Paperbag in Hyperventilation Syndrome

Q: 34 years old male is admitted to the ICU with severe anxiety and hyperventilation. Arterial blood gas (ABG) showed severe respiratory alkalosis with PH 7.7. The immediate maneuver should be to encourage him to breathe into a paper bag.

A) True

B) False

Answer: B

Despite popular belief, very little data supports breathing into a paper bag for hyperventilation syndrome. On the contrary, it can be harmful by inducing hypoxemia, which may quickly turn fatal in patients with underlying respiratory and/or cardiac disease. 

Also, in the past, attempts have been made to try this maneuver to counter metabolic acidosis if it occurs concurrently with respiratory alkalosis (mixed acid-base disorder), but it has been found to actually worsen the acidosis by dampening respiratory compensation.

#acid-base

#psychiatry

Reference:

Callaham M. Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Ann Emerg Med 1989; 18:622.