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Tuesday, December 9, 2014

Hyperventilation and CO2

What is hyperventilation ?


Hyperventilation literally means too much (hyper) breathing (ventilation). Who hyperventilating, ventilates more than necessary to the carbon dioxide content in the blood (CO2) to maintain the normal height.

Hyperventilation should not be defined as "rapid breathing" (tachypnea); could in fact be quite normal, eg before exercise. Depending on the situation it is possible, for instance in a metabolic alkalosis, rapid breathing, but still suffer from hypoventilation (too slow breathing).

Hyperventilation Causes


Hyperventilation is not a disease in itself, but a symptom. The underlying diseases include:

-Stress, overload, fatigue or a panic attack, improper breathing technique, breathing fast
-Metabolic acidosis, for example in diabetes mellitus type 1 dysregulated
-Hypoxia, such as in an asthma attack, in mountain climbing, during heavy exercise

Mechanism


Hyperventilation with stress
In a healthy body exchange oxygen and carbon dioxide from the lungs between blood and air. Hyperventilation at this gas exchange is more intense than normal.

In healthy people, the O2-saturation in the blood is almost always substantially 100%. Hyper ventilate change this situation is not. The release of CO2 may increase. The blood thus gives more CO2 than usual. When the CO2 content in the blood drops, we speak of hypocapnia. This blood is less acidic (alkaline, pH rises), which explains the symptoms of hyperventilation. Who hyperventilating dizzy, feeling light-headed, has tingling in fingers, hands, lips. Often this occurs pain or pressure sensation in the chest on; in extreme cases, also cramps of the fingers in expanded position. Often, one is agitated, or even in a panic.

One can have the idea to get enough air, causing the rapid breathing and the shortage of CO2 is maintained. To stop hyperventilating, one must allow the carbon dioxide level rise again. To this end, one can, for example, the exhaled breathing air again. The exhaled air, after all, still contains enough oxygen, but the content of carbon dioxide is higher, so the lungs will emit less carbon dioxide to the air. For this purpose, it is often recommended to breathe into a paper or plastic bag. Experimentally, however, showed that CO2 levels will rise very little, and that the method does not work better than placebo treatment (in which subjects thought to breathe in a closed system, that was open in reality). It seems probable that the effectiveness of the method is mainly due to expected effects in the patient and / or the fact that one is forced more conscious and controlled breathing. Today, the "bag" method by many doctors no longer possible, and he should certainly not be applied to others unless it is certain that the symptoms are caused by hyperventilation. Similar symptoms may also be caused by asthma or a heart attack, and in particular in the latter case it can breathe in a bag then be life-threatening. In addition, it is experimentally shown that the inhalation of CO2 just feelings of panic and anxiety can generate, in particular in people who are susceptible to this. It is better, therefore, in order to try to get deep breaths, for example, by the breath to take in as long as possible, and then to breathe out and to repeat the exercise, until the symptoms are reduced. The search of distraction can help breathing back under control.

Unlike many people fear, stress hyperventilation never leads to fainting. This hyperventilation is common in people who are otherwise healthy. Doctors can often clarify the diagnosis by the patient intentionally 1 to 2 minutes to let hyperventilating at surgery: patients often recognize the symptoms then occur. However, this one is not already there: hyperventilation attacks, especially if they occur more frequently, almost always a manifestation of an underlying panic disorder, who can try to treat a psychiatric practitioner. Sometimes it occurs when more than one person in a group, as a form of mass hysteria.

Hyperventilation with metabolic acidosis
When, for example, by a severe kidney problem, the blood is too acidic (the degree of acidity (pH) of the blood is too low), then the lungs will try to separate more CO2. After all the CO2 lowers the pH of the blood. By giving more separate from the blood pH will be higher and normalize. Through the mechanism of hyperventilation increases the body content of this carbon dioxide. This is called respiratory compensation. In this case, it is vital for the patient to hyperventilate, because they will die in blood too acidic. In humans, in order to survive, the pH of blood still lie between 7.35 and 7.45.

Hyperventilation during hypoxia
When there is too little oxygen in the blood, one will hyperventilate to raise the level of oxygen. Will obviously decrease the levels of carbon dioxide, but there prevails the usefulness of additional oxygen uptake. In this case, it is then also called physiological hyperventilation.

-Too little oxygen in the blood because there is too little oxygen is offered in the air, we see for example in mountain climbing at high altitude. Since the oxygen content in the air is lower than nearer to the sea level. He shall at high altitudes spontaneously begin to hyperventilate. This involves a lot of fluid lost: mountaineers dry out easily.
-Too little oxygen in the blood may be caused by insufficient air you can breathe in a normal amount of oxygen in the inhaled air. For example, in an asthma attack pulling the muscles together around the airways (bronchospasm), allowing the patient to breathe harder, and thus can absorb less oxygen. Likewise, the patient as a result of hypoxia approaches to hyperventilate.
-Too little oxygen in the blood can also be caused by a sudden higher oxygen demand of the body, such as during heavy physical exercise. Energy Release indeed requires oxygen. During heavy exercise one will be panting to meet the oxygen demand. If one allows greater ventilation than is necessary to CO2 at the normal height to keep there also exists of hyperventilating.

In the case of hypoxia is to administer the appropriate extra oxygen. In air contains 21% oxygen, at sea level it has a partial pressure of 0.21 bar (21 kPa). By administration of additional oxygen, the percentage of increase of oxygen in the inspired air and more oxygen can be absorbed into the blood. Mountaineers therefore often take oxygen bottles.

An asthma patient may also include a medicinal product in order to raise its bronchospasm. This can be done by beta-sympathomimetics into an aerosol (puffertje).

During heavy exercise and insufficient oxygen, the body can temporarily switch to a power source that does not require oxygen. The body while it produces lactic acid which causes muscle cramps and muscle pains.

Complications


-A common trap for people who need to identify what is wrong with a patient, that is a hyperventilation attack sometimes caused by an acute illness such as a heart attack - having a real hyperventilation attack closes another condition does not matter.
-Hyperventilation attack caused by stress, the patient can be a very unpleasant experience and lead to the avoidance of issues and situations. This can lead to agoraphobia and / or social isolation.
-People who are hyperventilating often, where stress is the cause, often feel misunderstood by doctors or other people in general. The often-heard "it's only hyperventilation" gives a patient no rest. One develops easy hypochondria. Patience and good information are very important.

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