Differential Diagnosis

• Single most likely diagnosis
  • Hyperventilation syndrome: This is the most likely diagnosis given the symptoms of hyperventilation, paraesthesias, and carpopedal spasms that resolved once the patient calmed down. Hyperventilation leads to respiratory alkalosis, which can cause these symptoms due to the reduction in carbon dioxide levels in the blood.
• Other Likely diagnoses
  • Anxiety or panic attack: These conditions can lead to hyperventilation and similar symptoms. The resolution of symptoms upon calming suggests a strong psychological component.
  • Electrolyte imbalance: Although less directly linked to the immediate resolution of symptoms with calmness, electrolyte imbalances (such as hypocalcemia) can cause muscle spasms and paraesthesias.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Tetany due to hypocalcemia: While the symptoms resolved with calmness, it's crucial to rule out hypocalcemia, as untreated, it can lead to severe complications, including seizures and cardiac arrest.
  • Respiratory or cardiac conditions leading to hypoxia: Conditions that lead to hypoxia can cause hyperventilation and other symptoms. Although less likely given the resolution with calmness, these conditions are critical to rule out due to their potential severity.
• Rare diagnoses
  • Other metabolic disorders: Rare metabolic disorders can cause similar symptoms, including certain types of porphyria or other electrolyte imbalances not commonly seen.
  • Neuromuscular disorders: Certain neuromuscular conditions could potentially cause these symptoms, although they would be less likely to resolve simply with the patient calming down.