Hyperventilation: The Tip of The Iceberg

Dr Claud LumDr L Claud Lum 1916-2008

Emeritus Chest Physician Papworth Hospital UK

Under the heading of ”hyperventilation syndrome” standard English texts mention only the classic triad of massive overbreathing, paraesthesiae and tetany: a syndrome well known to any recent graduate but spontaneous tetany is one of the rarest manifestations of hyperventilation and in my experience occurs in about one per cent of cases. This is merely the tip of the iceberg; the body of the iceberg, the ninety nine per cent who do not present in this fashion (and are not accorded the dignity of a mention in any standard
English text), presents a collection of bizarre and often apparently unrelated symptoms, which may affect any part of the body, and any organ or any system. The many organs involved are often reflected in the number of specialists to whom the patient gets referred, and my colleagues have variously dubbed this the “multiple doctor” or the “fat folder syndrome”. Indeed the thickness of the case file is often an important diagnostic clue.

Some of the conditions found associated with hyperventilation are shown below in the
table. Symptoms may show up anywhere, in any organ, in any system; for we are dealing with a profound biochemical disturbance, which is as real as hypoglycemia, and more far-reaching in its effects. Such patients are often pursued relentlessly with every investigative device known to modern science, and end up with the label of “anxiety state” and the implication that they are inadequate or in some way inferior.
They may be advised: “pull yourself together, it’s only your nerves” or possibly a more sympathetic surgeon may be persuaded to tinker with or remove the complaining organ–an organ, which, I may say, is merely protesting against an unbalanced diet deficient in carbon dioxide, bicarbonate, oxygen, and calcium ions: to name but a few of the well -known biochemical disturbances which accompany acute hypocapnia.

Hyperventilation has often been labelled–stigmatized is perhaps a better term–as anxiety
state. I would emphatically disagree with this. Anxiety, in my experience, has usually been the product, not the prime cause. Emotional upset has been the most frequent trigger which has set off the chain of symptoms; the anxiety state seems to have most frequently been engendered by doctors who have failed to recognize the profound biochemical disturbance just outlined. Unfortunately when his many investigations prove negative the patient is left with the belief that he is suffering from something which is beyond modern medical science, or he may begin to question his own sanity. Are these not sufficient
grounds for chronic anxiety?

It has always seemed to me that hyperventilation is essentially a bad habit; a habit of breathing in such a way that the day-to-day level of PCO2 is relatively low. Given this basic bad habit, any physical or emotional disturbance may trigger off a chain reaction of increased ventilation, rapidly producing hypocapnic symptoms, alarm engendered by the symptoms, consequent sympathetic arousal resulting in increased ventilation and increased symptoms.

(Oh yes! Some of the symptoms that you may be treated for with drugs that might be largely due to your over-breathing include: asthma, anxiety, panic attacks, angina, palpitations, hay fever, IBS, hypertension, sleep apnoea, snoring, headaches, migraines, orthodontic problems with young children, ME, tiredness, breathlessness, and more. M.Lingard)

Michael Lingard BSc DO BBEC