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==Symptoms==
==Symptoms==
* Symptoms of acute respiratory alkalosis are related to the decrease blood carbon dioxide levels (PaCO2) that leads to reduced cerebral blood flow and include: light-headedness, confusion, seizures, peripheral and circumoral paresthesias, cramps, and syncope. Signs include: tachypnea or hyperpnea, carpopedal spasm due to tetany  as a result of decreased levels of ionized calcium in the blood (ionized calcium are driven inside cells in exchange for hydrogen ion [H<sup>+</sup>]) with no fall in total serum calcium level.
* Symptoms of acute respiratory alkalosis are related to the decrease blood carbon dioxide levels (PaCO2) that leads to reduced cerebral blood flow and include: light-headedness, confusion, seizures, peripheral and circumoral paresthesias, cramps, and syncope. Signs include: tachypnea or hyperpnea, carpopedal spasm due to tetany  as a result of decreased levels of ionized calcium in the blood (ionized calcium are driven inside cells in exchange for hydrogen ion [H+] as compensatory mechanism to correct pH) with no fall in total serum calcium level.


==Related Chapters==
==Related Chapters==

Revision as of 18:02, 15 February 2018

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Resident
Survival
Guide
Respiratory alkalosis
ICD-10 E87.3
ICD-9 276.3
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]Madhu Sigdel M.B.B.S.[3]

Overview

Respiratory alkalosis results from increased alveolar respiration (hyperventilation) leading to decrease in blood carbon dioxide concentration measured as PaCO2. This leads to decreased hydrogen ion [H+] and bicarbonate [HCO3-] concentrations. Decreased [H+] leads to increase in pH leading to alkalosis (normal pH of blood is 7.35-7.45)

Pathophysiology

Compensation in respiratory alkalosis

Acute compensatory stage

  • Starts within minutes to hours
  • Mediated through the plasma buffer
  • For every pCO2 decrease of 10, serum bicarbonate decreases by 2
  • Change in pH is unpredictable

Chronic compensatory stage

  • Renal mediated
  • Starts within 1-3 days
  • For every pCO2 decrease of 10, serum bicarbonate decreases by 5
  • Change in pH is unpredictable

Classification

There are two types of respiratory alkalosis: chronic and acute.

Acute respiratory alkalosis

  • Increased levels of carbon dioxide are "blown off" by the lungs, which are hyperventilating.
  • During acute respiratory alkalosis, the person may lose consciousness where the rate of ventilation will resume to normal.

Chronic respiratory alkalosis

  • For every 10 mM drop in pCO2 in blood, there is a corresponding 5 mM of bicarbonate ion drop.
  • The drop of 5 mM of bicarbonate ion is a compensation effect which reduces the alkalosis effect of the drop in pCO2 in blood. This is termed metabolic compensation.

Causes

Lung and airways

Central respiratory drive

Systemic diseases

Special considerations

Symptoms

  • Symptoms of acute respiratory alkalosis are related to the decrease blood carbon dioxide levels (PaCO2) that leads to reduced cerebral blood flow and include: light-headedness, confusion, seizures, peripheral and circumoral paresthesias, cramps, and syncope. Signs include: tachypnea or hyperpnea, carpopedal spasm due to tetany as a result of decreased levels of ionized calcium in the blood (ionized calcium are driven inside cells in exchange for hydrogen ion [H+] as compensatory mechanism to correct pH) with no fall in total serum calcium level.

Related Chapters

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