Diagnostics
Here, the clinical signs play a decisive role. In addition, a blood gas analysis is performed to support the suspected diagnosis of hyperventilation. This is expected to result in lowered bicarbonate and CO2 values, usually with increased pH and O2 values.
Basically, the explicit diagnosis of the psychogenic hyperventilation form is an exclusion diagnosis. Therefore, problems with the heart (cardiac rhythm disturbances or cardiovascular disorders) and the lungs (asthma) must be excluded. The auscultation findings of the lungs should generally be normal in psychogenic hyperventilation.
Therapy
The first priority is always to try to calm the patient. By conscious inhalation and exhalation, it is often possible to bring the seizure-like hyperventilation under control, so that the pCO2 quickly returns to normal and the symptoms subside quickly. Psychogenic hyperventilation can be brought well under control with so-called “bag rebreathing”.
Here the patient should hold a plastic bag over his/her mouth and try to breathe slowly and calmly into it. In this way the exhaled CO2 content is immediately inhaled again and over time the initial pCO2 decrease is counteracted, which compensates for the respiratory alkalosis. It is important to note that bag rebreathing is only used when it is certain that psychogenic hyperventilation is present.
If this were not the case and the patient breathed too much due to a severe O2 deficiency, this measure would only make the situation worse. Patients who suffer from a known psychogenic form of hyperventilation are advised to train themselves. In this way they learn to handle the situation better and not to panic, but to use bag rebreathing, for example.
In addition, it often helps to consciously use diaphragmatic breathing and to place the hands on the abdomen in order to actively follow the breathing movement. Furthermore, it makes sense to regularly perform relaxing exercises and autogenic training to counteract the causes. The more confident a patient feels in dealing with the situation of psychogenic hyperventilation, the less severe the symptoms will be and the better the attack can be controlled.
If the above mentioned therapeutic measures do not help, psychosomatic treatment should be considered. If a patient develops hyperventilation tetany, diazepam, a muscle relaxant, must be administered in addition to the bag rebreathing measure.
