Hyperventilation: Causes, Symptoms & Immediate Management

Hyperventilation = breathing in excess of metabolic needs → respiratory alkalosis (low PaCO₂).

Symptoms

• Lightheadedness, dizziness, paresthesias (circumoral, fingers).
• Carpedal spasm (tetany) from hypocalcemia (alkalosis shifts Ca²⁺ to bound).
• Chest tightness, dyspnea (paradoxical air hunger).
• Palpitations, anxiety, panic.
• Visual changes, confusion.

Common Triggers

• Anxiety/panic attacks.
• Pain, fear, stress.
• Exercise (excessive).
• Medical: asthma, PE, DKA, sepsis, pregnancy, CNS lesions.
• Medications: salicylates, progesterone, stimulants.

Acute Management

• Reassurance, calm coaching.
• Slow breathing: 6–8 breaths/min; pursed-lip or diaphragmatic.
• Breathing into paper bag (controversial): Rebreathes CO₂; avoid if hypoxia possible (cardiopulmonary disease).
• Treat underlying cause.

When to Seek Care

If symptoms persist, recur, or associated with chest pain, syncope, focal neuro signs – evaluate for organic cause.