A 23 yo girl presented with perioral paresthesia and carpopedal spasm 20 mins after a huge
argument with her boyfriend. What is the next step for this pt?
a. SSRI
b. Diazepam
c. Rebreath into a paper bag
d. Propranolol
e. Alprazolam
Q. 1. What is the key?
Q. 2. What is the likely diagnosis?
Ans. 1. The key is C. Rebreathing in paper bag. [hyperventilation causes CO2 washout and respiratory
alkalosis. If you continue breathing and rebreathing in paper bag it will allow CO2 concentration to rise
in paper bag and as you rebreath this again and again you will regain some washed out CO2 and thus
relief to this alkalosis].
Ans. 2. The girl may have anxiety disorder when it precipitates leads to hyperventilation syndrome. X