Central neurogenic hyperventilation with acute respiratory alkalosis and transient lactic acidosis following endoscopic third ventriculostomy in a child - A case report

Introduction: Central neurogenic hyperventilation (CNH) is a rare but well documented complication after endoscopic third ventriculostomy (ETV) in adults. However, it is not well described in the pediatric population. CNH is attributed to irritation of the hypothalamus while irrigating the floor of the third ventricle with normal saline. Case Summary: 6 year old child developed CNH, acute respiratory alkalosis, intraoperative tachycardia and lactic acidosis following ETV for a pineal gland tumour causing obstructive hydrocephalus. CNH has been attributed to irritation of the hypothalamus while irrigating the floor of the third ventricle with normal saline. Treatment with sedation and oxygen via rebreathing mask resulted in normalization of symptoms and blood gas. Conclusion: CNH can occur in the pediatric population as well following ETV. A high index of suspicion is essential for early recognition. Measurement of ICP during ETV and use of alternative irrigation fluids such as lactated ringer’s or artificial CSF may minimize occurrence.