Hypoventilation: Difference between revisions

	Hypoventilation;
ICD-10	R06.8
DiseasesDB	29214
MeSH	D007040

VisualWikitext

Latest revision as of 21:51, 16 April 2018

For patient information, click Hypoventilation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Amresh Kumar MD [2] Iqra Qamar M.D.[3]

Synonyms and keywords:

Overview

In medicine, hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (hypo means "below") to perform needed gas exchange. It generally causes an increased concentration of carbon dioxide (hypercapnia) and respiratory acidosis. It can be caused by medical conditions, by holding one's breath, or by drugs, typically when taken in overdose. Hypoventilation may be dangerous for those with sleep apnea.

Pathophysiology

Hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (hypo meaning "below") to perform needed gas exchange. By definition it causes an increased concentration of carbon dioxide (hypercapnia) and respiratory acidosis.

Associated Conditions

Disorders like (CCHS) and Rapid-Onset Obesity, Hypothalamic Dysfunction, Hypoventilation, with Autonomic Dysregulation are recognized as conditions that are associated with hypoventilation. CCHS may be a significant factor in some cases of (SIDS), often termed "cot death" or "crib death".
The opposite condition is (too much ventilation), resulting in low carbon dioxide levels, rather than hypercapnia.

Differentiating hypoventilation from other Diseases

Abbreviations: Ab (antibody); ABG (arterial blood gas); BMP (basic metabolic panel); BPS (biophysical profile score); CHS (central hypoventilation syndrome); CBC (complete blood count); CPK (Creatine phosphokinase); CSF (cerebrospinal fluid); CT (computed tomography ); CXR (chest X-ray); DMD (dystrophin gene); ECG (electrocardiogram); EMG (electromyography); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FRC (functional residual capacity); FVC (forced vital capacity); GIT (gastrointestinal tract); JVD (jugular vein distention); MAS (meconium aspiration syndrome); MCV (mean corpuscular volume); MRI (magnetic resonance imaging); NCS (Nerve conduction studies); PEF (pulmonary expiratory flow); RDS (acute respiratory distress syndrome); ROHHAD (rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation); RV (residual volume); SIRS (systemic inflammatory response syndrome); SMN1 (survival of motor neuron 1); TLC (total lung capacity) TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);

Diseases	Clinical manifestations										Diagnosis					Associated features
	Symptoms						Physical exam				Diagnosis
	Chest pain	Dyspnea	Orthopnea	Fever	Palpitations	Poor quality sleep	Cyanosis	JVD	Peripheral edema	Auscultation	ABGs	Lab findings	Imaging	Spirometry	Gold standard
Central hypoventilation syndrome CHS^[1]^[2]^[3]	-	+	+	-	+/-	+	+	+/-	+/-	Normal	↓O2, ↑CO2	PHOX2B screening testing via fragment analysis or sequencing tests Polysomnography	Brain MRI (exclude other brainstem lesions)	Normal	Molecular testing for PHOX2B mutations	Hirschsprung disease Neural crest tumors Box-shaped face Miosis Strabismus
Asphyxia^[4]^[5]^[6]	-	+	+/-	-	+/-	+	+	+/-	+/-	Systolic murmur	↓O2, ↑CO2	Abnormal renal function tests Cardiac troponin T and I ↑	CXR typically shows cardiomegaly Echocardiography (to exclude other structural heart diseases)	Normal	The fetal biophysical profile score shows loss of accelerations of the fetal heart rate, decreased body movement, breathing, hypotonia and decreased amniotic fluid volume	Acute respiratory distress syndrome (RDS) Meconium aspiration syndrome (MAS) Necrotizing enterocolitis
Chiari II malformation (Arnold-Chiari)^[7]^[8]^[9]	-	+	+	-	+	+	-	-	-	Stridor	Normal	_	CT Scan of Brain (hydrocephalus, herniated cerebellar tonsils, and a flattened spinal cord)	_	MRI Brain	Myelomeningocele Hydrocephalus
Spinal muscular atrophy^[10]^[11]^[12]	-	+	+	-	+/-	+	+	-	-	Stridor	_	Electromyography shows fibrillations and positive sharp waves	_	_	Molecular genetic testing by detection of homozygous deletions of exons 7 of the SMN1 gene	Progressive muscle weakness and atrophy
Guillain-Barré syndrome^[13]^[14]^[15]	-	+	+/-	-	+	+/-	-	-	-	Diminished breath sounds Absence of bowel sound	↓O2, ↑CO2	Albuminocytologic dissociation on CSF analysis	MRI shows selective anterior nerve root enhancement	↓FEV1 ↓FVC ↓TLC	Nerve conduction studies (NCS) and needle electromyography (EMG)	Preceded by mild respiratory or GIT infection Ascending fashion of weakness
Phrenic nerve injury ((Cardiothoracic surgery, central venous catheter insertion, critical illness polyneuropathy, paralytic agents, Subacute inflammatory demyelinating polyneuropathy)^[16]^[17]^[18]	+/-	+	+	+/-	-	+/-	-	-	-	Normal	Normal	CBC (to rule out anemia as the cause of dyspnea) Thyroid function tests	CXR shows unilateral or bilateral diaphragmatic flattening	↓Vt, ↑RV (anatomical)	Fluoroscopic "sniff" test (diaphragmatic movement is observed fluoroscopically while the patient sniffs forcefully)	Respiratory insufficiency
Myasthenia gravis^[19]^[20]^[21]	-	+	+/-	-	-	+	-	-	-	Paradoxical abdominal breathing	↓O2, ↑CO2	Anti-AChR ab Anti–striated muscle ab Anti-MuSK ab	CT may show anterior mediastinal mass (thymoma)	↓FEV1,↓FVC ↓TLC	Anti–acetylcholine receptor antibody test	Ptosis Diplopia Fatigue
Muscular dystrophy^[22]^[23]	+/-	+	+/-	-	+/-	+/-	-	+/-	+/-	Mid-systolic murmur	↓O2, ↑CO2	Elevated CPK levels ECG shows right ventricular strain	Ultrasonography shows increased echogenicity in the affected muscles	↓FVC, ↓PEF	Genetic testing for mutation of the dystrophin gene (DMD)	Waddling, wide- based gait Gower sign
Pneumonia^[24]^[25]^[26]	+	+	+/-	+	+/-	+/-	-	-	-	Wheeze, Rhonchi and Crackles	Normal	↑WBC (neutrophilia)	Lobar consolidation	Normal	Normal	Productive cough
Aspiration^[27]^[28]^[29]	+/-	+	+/-	+	+/-	+/-	+	-	-	Diminished breath sounds	Normal	↑WBC Blood cultures	CXR shows atelectasis	↓Vt, ↑RV	Bronchoscopy	Choking
Obstructive sleep apnea^[30]	+	+	+/-	-	+/-	+	+/-	+/-	+/-	Wheeze Systolic ejection murmur	↓O2, ↑CO2	Polysomnography	MRI shows enlarged adenoids, tonsils and soft palate	↑FRC	Polysomnography	Loud snoring Depression Hypertension Coronary artery disease
Pulmonary hypoplasia^[31]^[32]^[33]	-	+	+/-	-	+/-	+/-	+	-	-	Breath sounds may be decreased or absent on the side of hypoplasia	↓O2, ↑CO2	Abnormal BMP Echocardiography is done to rule out cardiac complications	CXR shows crowded ribs and low thoracic-to- abdominal ratio CT scan of chest	↑RV	_	Myopathic facies
Metabolic alkalosis^[34]^[35]^[36]^[37]	-	+	+/-	-	+/-	+/-	-	+/-	+/-	_	↓O2, ↑CO2	Serum Anion Gap is elevated Abnormal Urine Sodium Ion Concentration	_	_	_	Hypokalemia
Sepsis^[38]^[39]^[40]	-	+	-	+	+/-	+/-	-	-	-	Normal	↓O2, ↑CO2	CBC shows ↑WBC (neutrophilia)	Normal	Normal	SIRS criteria	Chills Confusion
ROHHAD^[41]^[42]^[43]	-	+	+/-	-	+/-	+	+/-	-	-	Displaced cardiac impulse Loud pulmonic second heart sound	↓O2, ↑CO2	Abnormal Serum bicarbonate levels Attended laboratory nocturnal polysomnography	Lateral neck radiographs shows airway narrowing CXR shows chest wall deformity	↓Vt	_	Hypothalamic endocrine manifestations Tumors of neural crest origin
Encephalitis^[44]^[45]^[46]^[47]	-	+	-	+	+	-	+	-	-	Diminished breath sounds in case of small cell lung cancer and associated paraneoplastic encephalitis (associated with anti-neuronal antibodies)	↓O2, ↑CO2	CSF PCR: May reveal HSV-1, HSV-2, VZV, Enterovirus, parechovirus Viruses: IgM and IgG in CSF and serum (acute and convalescent), for antibodies against HSV 1 & 2, VZV, CMV, HHV6, HHV7, enteroviruses, RSV, parvovirus B19, adenovirus, influenza A & B If associated with atypical pneumonia, test serum for: Mycoplasma serology and cold agglutinins Chlamydia serology	Brain CT scan may show: In case of HSV, subtle swelling of the frontotemporal region with loss of the normal gyral pattern Brain MRI may show: In case of autoimmune encephalitis, unilateral or bilateral medial temporal T2 high signal In case of encephalitis associated with HSV, frontotemporal atrophy may be observed	Normal	Diagnostic criteria: Major criteria (must be present): Altered mental status (decreased level of consciousness, lethargy) present for greater than equal to 24 hours Minor criteria ( 2 required for possible encephalitis, greater than equal to 3 required for probable or confirmed diagnosis): Fever greater than equal to 24 hours without any other identified cause Seizures without any history of seizure disorders New onset focal neurological deficits EEG changes typical of encephalitis without presence of other causes CSF leukocyte count greater than equal to 5 cells/mm cube Acute brain parenchymal changes of neuroimaging PCR of CSF for viral encephalitis Anti-NMDA-R antibody in the blood or CSF	Psychosis
High cervical dislocation (severe whiplash injury)^[48]^[49]^[50]	-	+	-	-	-	+	+	-	-	Normal breath sounds	↓O2, ↑CO2	-	X-ray: Lateral shows subluxation of vertebral bodies CT scan: Demonstrates bony anatomy of the injury Malalignment or subtle subluxation of facet Facet fracture associated fractures of the pedicle or lamina	Normal	-	Traumatic injuries

Treatment

Pharmacotherapy

Respiratory stimulants such as nikethamide were traditionally used to counteract respiratory depression from CNS depressant overdose, but were of only limited effectiveness.
A new respiratory stimulant drug called BIMU8 is being investigated which seems to be significantly more effective and may be useful for counteracting the respiratory depression produced by opiates and similar drugs without offsetting their therapeutic effects.
If the respiratory depression is from opioid overdose, then the overdose itself is usually treated with an inverse agonist, most likely naloxone, which will itself almost instantaneously stop the respiratory depression if caused by an opioid (and also, depending on the dose, plunge the patient into precipitated withdrawal).

References

↑ Amiel J, Laudier B, Attié-Bitach T, Trang H, de Pontual L, Gener B; et al. (2003). "Polyalanine expansion and frameshift mutations of the paired-like homeobox gene PHOX2B in congenital central hypoventilation syndrome". Nat Genet. 33 (4): 459–61. doi:10.1038/ng1130. PMID 12640453.
↑ Weese-Mayer DE, Berry-Kravis EM, Zhou L, Maher BS, Silvestri JM, Curran ME; et al. (2003). "Idiopathic congenital central hypoventilation syndrome: analysis of genes pertinent to early autonomic nervous system embryologic development and identification of mutations in PHOX2b". Am J Med Genet A. 123A (3): 267–78. doi:10.1002/ajmg.a.20527. PMID 14608649.
↑ Shannon DC, Marsland DW, Gould JB, Callahan B, Todres ID, Dennis J (1976). "Central hypoventilation during quiet sleep in two infants". Pediatrics. 57 (3): 342–6. PMID 1256944.
↑ Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM; et al. (2005). "Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial". Lancet. 365 (9460): 663–70. doi:10.1016/S0140-6736(05)17946-X. PMID 15721471.
↑ Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF; et al. (2005). "Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy". N Engl J Med. 353 (15): 1574–84. doi:10.1056/NEJMcps050929. PMID 16221780.
↑ Kluckow M (2011). "Functional echocardiography in assessment of the cardiovascular system in asphyxiated neonates". J Pediatr. 158 (2 Suppl): e13–8. doi:10.1016/j.jpeds.2010.11.007. PMID 21238700.
↑ Sarnat HB (2008). "Disorders of segmentation of the neural tube: Chiari malformations". Handb Clin Neurol. 87: 89–103. doi:10.1016/S0072-9752(07)87006-0. PMID 18809020.
↑ Marin-Padilla M, Marin-Padilla TM (1981). "Morphogenesis of experimentally induced Arnold--Chiari malformation". J Neurol Sci. 50 (1): 29–55. PMID 7229658.
↑ Gilbert JN, Jones KL, Rorke LB, Chernoff GF, James HE (1986). "Central nervous system anomalies associated with meningomyelocele, hydrocephalus, and the Arnold-Chiari malformation: reappraisal of theories regarding the pathogenesis of posterior neural tube closure defects". Neurosurgery. 18 (5): 559–64. PMID 3714003.
↑ Kolb SJ, Kissel JT (2015). "Spinal Muscular Atrophy". Neurol Clin. 33 (4): 831–46. doi:10.1016/j.ncl.2015.07.004. PMC 4628728. PMID 26515624.
↑ Darras BT (2015). "Spinal muscular atrophies". Pediatr Clin North Am. 62 (3): 743–66. doi:10.1016/j.pcl.2015.03.010. PMID 26022173.
↑ Mercuri E, Bertini E, Iannaccone ST (2012). "Childhood spinal muscular atrophy: controversies and challenges". Lancet Neurol. 11 (5): 443–52. doi:10.1016/S1474-4422(12)70061-3. PMID 22516079.
↑ Anandan C, Khuder SA, Koffman BM (2017). "Prevalence of autonomic dysfunction in hospitalized patients with Guillain-Barré syndrome". Muscle Nerve. 56 (2): 331–333. doi:10.1002/mus.25551. PMID 28039863.
↑ Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC (2014). "Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria". Brain. 137 (Pt 1): 33–43. doi:10.1093/brain/awt285. PMID 24163275.
↑ Flachenecker P (2007). "Autonomic dysfunction in Guillain-Barré syndrome and multiple sclerosis". J Neurol. 254 Suppl 2: II96–101. doi:10.1007/s00415-007-2024-3. PMID 17503142.
↑ Laroche CM, Carroll N, Moxham J, Green M (1988). "Clinical significance of severe isolated diaphragm weakness". Am Rev Respir Dis. 138 (4): 862–6. doi:10.1164/ajrccm/138.4.862. PMID 3202460.
↑ Gierada DS, Slone RM, Fleishman MJ (1998). "Imaging evaluation of the diaphragm". Chest Surg Clin N Am. 8 (2): 237–80. PMID 9619304.
↑ Sandham JD, Shaw DT, Guenter CA (1977). "Acute supine respiratory failure due to bilateral diaphragmatic paralysis". Chest. 72 (1): 96–8. PMID 872664.
↑ Benatar M (2006). "A systematic review of diagnostic studies in myasthenia gravis". Neuromuscul Disord. 16 (7): 459–67. doi:10.1016/j.nmd.2006.05.006. PMID 16793269.
↑ Grob D, Brunner N, Namba T, Pagala M (2008). "Lifetime course of myasthenia gravis". Muscle Nerve. 37 (2): 141–9. doi:10.1002/mus.20950. PMID 18059039.
↑ Mantegazza R, Beghi E, Pareyson D, Antozzi C, Peluchetti D, Sghirlanzoni A; et al. (1990). "A multicentre follow-up study of 1152 patients with myasthenia gravis in Italy". J Neurol. 237 (6): 339–44. PMID 2277266.
↑ Takasugi T, Ishihara T, Kawamura J, Sasaki K, Toyoda T, Oosumi M; et al. (1995). "[Blood gas changes in Duchenne type muscular dystrophy]". Nihon Kyobu Shikkan Gakkai Zasshi. 33 (1): 17–22. PMID 7699962.
↑ Mayer OH, Finkel RS, Rummey C, Benton MJ, Glanzman AM, Flickinger J; et al. (2015). "Characterization of pulmonary function in Duchenne Muscular Dystrophy". Pediatr Pulmonol. 50 (5): 487–94. doi:10.1002/ppul.23172. PMC 4402127. PMID 25755201.
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↑ Vergani P (2012). "Prenatal diagnosis of pulmonary hypoplasia". Curr Opin Obstet Gynecol. 24 (2): 89–94. doi:10.1097/GCO.0b013e3283505a86. PMID 22249145.
↑ Berger RM, Beghetti M, Humpl T, Raskob GE, Ivy DD, Jing ZC; et al. (2012). "Clinical features of paediatric pulmonary hypertension: a registry study". Lancet. 379 (9815): 537–46. doi:10.1016/S0140-6736(11)61621-8. PMC 3426911. PMID 22240409.
↑ Tsukimori K, Masumoto K, Morokuma S, Yoshimura T, Taguchi T, Hara T; et al. (2008). "The lung-to-thorax transverse area ratio at term and near term correlates with survival in isolated congenital diaphragmatic hernia". J Ultrasound Med. 27 (5): 707–13. PMID 18424645.
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↑ FISHMAN LS, SAMSON JH, SPERLING DR (1965). "PRIMARY ALVEOLAR HYPOVENTILATION SYNDROME (ONDINE'S CURSE)". Am J Dis Child. 110: 155–61. PMID 14320765.
↑ Paz-Priel I, Cooke DW, Chen AR (2011). "Cyclophosphamide for rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome". J Pediatr. 158 (2): 337–9. doi:10.1016/j.jpeds.2010.07.006. PMC 3976575. PMID 20727534.
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Template:WikiDoc Sources

[pmid12640453-1] Amiel J, Laudier B, Attié-Bitach T, Trang H, de Pontual L, Gener B; et al. (2003). "Polyalanine expansion and frameshift mutations of the paired-like homeobox gene PHOX2B in congenital central hypoventilation syndrome". Nat Genet. 33 (4): 459–61. doi:10.1038/ng1130. PMID 12640453.

[pmid14608649-2] Weese-Mayer DE, Berry-Kravis EM, Zhou L, Maher BS, Silvestri JM, Curran ME; et al. (2003). "Idiopathic congenital central hypoventilation syndrome: analysis of genes pertinent to early autonomic nervous system embryologic development and identification of mutations in PHOX2b". Am J Med Genet A. 123A (3): 267–78. doi:10.1002/ajmg.a.20527. PMID 14608649.

[pmid1256944-3] Shannon DC, Marsland DW, Gould JB, Callahan B, Todres ID, Dennis J (1976). "Central hypoventilation during quiet sleep in two infants". Pediatrics. 57 (3): 342–6. PMID 1256944.

[pmid15721471-4] Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM; et al. (2005). "Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial". Lancet. 365 (9460): 663–70. doi:10.1016/S0140-6736(05)17946-X. PMID 15721471.

[pmid16221780-5] Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF; et al. (2005). "Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy". N Engl J Med. 353 (15): 1574–84. doi:10.1056/NEJMcps050929. PMID 16221780.

[pmid21238700-6] Kluckow M (2011). "Functional echocardiography in assessment of the cardiovascular system in asphyxiated neonates". J Pediatr. 158 (2 Suppl): e13–8. doi:10.1016/j.jpeds.2010.11.007. PMID 21238700.

[pmid18809020-7] Sarnat HB (2008). "Disorders of segmentation of the neural tube: Chiari malformations". Handb Clin Neurol. 87: 89–103. doi:10.1016/S0072-9752(07)87006-0. PMID 18809020.

[pmid7229658-8] Marin-Padilla M, Marin-Padilla TM (1981). "Morphogenesis of experimentally induced Arnold--Chiari malformation". J Neurol Sci. 50 (1): 29–55. PMID 7229658.

[pmid3714003-9] Gilbert JN, Jones KL, Rorke LB, Chernoff GF, James HE (1986). "Central nervous system anomalies associated with meningomyelocele, hydrocephalus, and the Arnold-Chiari malformation: reappraisal of theories regarding the pathogenesis of posterior neural tube closure defects". Neurosurgery. 18 (5): 559–64. PMID 3714003.

[pmid26515624-10] Kolb SJ, Kissel JT (2015). "Spinal Muscular Atrophy". Neurol Clin. 33 (4): 831–46. doi:10.1016/j.ncl.2015.07.004. PMC 4628728. PMID 26515624.

[pmid26022173-11] Darras BT (2015). "Spinal muscular atrophies". Pediatr Clin North Am. 62 (3): 743–66. doi:10.1016/j.pcl.2015.03.010. PMID 26022173.

[pmid22516079-12] Mercuri E, Bertini E, Iannaccone ST (2012). "Childhood spinal muscular atrophy: controversies and challenges". Lancet Neurol. 11 (5): 443–52. doi:10.1016/S1474-4422(12)70061-3. PMID 22516079.

[pmid28039863-13] Anandan C, Khuder SA, Koffman BM (2017). "Prevalence of autonomic dysfunction in hospitalized patients with Guillain-Barré syndrome". Muscle Nerve. 56 (2): 331–333. doi:10.1002/mus.25551. PMID 28039863.

[pmid24163275-14] Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC (2014). "Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria". Brain. 137 (Pt 1): 33–43. doi:10.1093/brain/awt285. PMID 24163275.

[pmid17503142-15] Flachenecker P (2007). "Autonomic dysfunction in Guillain-Barré syndrome and multiple sclerosis". J Neurol. 254 Suppl 2: II96–101. doi:10.1007/s00415-007-2024-3. PMID 17503142.

[pmid3202460-16] Laroche CM, Carroll N, Moxham J, Green M (1988). "Clinical significance of severe isolated diaphragm weakness". Am Rev Respir Dis. 138 (4): 862–6. doi:10.1164/ajrccm/138.4.862. PMID 3202460.

[pmid9619304-17] Gierada DS, Slone RM, Fleishman MJ (1998). "Imaging evaluation of the diaphragm". Chest Surg Clin N Am. 8 (2): 237–80. PMID 9619304.

[pmid872664-18] Sandham JD, Shaw DT, Guenter CA (1977). "Acute supine respiratory failure due to bilateral diaphragmatic paralysis". Chest. 72 (1): 96–8. PMID 872664.

[pmid16793269-19] Benatar M (2006). "A systematic review of diagnostic studies in myasthenia gravis". Neuromuscul Disord. 16 (7): 459–67. doi:10.1016/j.nmd.2006.05.006. PMID 16793269.

[pmid18059039-20] Grob D, Brunner N, Namba T, Pagala M (2008). "Lifetime course of myasthenia gravis". Muscle Nerve. 37 (2): 141–9. doi:10.1002/mus.20950. PMID 18059039.

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@@ Line 14: / Line 14: @@
 '''For patient information, click [[Hypoventilation (patient information)|Hypoventilation]]'''
-{{CMG}},{{AE}}{{AMK}}
+{{CMG}},{{AE}} {{AMK}} {{IQ}}
 '''''Synonyms and keywords:'''''
@@ Line 20: / Line 20: @@
 ==Overview==
 In [[medicine]], '''hypoventilation''' (also known as '''respiratory depression''') occurs when ventilation is inadequate (''hypo'' means "below") to perform needed [[gas exchange]]. It generally causes an increased concentration of [[carbon dioxide]] ([[hypercapnia]]) and [[respiratory acidosis]]. It can be caused by medical conditions, by holding one's breath, or by [[medication|drugs]], typically when taken in [[overdose]].  Hypoventilation may be dangerous for those with [[sleep apnea]].
-==Classification==
 ==Pathophysiology==
 Hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (hypo meaning "below") to perform needed gas exchange. By definition it causes an increased concentration of carbon dioxide (hypercapnia) and respiratory acidosis.
@@ Line 27: / Line 25: @@
 * Disorders like (CCHS) and Rapid-Onset Obesity, Hypothalamic Dysfunction, Hypoventilation, with Autonomic Dysregulation  are recognized as conditions that are associated with hypoventilation. CCHS may be a significant factor in some cases of  (SIDS), often termed "cot death" or "crib death".
 * The opposite condition is  (too much ventilation), resulting in low carbon dioxide levels, rather than hypercapnia.
-==Causes==
-===Life Threatening Causes===
-===Common Causes===
-===Causes by Organ System===
-{| style="width:80%; height:100px" border="1"
-| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
-| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
-|-
-| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Dental'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Dermatologic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Drug Side Effect'''
-| bgcolor="Beige" | [[Acetaminophen/Codeine Phosphate]], [[Acetaminophen/Oxycodone Hydrochloride]], [[Alcuronium]], [[Alfentanyl]], [[Alfentanil Hydrochloride]], [[Alprostadil]], [[Amobarbital sodium]], [[Apomorphine]], [[Aspirin/Caffeine/Dihydrocodeine Bitartrate]], [[Aspirin/Codeine Phosphate]], [[Aspirin/Oxycodone Hydrochloride]], [[Atropine Sulfate]], [[Baclofen]], [[Brimonidine]], [[Bupivacaine]], [[Buprenorphine]], [[Buprenorphine Hydrochloride]], [[Buprenorphine/Naloxone]], [[Butalbital/Acetaminophen/Caffeine/Codeine Phosphate]], [[Butalbital/Aspirin/Caffeine/Codeine Phosphate]], [[Butorphanol]], [[Butorphanol Tartrate]], [[Carisoprodol/Aspirin/Codeine Phosphate]], [[Cifenline]], [[Clobazam]], [[Clonazepam]], [[Clonidine]], [[Codeine]], [[Codeine Phosphate/Guaifenesin]], [[Codeine Sulfate]], [[Dantrolene]], [[Desflurane]], [[Dexmedetomidine]], [[Dexmedetomidine Hydrochloride]], [[Diazepam]], [[Diclofenac]], [[Dihydrocodeine]], [[Disulfiram]], [[Droperidol]], [[Enflurane]], [[Ethanol]], [[Fentanyl]], [[Fentanyl Citrate]], [[Fentanyl/Droperidol]], [[Halazepam]], [[Homatropine Methylbromide/Hydrocodone Bitartrate]], [[Hydrocodone]], [[Hydrocodone Bitartrate]], [[Hydrocodone Bitartrate/Acetaminophen]], [[Hydrocodone Bitartrate/Chlorpheniramine Maleate]], [[Hydrocodone Bitartrate/Guaifenesin]], [[Hydrocodone Bitartrate/Ibuprofen]], [[Hydrocodone Bitartrate/Pseudoephedrine Hydrochloride]], [[Hydrocodone Polistirex/Chlorpheniramine Polistirex]], [[Hydrocodone/Chlorpheniramine/Pseudoephedrine]], [[Hydromorphone]], [[Hydromorphone Hydrochloride]], [[Ipratropium]], [[Isoflurane]], [[Ketamine]], [[Ketamine Hydrochloride]], [[Levorphanol]], [[Levorphanol Tartrate]], [[Lidocaine]], [[Lopinavir/Ritonavir]], [[Lorazepam]], [[Magnesium]], [[Meperidine]], [[Meperidine Hydrochloride]], [[Methadone]], [[Methadone Hydrochloride]], [[Methohexital]], [[Methohexital Sodium]], [[Midazolam]], [[Midazolam Hydrochloride]], [[Morphine]], [[Morphine Sulfate]], [[Morphine Sulfate Liposome]], [[Morphine Sulfate/Naltrexone Hydrochloride]], [[Nalbuphine]], [[Nalbuphine Hydrochloride]], [[Nefopam]], [[Neostigmine]], [[Nortriptyline]], [[Onabotulinumtoxina]], [[Opium]], [[Oxaprozin]], [[Oxycodone]], [[Oxycodone Hydrochloride]], [[Oxycodone Hydrochloride/Naloxone Hydrochloride]], [[Oxycodon]], [[Oxycodone Hydrochloride]], [[Oxycodone Hydrochloride/Naloxone Hydrochloride]],  [[Oxycodone/Ibuprofen]], [[Oxymorphone]], [[Oxymorphone Hydrochloride]], [[Paregoric]], [[Pancuronium]], [[Pancuronium Bromide]], [[Pentazocine]], [[Pentazocine Hydrochloride/Acetaminophen]], [[Pentazocine Hydrochloride/Naloxone Hydrochloride]], [[Pentazocine Lactate]], [[Pentobarbital]], [[Phenelzine]], [[Polymixinb]], [[Prilocaine]], [[Prilocaine Hydrochloride]], [[Promethazine]], [[Promethazine Hydrochloride]], [[Promethazine Hydrochloride/Codeine Phosphate]], [[Promethazine/Phenylephrine/Codeine Phosphate]], [[Propoxyphene]], [[Propoxyphene Napsylate/Acetaminophen]], [[Quinine]], [[Remifentail]], [[Remifentanil Hydrochloride]], [[Riluzole]], [[Rimabotulinumtoxinb]], [[Secobarbital sodium]], [[Sevoflurane]], [[Sodium Oxybate]], [[Succinylcholine]], [[Succinylcholine Chloride]], [[Sufentanil]], [[Sufentanil Citrate]], [[Tapentadol]], [[Tapentadol Hydrochloride]], [[Thiopental Sodium]], [[Tilidine]], [[Tramadol]], [[Tramadol Hydrochloride]], [[Tromethamine]], [[Zanamivir]]
-|-
-|- bgcolor="LightSteelBlue"
-| '''Ear Nose Throat'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Endocrine'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Environmental'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Gastroenterologic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Genetic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Hematologic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Iatrogenic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Infectious Disease'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Musculoskeletal/Orthopedic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Neurologic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Nutritional/Metabolic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Obstetric/Gynecologic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Oncologic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Ophthalmologic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Overdose/Toxicity'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Psychiatric'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Pulmonary'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Renal/Electrolyte'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Rheumatology/Immunology/Allergy'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Sexual'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Trauma'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Urologic'''
-| bgcolor="Beige" | No underlying causes
-|-
-|- bgcolor="LightSteelBlue"
-| '''Miscellaneous'''
-| bgcolor="Beige" | No underlying causes
-|-
-|}
 ==Differentiating hypoventilation from other Diseases==
-<small>'''''Abbreviations:''''' '''Ab ('''[[antibody]]'''); ABG ('''[[arterial blood gas]]'''); BMP ('''[[basic metabolic panel]]'''); BPS''' ([[Biophysical profile|biophysical profile score]]'''); CHS''' ([[Congenital central hypoventilation syndrome|central hypoventilation syndrome]]''');''' '''CBC ('''[[Complete blood counts|complete blood count]]'''); CPK ('''[[Creatine phosphokinase]]'''); CSF ('''[[cerebrospinal fluid]]'''); CT ('''[[computed tomography]]''' ); CXR ('''[[chest X-ray]]'''); DMD ('''[[Dystrophin|dystrophin gene]]); ''' ECG ('''[[electrocardiogram]]'''); EMG ('''[[electromyography]]''');''' '''FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FRC ('''[[functional residual capacity]]'''); FVC ('''[[forced vital capacity]]'''); GIT ('''[[gastrointestinal tract]]'''); JVD ('''[[jugular vein distention]]'''); MAS ('''[[meconium aspiration syndrome]]); '''MCV ('''[[mean corpuscular volume]]'''); MRI''' ([[magnetic resonance imaging]]'''); NCS ('''[[Nerve conduction studies|Nerve conduction studies''')''']];  '''PEF ('''pulmonary expiratory flow'''); RDS ('''[[Acute respiratory distress syndrome|acute respiratory distress syndrome]]); '''ROHHAD''' (rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation'''); RV ('''[[residual volume]]'''); SIRS ('''[[systemic inflammatory response syndrome]]'''); SMN1 ('''[[SMN1|survival of motor neuron 1]]'''); TLC ('''[[total lung capacity]]''')''' '''TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]''');'''</small>
+<small><small>
+'''''Abbreviations:''''' '''Ab ('''[[antibody]]'''); ABG ('''[[arterial blood gas]]'''); BMP ('''[[basic metabolic panel]]'''); BPS''' ([[Biophysical profile|biophysical profile score]]'''); CHS''' ([[Congenital central hypoventilation syndrome|central hypoventilation syndrome]]''');''' '''CBC ('''[[Complete blood counts|complete blood count]]'''); CPK ('''[[Creatine phosphokinase]]'''); CSF ('''[[cerebrospinal fluid]]'''); CT ('''[[computed tomography]]''' ); CXR ('''[[chest X-ray]]'''); DMD ('''[[Dystrophin|dystrophin gene]]); ''' ECG ('''[[electrocardiogram]]'''); EMG ('''[[electromyography]]''');''' '''FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FRC ('''[[functional residual capacity]]'''); FVC ('''[[forced vital capacity]]'''); GIT ('''[[gastrointestinal tract]]'''); JVD ('''[[jugular vein distention]]'''); MAS ('''[[meconium aspiration syndrome]]); '''MCV ('''[[mean corpuscular volume]]'''); MRI''' ([[magnetic resonance imaging]]'''); NCS ('''[[Nerve conduction studies|Nerve conduction studies''')''']];  '''PEF ('''pulmonary expiratory flow'''); RDS ('''[[Acute respiratory distress syndrome|acute respiratory distress syndrome]]); '''ROHHAD''' (rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation'''); RV ('''[[residual volume]]'''); SIRS ('''[[systemic inflammatory response syndrome]]'''); SMN1 ('''[[SMN1|survival of motor neuron 1]]'''); TLC ('''[[total lung capacity]]''')''' '''TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]''');'''
 {| class="wikitable"
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="3" |Diseases
+! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
-! colspan="10" |Clinical manifestations
+! colspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
-! colspan="5" rowspan="2" |Diagnosis
+! colspan="5" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
-! rowspan="3" |Associated features
+! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated features
 |-
-! colspan="6" |Symptoms
+! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
-! colspan="4" |Physical exam
+! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
 |-
-!Chest pain
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Chest pain
-!Dyspnea
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
-!Orthopnea
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Orthopnea
-!Fever
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
-!Palpitations
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Palpitations
-!Poor
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Poor
 quality sleep
-!Cyanosis
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cyanosis
-!JVD
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |JVD
-!Peripheral edema
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Peripheral edema
-!Auscultation
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Auscultation
-!ABGs
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |ABGs
-!Lab findings
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
-!Imaging
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
-!Spirometry
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Spirometry
-!Gold standard
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
 |- style="background: #DCDCDC; padding: 5px; text-align: center;" |
 ![[Congenital central hypoventilation syndrome|Central hypoventilation syndrome CHS]]<ref name="pmid12640453">{{cite journal| author=Amiel J, Laudier B, Attié-Bitach T, Trang H, de Pontual L, Gener B et al.| title=Polyalanine expansion and frameshift mutations of the paired-like homeobox gene PHOX2B in congenital central hypoventilation syndrome. | journal=Nat Genet | year= 2003 | volume= 33 | issue= 4 | pages= 459-61 | pmid=12640453 | doi=10.1038/ng1130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12640453  }} </ref><ref name="pmid14608649">{{cite journal| author=Weese-Mayer DE, Berry-Kravis EM, Zhou L, Maher BS, Silvestri JM, Curran ME et al.| title=Idiopathic congenital central hypoventilation syndrome: analysis of genes pertinent to early autonomic nervous system embryologic development and identification of mutations in PHOX2b. | journal=Am J Med Genet A | year= 2003 | volume= 123A | issue= 3 | pages= 267-78 | pmid=14608649 | doi=10.1002/ajmg.a.20527 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14608649  }} </ref><ref name="pmid1256944">{{cite journal| author=Shannon DC, Marsland DW, Gould JB, Callahan B, Todres ID, Dennis J| title=Central hypoventilation during quiet sleep in two infants. | journal=Pediatrics | year= 1976 | volume= 57 | issue= 3 | pages= 342-6 | pmid=1256944 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1256944  }} </ref>
@@ Line 203: / Line 81: @@
 * [[Neural crest cell|Neural crest             tumors]]
 * Box-shaped face
-* [[Meiosis]]
+* [[Miosis]]
 * [[Strabismus]]
 |-
@@ Line 306: / Line 184: @@
 * Ascending fashion     of [[weakness]]
 |-
-![[Phrenic nerve paralysis|Phrenic nerve injury]]<ref name="pmid3202460">{{cite journal| author=Laroche CM, Carroll N, Moxham J, Green M| title=Clinical significance of severe isolated diaphragm weakness. | journal=Am Rev Respir Dis | year= 1988 | volume= 138 | issue= 4 | pages= 862-6 | pmid=3202460 | doi=10.1164/ajrccm/138.4.862 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3202460  }} </ref><ref name="pmid9619304">{{cite journal| author=Gierada DS, Slone RM, Fleishman MJ| title=Imaging evaluation of the diaphragm. | journal=Chest Surg Clin N Am | year= 1998 | volume= 8 | issue= 2 | pages= 237-80 | pmid=9619304 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9619304  }} </ref><ref name="pmid872664">{{cite journal| author=Sandham JD, Shaw DT, Guenter CA| title=Acute supine respiratory failure due to bilateral diaphragmatic paralysis. | journal=Chest | year= 1977 | volume= 72 | issue= 1 | pages= 96-8 | pmid=872664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=872664  }} </ref>
+![[Phrenic nerve paralysis|Phrenic nerve injury]] ((Cardiothoracic surgery, central venous catheter insertion, critical illness polyneuropathy, paralytic agents, Subacute inflammatory demyelinating polyneuropathy)<ref name="pmid3202460">{{cite journal| author=Laroche CM, Carroll N, Moxham J, Green M| title=Clinical significance of severe isolated diaphragm weakness. | journal=Am Rev Respir Dis | year= 1988 | volume= 138 | issue= 4 | pages= 862-6 | pmid=3202460 | doi=10.1164/ajrccm/138.4.862 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3202460  }} </ref><ref name="pmid9619304">{{cite journal| author=Gierada DS, Slone RM, Fleishman MJ| title=Imaging evaluation of the diaphragm. | journal=Chest Surg Clin N Am | year= 1998 | volume= 8 | issue= 2 | pages= 237-80 | pmid=9619304 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9619304  }} </ref><ref name="pmid872664">{{cite journal| author=Sandham JD, Shaw DT, Guenter CA| title=Acute supine respiratory failure due to bilateral diaphragmatic paralysis. | journal=Chest | year= 1977 | volume= 72 | issue= 1 | pages= 96-8 | pmid=872664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=872664  }} </ref>
 !+/-
 !+
@@ Line 548: / Line 426: @@
 * [[Hypothalamus|Hypothalamic]]             [[Endocrine system|endocrine]]                   manifestations
 * [[Tumors]] of [[Neural crest cell|neural crest origin]]
-|-
-!Drugs ( e.g. morphine and barbiturates)
-!
-!
-!
-!
-!
-!
-!
-!
-!
-!
-!
-!
-!
-!
-!
-!
 |-
 !Encephalitis<ref name="pmid20113599">{{cite journal |vauthors=Liu XJ, Li W, Zhang YQ, Liu YM, Liu LZ |title=[Clinical features and treatment of serious brainstem encephalitis caused by enterovirus 71 infection] |language=Chinese |journal=Zhongguo Dang Dai Er Ke Za Zhi |volume=11 |issue=12 |pages=967–9 |date=December 2009 |pmid=20113599 |doi= |url=}}</ref><ref name="pmid25214951">{{cite journal |vauthors=Zhang YC, Li XW, Zhu XD, Qian SY, Shang YX, Li BR, Liu XL |title=Clinical characteristics and treatment of severe encephalitis associated with neurogenic pulmonary edema caused by enterovirus 71 in China |journal=World J Emerg Med |volume=1 |issue=2 |pages=108–13 |date=2010 |pmid=25214951 |pmc=4129752 |doi= |url=}}</ref><ref name="urlAseptic meningitis and encephalitis: the role of PCR in the diagnostic laboratory.">{{cite web |url=http://jcm.asm.org/content/35/3/691 |title=Aseptic meningitis and encephalitis: the role of PCR in the diagnostic laboratory. |format= |work= |accessdate=}}</ref><ref name="pmid25061311">{{cite journal |vauthors=Mann AP, Grebenciucova E, Lukas RV |title=Anti-N-methyl-D-aspartate-receptor encephalitis: diagnosis, optimal management, and challenges |journal=Ther Clin Risk Manag |volume=10 |issue= |pages=517–25 |date=2014 |pmid=25061311 |pmc=4085332 |doi=10.2147/TCRM.S61967 |url=}}</ref>
@@ Line 595: / Line 455: @@
 !Normal
 !
+* Diagnostic criteria:
+** Major criteria (must be present):
+*** Altered mental status (decreased level of consciousness, lethargy) present for greater than equal to 24 hours
+** Minor criteria ( 2 required for possible encephalitis, greater than equal to 3 required for probable or confirmed diagnosis):
+*** Fever greater than equal  to 24 hours  without  any other identified cause
+*** Seizures without any history of seizure disorders
+*** New onset focal neurological deficits
+*** EEG changes typical of encephalitis without presence of other causes
+*** CSF leukocyte count greater than equal to 5 cells/mm cube
+*** Acute brain parenchymal changes of neuroimaging
 * PCR of CSF for viral encephalitis
 * Anti-NMDA-R antibody in the blood or CSF
 !
+* Psychosis
 |-
-!High cervical dislocation
+!High cervical dislocation (severe whiplash injury)<ref name="urlCritical Care Medicine: Principles of Diagnosis and Management in the Adult ... - Joseph E. Parrillo, R. Phillip Dellinger - Google Books">{{cite web |url=https://books.google.com/books?id=NXuzAQAAQBAJ&pg=PA694&lpg=PA694&dq=cervical+dislocation+hypoventilation&source=bl&ots=phZTyz6buv&sig=Isi8FVDwV8ictgYaT325ZHU5x4Q&hl=en&sa=X&ved=0ahUKEwjy-PChgPHZAhXPct8KHS7HCQwQ6AEIYTAF#v=onepage&q=cervical%20dislocation%20hypoventilation&f=false |title=Critical Care Medicine: Principles of Diagnosis and Management in the Adult ... - Joseph E. Parrillo, R. Phillip Dellinger - Google Books |format= |work= |accessdate=}}</ref><ref name="pmid28825009">{{cite journal |vauthors=Yu E, Romero N, Miles T, Hsu SL, Kondrashov D |title=Dyspnea as the Presenting Symptom of Cervical Spondylotic Myelopathy |journal=Surg J (N Y) |volume=2 |issue=4 |pages=e147–e150 |date=October 2016 |pmid=28825009 |pmc=5553503 |doi=10.1055/s-0036-1597664 |url=}}</ref><ref name="urlDyspnea Caused by Atlantoaxial Subluxation in a Patient with Rheumatoid Arthritis">{{cite web |url=http://dx.doi.org/10.1155/2012/170956 |title=Dyspnea Caused by Atlantoaxial Subluxation in a Patient with Rheumatoid Arthritis |format= |work= |accessdate=}}</ref>
-!
+!-
-!
+!+
-!
+!-
-!
+!-
-!
+!-
-!
+!+
-!
+!+
-!
+!-
-!
+!-
-!
-!
-!
-!
 !
+* Normal breath sounds
+!↓[[Oxygen|O2]], ↑[[Carbon dioxide|CO2]]
+!-
 !
+* X-ray:
+** Lateral shows subluxation of vertebral bodies
+* CT scan:
+** Demonstrates bony anatomy of the injury
+** Malalignment or subtle subluxation of facet
+** Facet fracture  associated fractures of the pedicle or lamina
+!Normal
+!-
 !
+* Traumatic injuries
 |}
+</small></small>
-== Epidemiology and Demographics ==
-== Risk Factors ==
-== Screening ==
-== Natural History, Complications, and Prognosis==
 == Treatment ==

Hypoventilation
ICD-10	R06.8
DiseasesDB	29214
MeSH	D007040