Respiratory Dyskinesia With Refractory Tachypnea and Alkalosis Treated by Vesicular Monoamine Transporter 2 Inhibitor

We present the case of a 69-year-old woman with a 25-year history of psychosis, managed with risperidone, who developed refractory tachypnea and alkalosis over 2 weeks. Despite multidisciplinary evaluation, she was initially misdiagnosed with psychogenic hyperventilation. Ultimately, a diagnosis of respiratory dyskinesia (RD) was established, and substantial clinical improvement was achieved after initiation of a vesicular monoamine transporter 2 (VMAT2) inhibitor. The substantial effectiveness of this therapy was confirmed over a 7-month follow-up period, with monitoring of both clinical symptoms and arterial blood gas parameters. This case highlights the diagnostic challenges posed by RD and underscores the potential utility of VMAT2 inhibitor as a novel therapeutic option.