Effective January 2014

Clinical Management Guideline for

Hyperventilation Pathway

Patient presents
with hyperventilation

Patient stable vital signs

(SpO2 > 97% RA)

Resus Room
Is patient’s mental No  ABCD’s
function normal?  Exclude life threatening
differential diagnosis

Yes

Manage in intermediate
acuity area P2

High Risk factors:

Drugs
- Withdrawal VS and SpO2 monitoring. BSL
- Amphetamine consider ECG, ABG, CXR
- Cocaine

Cardiovascular
- Arrythmia
- Cardiomyopathy Diagnose
- Coronary artery disease Does patient Hyperventilation attack:
have any: No  reassure
Central nervous system 1) high risk factors?  advise breathing technique
- complex partial seizure 2) abnormal investigations?  do not rebreathe into
- central neurogenic paperbag
hyperventilation  observe up to 1H

Endocrine Yes
- cushing’s
- electrolyte abnormalities Exclude other medical causes
- hyperthyroidism  little response to test
- Hyperparathyroidism  assurance
- hypoglycaemia
- hyperthermia

Treatment: Is patient:
Valium (diazepam):  symptom free No Admit
Dosage: 5 mg PO or  normal vitals
JGH Med/Surg
 no other issues
requiring admission
Dormicum (midazolam):
Dosage: 2.5 mg IV (rarely required)

Observe up to 1H Yes

Discharge
 Home with advise
REFERENCES/FURTHER READING
1. Saisch SG, Wessely S, Gardner WN. Patients with a cute hyperventilation
 KIV refer PSY SOC
presenting to an inner-city emergency departmen t. Chest. 1996;110(4):952–957.  KIV low dose diazepam
(2mg)or for - 1–2 doses of
2. Callaham M. Hypoxic haz ard s o f traditional paper bag rebreathing in
hyperventilating patien ts. Ann Emerg Med. 1989;18(6):622–628.
oral alprazolam (Xanax).

3. Kroenke, K, Mangelsdorff, AD. Common symptoms in ambu la tory care:

Incidence, eva lua tion, therap y, and outcome. Am J Med 1989; 86:262.