Clinical Utility of Venous Blood Gas Analysis for the Evaluation of Psychogenic Hyperventilation in the Emergency Department

Urushidani, Seigo; Kuriyama, Akira; Matsumura, Masami

doi:10.7759/cureus.12273

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…The ROC curve results suggest that the degree of alkalemia or PCO2 depression in ABG may help distinguish HVS from UTI with suspected sepsis. The results further suggest that patients with a typical medical history and physical examination findings as well as an increased degree of respiratory alkalosis and low PCO2 level are more likely to experience HVS, even if their serum lactate level is high, than UTI with suspected sepsis (8,9). Conversely, when managing tachypneic patients with high serum lactate levels who do not have significant respiratory alkalosis or low PCO2, physicians should consider critical conditions, such as sepsis.…”

Section: Discussionmentioning

confidence: 83%

“…The sex distribution of the two groups was compared using Fisher's exact test. Several studies have shown an inverse correlation between PCO 2 and serum lactate levels in patients with HVS ( 8 , 9 ). Thus, we investigated the correlation between PCO 2 and serum lactate levels with patients who met two of the three qSOFA criteria in both the HVS and UTIs groups using Spearman's rank correlation coefficient.…”

Section: Methodsmentioning

confidence: 99%

“…Elevated serum lactate levels are sometimes present in patients with HVS, yet these patients have a good prognosis (8,9), while patients with hyperlactatemia due to a critical condition, such as sepsis, have a poor prognosis (10)(11)(12). In patients with HVS, respiratory alkalosis and inverse correlation between PCO2 and serum lactate levels are detected by blood gas analyses (9). However, no studies have directly compared the serum lactate levels or blood gas analysis results in patients with HVS and those with UTI with suspected sepsis.…”

Section: Introductionmentioning

confidence: 99%

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Blood Gas Analysis Results and Serum Lactate Levels in Patients with Psychogenic Hyperventilation and Urinary Tract Infection with Suspected Sepsis: A Retrospective Comparative Study

2022

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ObjectivesThe prognosis differs considerably between patients with psychogenic hyperventilation syndrome (HVS) and those with urinary tract infection (UTI)-associated sepsis; however, the nonspecific symptoms and signs make the diagnosis and management difficult. We herein report the utility of a blood gas analysis for distinguishing HVS from UTI with suspected sepsis. Methods This single-center retrospective cohort study was conducted in a tertiary-care hospital in Japan. Patients ! 18 years old with a quick Sequential Organ Failure Assessment (qSOFA) score !2 and HVS or UTIs were included. The results of an arterial blood gas (ABG) or venous blood gas (VBG) analysis of the two groups were compared using the Mann-Whitney U test. We used a receiver-operating characteristic curve (ROC) analysis of the arterial pH and arterial PCO2 to assess the ability of these analyses to distinguish HVS from UTI with suspected sepsis. Results A total of 64 patients with HVS (ABG, n=14; VBG, n=50) and 53 with UTI with suspected sepsis (ABG, n=35; VBG, n=18) were included. Patients with HVS had alkalemia and lower PCO2 levels than patients with UTI with suspected sepsis, but the serum lactate levels were similar between the groups. The ROC analysis determined the pH cut-off value to be 7.509 (sensitivity: 0.91; specificity: 0.86) and the PCO2 cut-off value to be 21.6 mmHg (sensitivity: 1.00; specificity: 0.64). Conclusion Elevated serum lactate levels alone cannot be used to differentiate between patients with HVS and those with UTI with suspected sepsis, but the degree of pH and PCO2 abnormality can help with the differential diagnosis.

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Section: Discussionmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Blood Gas Analysis Results and Serum Lactate Levels in Patients with Psychogenic Hyperventilation and Urinary Tract Infection with Suspected Sepsis: A Retrospective Comparative Study

2022

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“…13 A study examining patients with psychogenic hyperventilation attending a tertiary care Emergency Department found similar correlation between PaCO 2 and lactate in arterial and venous blood gases, indicating that venous blood gas analysis might be used as an alternative to arterial blood gas analysis for evaluating psychogenic hyperventilation. 14…”

Section: Discussionmentioning

confidence: 99%