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August 5, 1974

The "Oily" Paper Bag and Hyperventilation

JAMA. 1974;229(6):638. doi:10.1001/jama.1974.03230440014009

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To the Editor.—  Treating acute psychogenic hyperventilation by rebreathing into a paper bag restores arterial carbon dioxide pressure (PCO2) to normal, and leads to relief of symptoms. We compared the retention of CO2 during rebreathing in three different types of bags to determine their clinical usefulness. A plain paper bag, a paraffin-treated ("oily") paper bag, and a clear plastic bag of the same size (No. 12) were tested. Bag gas was sampled continuously through a small catheter, and CO2 concentration was measured with an infrared CO2 analyzer. With the bag held tightly over the mouth and nose, a subject hyperventilated at a constant rate, and the rise in bag CO2 was recorded. When the plain paper bag was used, CO2 reached a plateau of 43±7 (mean±SD) mm Hg after 15 to 20 breaths. In contrast, CO2 rose slightly faster in the "oily" paper