To the Editor:—
The review of hyperventilation syndrome by Missri and Alexander (240:2093, 1978) was excellent, but they neglected to emphasize one important effect of respiratory alkalosis—severe hypophosphatemia. Their observation that "substantial reduction in organic phosphate levels has been recorded" is a profound understatement.In what I think is a much unappreciated review of the pathophysiology of hypophosphatemia, Knochel1 cites many documented examples of respiratory-alkalosis-induced hypophosphatemia and details its many serious, even potentially fatal, sequelae, including rhabdomyolysis, hemolytic anemia, and metabolic encephalopathy. Clinicians should be aware of the consequences of profound hypophosphatemia in those groups of patients who are susceptible: alcoholics, diabeticketoacidotics, and those with marked respiratory alkalosis, be it caused by anxiety, cardiopulmonary disease, hepatic coma, stroke, meningitis, or drugs such as aspirin or progesterone.
Record G. Hyperventilation Syndrome. JAMA. 1980;243(13):1325-1326. doi:10.1001/jama.1980.03300390011007