{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:46:45Z","timestamp":1777312005599,"version":"3.51.4"},"reference-count":26,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026]]},"abstract":"\n Background:<\/jats:bold>\n Acute asthma exacerbations commonly lead to hyperventilation-induced hypocapnia (low arterial CO\n 2<\/jats:sub>\n levels). While mild hypocapnia is frequent, extreme hypocapnia (PaCO\n 2<\/jats:sub>\n \u226410 mmHg) causing coma is rare. This case highlights a life-threatening instance of severe hypocapnia in an asthma patient, complicated by anxiety-related hyperventilation and management challenges related to oxygen therapy.\n <\/jats:p>\n \n Case presentation:<\/jats:bold>\n A 43-year-old man with a history of bronchial asthma presented to the emergency department with flu-like symptoms and acute shortness of breath. On arrival, he was normoxic, but he subsequently developed marked hyperventilation accompanied by carpopedal spasm and a state of unresponsiveness. Arterial blood gas analysis, while on supplemental oxygen, revealed profound respiratory alkalosis, with a pH of 7.75, PaCO\n 2<\/jats:sub>\n of 10 mmHg, and PaO\n 2<\/jats:sub>\n of 237 mmHg. Management consisted of cautious oxygen titration, controlled rebreathing to gradually restore carbon dioxide levels, light sedation to alleviate hyperventilation, and correction of electrolyte imbalances. Neuroimaging excluded intracranial pathology. The patient\u2019s neurological status improved within hours, leading to complete recovery without the need for invasive mechanical ventilation.\n <\/jats:p>\n \n Discussion:<\/jats:bold>\n Asthma exacerbations complicated by severe hypocapnia present a unique and often underrecognized therapeutic dilemma. Although oxygen is essential to prevent hypoxemia, excessive administration may further lower PaCO\n 2<\/jats:sub>\n , exacerbate cerebral vasoconstriction, and impair perfusion. Anxiety-related hyperventilation can further amplify these effects, potentially leading to transient cerebral dysfunction. Prompt recognition of extreme hypocapnia, careful modulation of oxygen delivery, and physiologically guided ventilation are essential to restore cerebral and systemic homeostasis.\n <\/jats:p>\n \n Conclusion:<\/jats:bold>\n This case emphasizes the need to recognize extreme hypocapnia as a potential cause of coma in asthma exacerbations, especially when anxiety-driven hyperventilation is involved. With timely supportive care and careful ventilatory management, balancing oxygen therapy and CO\n 2<\/jats:sub>\n control, full neurological recovery and clinical stability were achieved.\n <\/jats:p>","DOI":"10.5339\/qmj.2026.17","type":"journal-article","created":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T19:30:26Z","timestamp":1774207826000},"source":"Crossref","is-referenced-by-count":0,"title":["Severe hypocapnia-induced coma in an asthma patient: When oxygen therapy becomes a double-edged sword"],"prefix":"10.5339","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5737-2452","authenticated-orcid":true,"given":"Waheeb","family":"Naser","sequence":"first","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Waheeb Naser wnaser@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yavuz","family":"Yigit","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Waheeb Naser wnaser@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"issue":"2","key":"B1","series-title":"J Allergy Clin Immunol","first-page":"438","article-title":"Acute asthma, prognosis, and treatment","volume":"139","author":"Fergeson\n \nJE","year":"2017"},{"issue":"4","key":"B2","series-title":"J Clin Med","article-title":"Acid\u2013base disturbances in patients with asthma: A literature review and comments on their pathophysiology","volume":"8","author":"Vasileiadis\n \nI","year":"2019"},{"key":"B3","series-title":"Philadelphia: Elsevier","article-title":"Hypocapnia and hypercapnia Murray & Nadel\u2019s textbook of respiratory medicine","author":"Curley\n \nGF","year":"2016"},{"key":"B4","series-title":"Teaching pearls in noninvasive mechanical ventilation","article-title":"Non invasive ventilation in asthma exacerbation","author":"Kal\u0131n\n \nB","year":"2022"},{"issue":"3","key":"B5","series-title":"J Clin Med","article-title":"Critical care management of severe asthma exacerbations","volume":"13","author":"Gayen\n \nS","year":"2024"},{"issue":"5","key":"B6","series-title":"Stroke","first-page":"566","article-title":"Hyperventilation and cerebral blood flow","volume":"3","author":"Raichle\n \nME","year":"1972"},{"issue":"4","key":"B7","first-page":"384","article-title":"Respiratory alkalosis","volume":"46","author":"Foster\n \nGT","year":"2001"},{"issue":"2","key":"B8","series-title":"Qatar Med J","article-title":"An analysis of unplanned postoperative admissions to the intensive care units at different hospitals across Hamad Medical Corporation in Qatar","volume":"2025","author":"Ghafoor\n \nH","year":"2025"},{"key":"B9","article-title":"Status asthmaticus [Updated 9 Feb 2024]","author":"Chen\n \nRJ","year":"2024"},{"issue":"1","key":"B10","series-title":"Crit Care","first-page":"30","article-title":"Clinical review: Severe asthma","volume":"6","author":"Papiris\n \nS","year":"2002"},{"issue":"4","key":"B11","series-title":"Rev Med Chile","first-page":"554","article-title":"Alcalosis respiratoria grave, la transformaci\u00f3n de un cuadro funcional en org\u00e1nico","volume":"150","author":"Sep\u00falveda\n \nRA","year":"2022"},{"issue":"20","key":"B12","series-title":"J Clin Med","article-title":"The effect of extreme alkalemia upon presentation to the Emergency Department on patient outcomes","volume":"13","author":"Gur\n \nI","year":"2024"},{"issue":"10","key":"B13","series-title":"J Asthma","first-page":"1062","article-title":"Acid\u2013base patterns in acute severe asthma","volume":"50","author":"Raimondi\n \nGA","year":"2013"},{"issue":"2","key":"B1","series-title":"J Allergy Clin Immunol","first-page":"438","article-title":"Acute asthma, prognosis, and treatment","volume":"139","author":"Fergeson\n \nJE","year":"2017"},{"issue":"4","key":"B2","series-title":"J Clin Med","article-title":"Acid\u2013base disturbances in patients with asthma: A literature review and comments on their pathophysiology","volume":"8","author":"Vasileiadis\n \nI","year":"2019"},{"key":"B3","series-title":"Philadelphia: Elsevier","article-title":"Hypocapnia and hypercapnia Murray & Nadel\u2019s textbook of respiratory medicine","author":"Curley\n \nGF","year":"2016"},{"key":"B4","series-title":"Teaching pearls in noninvasive mechanical ventilation","article-title":"Non invasive ventilation in asthma exacerbation","author":"Kal\u0131n\n \nB","year":"2022"},{"issue":"3","key":"B5","series-title":"J Clin Med","article-title":"Critical care management of severe asthma exacerbations","volume":"13","author":"Gayen\n \nS","year":"2024"},{"issue":"5","key":"B6","series-title":"Stroke","first-page":"566","article-title":"Hyperventilation and cerebral blood flow","volume":"3","author":"Raichle\n \nME","year":"1972"},{"issue":"4","key":"B7","first-page":"384","article-title":"Respiratory alkalosis","volume":"46","author":"Foster\n \nGT","year":"2001"},{"issue":"2","key":"B8","series-title":"Qatar Med J","article-title":"An analysis of unplanned postoperative admissions to the intensive care units at different hospitals across Hamad Medical Corporation in Qatar","volume":"2025","author":"Ghafoor\n \nH","year":"2025"},{"key":"B9","article-title":"Status asthmaticus [Updated 9 Feb 2024]","author":"Chen\n \nRJ","year":"2024"},{"issue":"1","key":"B10","series-title":"Crit Care","first-page":"30","article-title":"Clinical review: Severe asthma","volume":"6","author":"Papiris\n \nS","year":"2002"},{"issue":"4","key":"B11","series-title":"Rev Med Chile","first-page":"554","article-title":"Alcalosis respiratoria grave, la transformaci\u00f3n de un cuadro funcional en org\u00e1nico","volume":"150","author":"Sep\u00falveda\n \nRA","year":"2022"},{"issue":"20","key":"B12","series-title":"J Clin Med","article-title":"The effect of extreme alkalemia upon presentation to the Emergency Department on patient outcomes","volume":"13","author":"Gur\n \nI","year":"2024"},{"issue":"10","key":"B13","series-title":"J Asthma","first-page":"1062","article-title":"Acid\u2013base patterns in acute severe asthma","volume":"50","author":"Raimondi\n \nGA","year":"2013"}],"container-title":["Qatar Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2026\/1\/article-17.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2026\/1\/article-17.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2026\/1\/article-17.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:10:02Z","timestamp":1777309802000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2026\/1\/article-17.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":26,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.5339\/qmj.2026.17","relation":{},"ISSN":["2227-0426"],"issn-type":[{"value":"2227-0426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}