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_NOTOC _
_NOTOC _
{{CMG}};{{AE}}{{Vbe}}
{{CMG}};{{AE}}{{Vbe}}
== Hyperventilation ==
{| class="wikitable"
! rowspan="3" |Organ system
! rowspan="3" |Diseases
! colspan="9" |Clinical manifestations
! colspan="5" rowspan="2" |Diagnosis
! rowspan="3" |Other features
|-
! colspan="4" |Symptoms
! colspan="5" |Physical exam
|-
!Chest pain
!Dyspnea
!Fever
!Palpitations
!Cyanosis
!Tachypnea
!JVD
!Peripheral edema
!Auscultation
!ABGs
!Lab findings
!Imaging
!PFT
!Gold standard


|-
==Causes==
! rowspan="8" |Pulmonary system
[[Hypogammaglobulinemia]] is caused by:
!Pneumothorax
!+
!+
!+
!+
!+
!+
!_
!_
!
* Decreased breath sounds
!
-
!
Decreased Vt
!X- ray -
*Mediastinal shift
*Deep sulcus sign
*Hydropneumothorax
*CT-scan- Bullae
!
Decreased Vt
! CT-scan
!
*Hypoxia,
*Hypercapnia
* Hyperesonance to percussion,
* Vocal resonance
*Tactile fremitus decreased
|-
!Pulmonary embolism
!+
!+
!+
!+
!+
!+
!-
!-
!
* S3 gallop
*S4 gallop
!
Respiratory alkalosis
!
* Increased D- dimers
*Increased Troponins
!
* Duplex ultrasound
*EChocardiography
* Ventilation-perfusion scanning
!
Normal
!
CT angiography
!
* Hemoptysis
*History of coagulation abnormalities
* Malignancy
|-
!Pneumonia
!+
!+
!+
!+
!+
!+
!-
!-
!
*Bronchial breath sounds
*Crepitations
*Bronchophony
*Egophony
*Whispering pectoroloqy
!
Normal
!
*CBC
*Blood culture
*Mantoux test
*Serology (mycoplasma, viruses)
*Sputum: Gram stain and culture
!
*CXR- Lobar consolidation, Air bronchogram;
*Atypical pneumonia: Diffuse interstitial infiltrates
!
Normal
!
*CXR- Lung infiltrates
* Blood culture
!
* Productive cough
*Altered mental status
* Tachycardia
* Central cyanosis


|-
Immunodeficiency secondary to:
!Exacerbation of asthma/COPD
*[[Uremia]]
!-
*Protein losing enteropathy
!+
*[[Nephrotic syndrome]]
!-
*Malnutrition
!+
*Cirrhosis
!+
*Hemodialysis
!+
* Intestinal lymphangiectasia
!-
!-
!
*Decreased breath sounds
*Wheezing
*Coarse crackles


!
* Protein-losing gastroenteropathy
*Increased PaCo2
*[[Nephrotic syndrome]]
*Decreased PaO2
*[[Thymoma]] <ref name="pmid29881497">{{cite journal |vauthors=Aouadi S, Ghrairi N, Braham E, Kaabi M, Maâlej S, Elgharbi LD |title=[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome] |language=French |journal=Pan Afr Med J |volume=28 |issue= |pages=253 |date=2017 |pmid=29881497 |pmc=5989270 |doi=10.11604/pamj.2017.28.253.11352 |url=}}</ref>
!
* Medications :
*CBC- Increased hematocrit from chronic hypoxia
** Gold
*Sputum evaluation, BNP( to rule out heart failure)
**D-Penicillamine
!
**Sulfasalazin
*X- ray:
**Anticonvulsants
*Hyperinflated lungs
**Glucocorticoids
*Flattening of the diaphragm
**Methotrexate
*Narrow heart shadow
**Calcineurin inhibitors
*Cardiomegaly
** Rituximab<ref name="pmid29755528">{{cite journal |vauthors=Shoukat BA, Ali O, Kumar D, Bilal Gilani M, Zahid A, Aslam Joiya S, Anwar Malik M |title=Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura |journal=Case Rep Med |volume=2018 |issue= |pages=2096186 |date=2018 |pmid=29755528 |pmc=5884289 |doi=10.1155/2018/2096186 |url=}}</ref><ref name="pmid29752554">{{cite journal |vauthors=Farhat L, Dara J, Duberstein S, De A |title=Secondary Hypogammaglobulinemia After Rituximab for Neuromyelitis Optica: A Case Report |journal=Drug Saf Case Rep |volume=5 |issue=1 |pages=22 |date=May 2018 |pmid=29752554 |pmc=5948191 |doi=10.1007/s40800-018-0087-y |url=}}</ref><ref name="pmid29627491">{{cite journal |vauthors=Thorlacius H, Jerkeman A, Marginean FE, Toth E |title=Colorectal malakoplakia in a patient with hypogammaglobulinemia |journal=Gastrointest. Endosc. |volume= |issue= |pages= |date=April 2018 |pmid=29627491 |doi=10.1016/j.gie.2018.04.001 |url=}}</ref>
!
*Increased TLC
*Increased RV
*Decreased Vital capacity
*Decreased DLco ( Emphysema)
*Normal DLco ( Chronic bronchitis)
!
*HRCT ( High resolution computed tomography of the lung)
!
*Productive cough
*Exercise intolerance
*Altered mental status
*Cor-pulmonale
*Hyperresonance on percussion
|-
!Interstitial lung disease
!+
!+
!-/+
!+
!+
!+
!-/+
!-
!
* Fine crackles
* Loud P2
!
* Increased A-a gradient
*Decreased PaO2
*Increased PaCo2
!-
!
* Chest X-ray- Reticular infiltrates
* Honey combing
!
*FEV1 decreased
*FVC decreased
*TLC decreased
* RV decreased
*DLco decreased
*FEV1/FVC normal


!
* Environmental hazards:
* HRCT -more accurate than chest xray
** Ionizing radiation
* Most accurate test is lung biopsy
**Toxins
!
*Physical examination shows clubbing
*Decreased pulmonary compliance
|-
!Intrapulmonary shunt
!+/-
!+
!-
!-
!+
!+/-
!-
!-
!Diminished breath sounds
! * Decreased O2
*Increased CO2
!
*CBC- Anemia, polycythemia
!
* Chest X-ray and CT : Smooth nodule with a feeding artery and a draining vein
!
* Decreased Vt, increased residual volume ( physiological)
!
CT angiography
!
* Chronic hypoxemia
* Clubbing
|-
!Upper airway obstruction
!-/+
!+
!-
!-/+
!-/+
!+
!-/+
!-
!Inspiratory stridor
!
* Increased PaCo2
* Decreased PaO2
!
-
!
*Plain radiograph of the neck
*Steeple sign (Croup in pediatric population)
*CT
*MRI
!Decreased vital capacity
!
* HRCT
* Bronchoscopy
!
* Hoarseness
* Accessory muscle use during respiration
*Chest retractions
|-
!High altitude sickness
!-
!+
!+/-
!+
!+/-
!+
!-
!+
!-/+
* Crackles
!
* Respiratory alkalosis
!
*CBC
*EKG- Right sided heart strain
!
*CXR- Bilateral patchy infiltrates
*Brain Ct scan
!
Decreased FVC
!
Test in hypobaric chamber with and without supplemental oxygen
!
* Headache
* Altered mental status
* Pulmonary edema
*Peripheral edema
*Epistaxis
*Rapid pulse
|-
! rowspan="4" |Cardiovascular system
!Acute coronary syndrome
!+
!+
!-
!+/-
!+/-
!+/-
!+/-
!+/-
!
* S3
*Systolic murmur
*Rales
!-
!
*Cardiac enzymes
*EKG
*CBC
*BNP
!
*Chest radiograph:
* Cardiomegaly
* Pulmonary edema
*Echo cardiography
*Myocardial perfusion imaging
*Cardiac angiography
!-
!
* Cardiac troponin
*Coronary angiography
!
* Diaphoresis
*Nausea
*Vomiting
*Presyncope
*Displacement of apical impulse
|-
!Heart failure
!+
!+


!-
*Infections
!
** Viral(Herpes, Measles)
+/-
**Bacterial(Mycobacterial)
!
**Parasitic(Malaria, helminthic infections)
+/-
!
+/-
!
+
!
+
!S3
! Respiratory alkalosis
!
!
!
!
!
|-
!Dysrhythmias
!+/-
!+
!-
!+
!-
!+/-
!-
!-
!Tachycardia
!Normal
! Abnormal BMP
!Normal
!Normal
!EKG
! Etiology:
* Cardiac
* Throtoxicosis
*Electrolyte abnormalities
*Psychiatric
* Medication induced
|-
!Shock
!+/-
!+/-
!+
!+/-
!+/-
!+/-
!+/-
*Wheezing
*Stridor
!
* Mixed acid base disorders
!
Leukocytosis
!
Chest X-ray
!
Decreased Vt
!
Depends on the cause of shock
!
*Hypotension
*Pulsus paradoxus
*Altered mental status
*Oliguria
|-
! rowspan="3" |Metabolic/Systemic disorders
!Diabetic ketoacidosis
!-
! +
!-
!-
!-
!+
!-
!-
!-
! Respiratory acidosis
!
* Anion gap metabolic acidosis
*Serum Beta- hydroxy butyrate
*Acetone
* acetoacetate
* Urine ketones
*Hyponatremia
*Hyperkalemia
*Azotemia
* Hyperosmolality
*EKG
!
-
!
-
!
-
!
-
|-
!Hypocalcemia
!-
!-/+
!-
!+
!-/+
!-/+
!-/+
!-/+
!
* Inspiratory/expiratory wheezes
*S3
!
!
* BMP
*LFT
* Serum albumin
*Coagulation markers
* Serum inonized calcium
*Serum 25 hydroxy Vitamin D
*Serum PTH ( Para thyroid hormone)
* EKG: QT prolongation
!
!
!
!
*Chvostek sign
*Trousseausign
*Tetany
*Seizures
|-
!Hypoglycemia
!-
!-
!-
!+
!-
!-
!-
!-
!-
!-
!
* BMP
*Oral glucose tolerance test
*72 hr fasting plasma glucose
*Serum Insulin level
* Serum Pro insulin
*Plasma C- Peptide
*Serum Cortisol
*Serum Thyroid hormone levels
* Urine analysis
* Blood culture
Liver function tests
!
*Chest X-ray: to rule out any infectious cause
*MRI : To rule out tumors like Insulinoma
* CT scan : To rule out any tumors producing Insulin like growth factors
!
!
* Glucose tolerance test
!
|-
! rowspan="2" |Endocrine system
!Hyperthyroidism
!-/+
!+
!-/+
!+
!-
!+/-
!-/+
!-/+
!
* Systolic hypertension with wide pulse pressure
!
* Respiratory acidosis
!
*Serum freeT3
*Serum freeT4
*Serum TSH
*Radioactive iodine uptake (RAIU)
*Antithyroglobulin antibodies
*Antimicrosomal antibodies
!
* Diffuse/ nodular uptake on thyroid scanning
!
Normal
!
* Serum TSH level
!
*Tremors
*Heat intolerance
*Excessive sweating
*Atrial fibrillation
*Exopthalmos
|-
!Pheochromocytoma
!-
!+
!-/+
!+
!-
!-/+
!-
!-
!
-
!
Normal
!
* Increased Plasma and urinary catecholamines and metanephrines
*Increased Urinary Vanillylmandelic acid level
!
* Non contrast CT
*MRI
*Nuclear Imaging: Meta Iodo-benzyl guanidine(I-123 MIBG)
 
!
Normal
!
* 24 hr urine test for metanephrines, catechoalmines and Vanillyl mandelic acid
!
* Von-Hippel Lindau syndrome
*MEN-I and MEN-II syndromes
*Hereditary paraganglionic syndromes
* Neurofibromatosis-I
|-
! rowspan="2" |CNS
!Central nervous system tumor
!-
!-/+
!-/+
!-
!-
!-/+
!-
!-
!Normal
!Respiratory acidosis
!
* CSF analysis- tumor cella
* Evoked potentials
* Audiometry
!
*MRI with contrast
*CT scan
!Normal
!Contrast enhanced Magnetic resonance imaging
!
*Headaches
*Focal neurological deficits
*Seizures
*Diplopia
*Gait ataxia
*Personality changes
|-
!Anxiety/panic attacks
!+/-
!+
!-
!+/-
!-
!-
!-
!
Normal
!
Normal
!
Normal
!
*Urine toxicology
*EKG- sinus tachycardia
!
Normal
!Normal
!
* Psychiatric mental status examination
* General medical and neurologic examination
!
*Restlessness
*Easy fatiguability
*Difficulty concentrating
*Irritability
*Sleep problems
*Muscle tension
|-
! rowspan="3" |Others
!Pregnancy
!-/+
!+
!-
!-
!-
!-
!-
!-/+
!
* Normal
*Systolic murmur in some women
*S3 heard in some women
!
Respiratory  alkalosis
!
*CBC
*Rh type and screen
*Urine analysis
*Beta-HCG
*Glucose tolerance test
*Cervical cultures for Gonorrhea and Chlamydia
!
*Ultrasound
!
* Decreased Vt
* Increased residual volume
!
* Beta- HCG
* Ultrasound
!
* Amenorrhea
* Hypercoagulability
* Hyperemesis gravidarum
*Hemodilution
* Chloasma
* Striae gravidarum
|-
!Hepatic failure
!-
!-/+
!-/+
!-/+
!-/+
!+
!+
!+
!
*Right ventricular gallop
* Abdominal venous hum (portal vein hypertension)
*Hepatic arterial bruit( Alcoholic hepatitis, Cancer)
* Hepatic friction rub(Cancer, Fitz-Hugh-Curtis syndrome)
!
Respiratory alkalosis
!
* CBC
*Blood culture
* Abnormal liver function tests
*Abnormal prothrombin time
*Abnormal Serum ammonia levels
*Gamma glutamyl transpeptidase(GGT)
*Serum ceruloplasmin level
*Serum alpha-1 antitrypsin levels
*Serum alpha- feto protein levels
*Serum cholesterol levels
 
!
* Doppler ultrasound establishes patency and direction of blood flow in hepatic and portal veins
*Ultrasound- ascites
* CT scan with contrast( in evaluation of parenchymal disease)
* Magnetic resonance imaging
* Magnetic resonance cholangio pancreatography (MRCP: for visualizing intra and extra hepatic bile ducts)
!
Normal
!
Liver biopsy
!
* Jaundice
*Encephalopathy
*Ascites
*Hepatomegaly
*Splenomegaly
*Gynecomastia
|-
!Sepsis
!-
!+
!+
!-/+
!-
!-
!-
!-
! Normal
!Respiratory acidosis
!Leukocytosis
!Normal
!Normal
!SIRS criteria
!
* Altered mental status
*Chills
|}

Latest revision as of 14:23, 3 August 2018


_NOTOC _ Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Causes

Hypogammaglobulinemia is caused by:

Immunodeficiency secondary to:

  • Protein-losing gastroenteropathy
  • Nephrotic syndrome
  • Thymoma [1]
  • Medications :
    • Gold
    • D-Penicillamine
    • Sulfasalazin
    • Anticonvulsants
    • Glucocorticoids
    • Methotrexate
    • Calcineurin inhibitors
    • Rituximab[2][3][4]
  • Environmental hazards:
    • Ionizing radiation
    • Toxins
  • Infections
    • Viral(Herpes, Measles)
    • Bacterial(Mycobacterial)
    • Parasitic(Malaria, helminthic infections)
  1. ↑ Aouadi S, Ghrairi N, Braham E, Kaabi M, Maâlej S, Elgharbi LD (2017). "[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome]". Pan Afr Med J (in French). 28: 253. doi:10.11604/pamj.2017.28.253.11352. PMC 5989270. PMID 29881497.
  2. ↑ Shoukat BA, Ali O, Kumar D, Bilal Gilani M, Zahid A, Aslam Joiya S, Anwar Malik M (2018). "Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura". Case Rep Med. 2018: 2096186. doi:10.1155/2018/2096186. PMC 5884289. PMID 29755528.
  3. ↑ Farhat L, Dara J, Duberstein S, De A (May 2018). "Secondary Hypogammaglobulinemia After Rituximab for Neuromyelitis Optica: A Case Report". Drug Saf Case Rep. 5 (1): 22. doi:10.1007/s40800-018-0087-y. PMC 5948191. PMID 29752554.
  4. ↑ Thorlacius H, Jerkeman A, Marginean FE, Toth E (April 2018). "Colorectal malakoplakia in a patient with hypogammaglobulinemia". Gastrointest. Endosc. doi:10.1016/j.gie.2018.04.001. PMID 29627491.
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