Tachypnea

Tachypnea is defined as an increase in the normal respiratory rate. The normal respiratory rate varies with age (24–38 respirations per minute for children <1 year of age; 12–19 rpm for adults). Tachypnea is typically associated with dyspnea (the feeling of inadequate respiration); however, processes that cause metabolic acidosis will result in a Kussmaul breathing pattern, characterized by “comfortable” tachypnea.

Differential Diagnosis

• Cardiovascular etiologies
  –Pulmonary embolism: Associated with pleuritic chest pain, tachycardia, hypoxia, possible cyanosis, hypercoagulable states
  –CHF: Associated with history of ischemic heart disease, pitting peripheral edema, elevated jugular venous pressure, third heart sound, dyspnea
  –Acute MI/angina: Associated with chest pain, diaphoresis, dyspnea, nausea
  –Hypotension (e.g., cardiomyopathy): Low BP, tachycardia if acute, may be due to medications
• Pulmonary etiologies
  –COPD/asthma: Associated with a history of wheezing, cigarette use
  –Pneumonia: Associated with fever, cough, sputum production, dyspnea
  –Pneumothorax: Associated with pleuritic chest pain, history of rib trauma, COPD, hyperresonance to percussion
  –Restrictive lung diseases: Interstitial lung disease, thoracic abnormalities (e.g., kyphosis, pneumonectomy), neuromuscular diseases (e.g., ALS, Guillain-Barré, diaphragmatic paralysis)
• Metabolic and toxicologic etiologies
  –Diabetic ketoacidosis: Associated with dehydration, Kussmaul respirations, acetone breath
  –Severe dehydration: May occur in the setting of vomiting, diarrhea, burns, inadequate fluid intake
  –Salicylate toxicity: Associated with nausea, vomiting, tinnitus, altered mental status, convulsions
  –Metabolic acidosis
• Neurologic etiologies
  –CVA
  –Head trauma
• Anxiety/hyperventilation
• Sepsis
• Hyperthyroidism
• Medications/drugs
  –Sympathomimetics (e.g., cocaine)
  –Aspirin
  –β-agonists
  –Methylxanthines
• Less common etiologies (“zebras”) include pericardial effusion, malignancy, tuberculosis, pheochromocytoma

Workup and Diagnosis

• History and physical examination focusing on precipitants, time course, associated symptoms, and past medical history
• Initial laboratory studies may include pulse oximetry, CBC, electrolytes, renal function, glucose, urinalysis, blood culture, urine culture, pulmonary function tests, serum aspirin level, and urine toxicology screen
• Electrocardiography and cardiac enzymes to rule out myocardial ischemia/infarction
• Chest X-ray
• Arterial blood gas
  –Determine whether cause is primary respiratory alkalosis or secondary to primary metabolic acidosis
  –Increased A-a gradient suggests pulmonary disease or pulmonary embolism

Treatment

• Immediate assessment of ABCs (airway, breathing, circulation)
• Administer supplemental O₂
• Treat pain if appropriate
• Evaluate for toxic ingestions and treat immediately as per toxicology protocols
• Treat underlying etiologies as appropriate

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Rapid breathing

Read excerpts from these other book chapters related to Rapid breathing:

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Rapid breathing

• Back to symptom: Rapid breathing: Introduction (review 336 causes)
• Next Book Extract About Rapid breathing: Stridor & Wheezing (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Rapid breathing

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Stridor & Wheezing (In a Page: Signs and Symptoms)

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