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Hyperventilation Syndrome-Reply

José C. Missri, MD; Sidney Alexander, MD
JAMA. 1980;243(13):1326-1327. doi:10.1001/jama.1980.03300390011009.
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In Reply.—  We certainly agree with Dr Record that hypophosphatemia is potentially dangerous. Indeed, a recent report1 suggests still another serious effect—severe, but, fortunately, reversible heart failure. Perhaps we did not emphasize this enough, but our review was not concerning the effects of severe, chronic alkalosis, but, rather, hyperventilation occurring in the absence of known organic disease. While phosphate levels in these patients can be acutely depressed,2 presumably phosphate concentration returns rather promptly to normal once hyperventilation ceases. We know of no data defining phosphate levels in chronic, sustained hyperventilation, but this is rare in our experience, anyway. The majority of our patients hyperventilate for brief periods only and feel relatively well in between.Dr Martin raises some interesting questions. We never stated that all anxious people hyperventilate and certainly made no claim to know why some do and others do not. Nor do we think our statement


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