Abstract
BackgroundPatients with psychogenic hyperventilation frequently visit emergency departments (EDs). Arterial blood gas (ABG) analysis is performed to evaluate patients with dyspnea. This may show respiratory alkalosis in patients with hyperventilation. ABG may also reveal elevated serum lactate levels, although psychogenic hyperventilation syndrome is a benign condition. However, arterial puncture is a painful and risky procedure. We hypothesized that venous blood gas (VBG) analysis would be sufficient for evaluating patients with suspected psychogenic hyperventilation.ObjectivesTo compare the clinical utility of VBG analysis with ABG analysis for evaluating psychogenic hyperventilation.MethodsThis was a single-center retrospective cross-sectional study of patients aged ≥18 years with psychogenic hyperventilation attending a tertiary care hospital. We extracted data on age, sex, vital signs, blood gas components, and serum lactate. Spearman’s rank correlation coefficient (ρ) was used to examine the associations between the serum lactate levels and the carbon dioxide partial pressure (PCO2) in the ABG and VBG groups.ResultsA total of 236 patients (ABG group, n=57; VBG group, n=179) were included in the analysis. Both the ABG and VBG groups had respiratory alkalosis and similarly elevated serum lactate levels (p=0.44). The PCO2 and serum lactate levels were inversely correlated, and the ρ values were −0.74 and −0.50 for the ABG and VBG groups, respectively (both p<0.001). In addition, the bicarbonate ion (textrm{HCO}_{3}^{-}) level was inversely correlated with the serum lactate level, and the pH was positively correlated with the serum lactate levels in both the ABG and VBG groups.ConclusionsAmong patients with psychogenic hyperventilation, respiratory alkalosis, and the correlation between the PCO2 and serum lactate levels were similar in the ABG and VBG groups, indicating that VBG analysis might be used as an alternative to ABG analysis for evaluating psychogenic hyperventilation.
Highlights
Psychogenic hyperventilation syndrome is a common medical condition
The bicarbonate ion (HCO−3 ) level was inversely correlated with the serum lactate level, and the pH was positively correlated with the serum lactate levels in both the Arterial blood gas (ABG) and venous blood gas (VBG) groups
Among patients with psychogenic hyperventilation, respiratory alkalosis, and the correlation between the partial pressure of carbon dioxide (PCO2) and serum lactate levels were similar in the ABG and VBG groups, indicating that VBG analysis might be used as an alternative to ABG analysis for evaluating psychogenic hyperventilation
Summary
Psychogenic hyperventilation syndrome is a common medical condition. Pfortmueller et al reported that the incidence of psychogenic hyperventilation among adult patients who presented to an emergency department (ED) was 0.3% [1]. Blood gas analysis is used in the evaluation of hyperventilation syndrome. It often reveals respiratory alkalosis in patients with psychogenic hyperventilation, whereas respiratory or metabolic acidosis, with or without respiratory compensation, is often observed in critically ill patients with hyperventilation [3]. Arterial blood gas (ABG) analysis is performed to evaluate patients with dyspnea. This may show respiratory alkalosis in patients with hyperventilation. ABG may reveal elevated serum lactate levels, psychogenic hyperventilation syndrome is a benign condition. We hypothesized that venous blood gas (VBG) analysis would be sufficient for evaluating patients with suspected psychogenic hyperventilation
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