CO₂ is exhaled again. Reducing the amount of CO₂ in the organism also reduces the activity of the respiratory center.

Respiratory alkalosis

When someone breathes more than is necessary to maintain a normal amount of CO₂ in the body, too much CO₂ will be exhaled by the accelerated breathing. This creates a deficiency of this substance in the blood and tissues. This results in a respiratory alkalosis and then one speaks of hyperventilation.

A state of respiratory alkalosis has a number of effects on the organism. Some of these are for example:

• CO₂ functions as a regulator of the blood vessel width. In case of a shortage of CO₂, vasoconstriction occurs This vasoconstriction can lead to a reduction in cerebral blood supply of 30% to 40%.
• Erythrocytes in alkaline environment are less able to deliver their oxygen to the tissues (Bohr-Hasselbalch equilibrium).

It is clear that as a result of this, during a respiratory alkalosis (alkalosis due to hyperventilation), a reduction of functions of, for example, the central nervous system can occur: blurred vision, hearing everything far away; unable to think properly; feeling of imminent loss of consciousness.

Carbon dioxide buffer systems

Buffer systems in the body fluids correct the resulting CO₂ loss for some time. The most important buffer system is the CO₂-dependent HCO₃, which leaves the body with repeated or frequent hyperventilation via the kidneys such as NaHCO₃ and KHCO₃. As a result, buffer capacity is lost. If there is a new CO₂ loss – as a result of hyperventilation – then sufficient corrections can no longer be made. The blood becomes more alkaline easily.

Re-setting of the respiratory center

The patient can then only lose a small amount of CO₂ before becoming alkaline, which means the associated symptoms will show much quicker. But also in the respiratory center in the brain something changes under the influence of repeated or continuous existence of a respiratory alkalosis. The respiratory center will get used to the less acidic condition. It’s going to regard that as a normal condition, which means that even with small increases in the CO₂ content, an increase in respiratory activity will be the result.

Both the reduction of HCO₃ buffer and the lower tolerance to CO₂ of the respiratory center thus make the condition permanent. The patient hyperventilates faster on the authority of the respiratory center. He or she gets the alarming symptoms more easily due to a shortage of buffer. The result seems to be a constant uncertainty and anxious tense anticipation of a subsequent hyperventilation attack. And this anticipation in itself give will give rise to more hyperventilation.

Hyperventilation = chronic hyperventilation

Hyperventilation is a condition that tends to maintain itself. As a result, hyperventilation is usually chronic hyperventilation. There are a number of different other observable changes. These changes often occur in the context of chronic hyperventilation. Examples of this are:

• Shifts in the electrolyte balance.
• Shifts in the concentration ionized Calcium, also called the lactic acid metabolism.

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