Respiratory alkalosis resident survival guide: Difference between revisions
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==Treatment== | ==Treatment== | ||
#Respiratory alkalosis is not self-limiting. | #Respiratory alkalosis is not self-limiting. | ||
#Correction of the primary disorder of the respiratory alkalosis is needed | #Correction of the primary disorder of the [[respiratory alkalosis]] is needed | ||
Shown below is an algorithm summarizing the treatment of Respiratory Alkalosis: | Shown below is an algorithm summarizing the treatment of Respiratory Alkalosis: | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=If patient comes with Anxiety or hyperventilation | {{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=If patient comes with [[Anxiety]] or [[hyperventilation]] | ||
syndromes |A02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | syndromes |A02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑Rebreathing into a paper or plastic bag<br>❑mild sedation <br>❑Reassurance<br> </div>}} | ❑Rebreathing into a paper or plastic bag<br>❑mild sedation <br>❑Reassurance<br> </div>}} | ||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=If patient is Hypoxic |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | {{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=If patient is [[Hypoxic]] |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑Give O<sub>2</sub><br> </div> }} | ❑Give O<sub>2</sub><br> </div> }} | ||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | | |C01= Respiratory Alkalosis|C02=Salicylates overdose |C03=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | {{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | | |C01= [[Respiratory Alkalosis]]|C02=Salicylates overdose |C03=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑Urinary alkalinization <br>❑Forced diuresis<br> ❑Dialysis</div> }} | ❑Urinary alkalinization <br>❑Forced diuresis<br> ❑Dialysis</div> }} | ||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has Hyperthyroidism |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | {{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has [[Hyperthyroidism]] |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑[[β-Blockers]] <br>❑[[Antithyroid]] medications</div> }} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has Asthma |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | {{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has [[Asthma]] |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑[[Bronchodilators]] <br>❑[[Corticosteroid]]s</div> }} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has Pneumonia |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | {{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has [[Pneumonia]] |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑[[Antibiotics]]</div> }} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has Pulmonary oedema |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | {{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has Pulmonary oedema |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑[[Diuretics]]<br> ❑Treatment and improvement in [[CHF]]</div> }} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has Pulmonary embolism |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | {{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=If patient has [[Pulmonary embolism]] |D02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑Give O<sub>2</sub><br> | ❑Give O<sub>2</sub><br>❑[[Anticoagulation]]</div> }} | ||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
Line 174: | Line 174: | ||
❑Give O<sub>2</sub><br>❑[[Acetazolamide]]</div> }} | ❑Give O<sub>2</sub><br>❑[[Acetazolamide]]</div> }} | ||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | | |`|-| E01 |-| E02 | | | |E01= Mechanical ventilation|E02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | {{familytree | | | | | | | | | |`|-| E01 |-| E02 | | | |E01= [[Mechanical ventilation]]|E02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Treatment options'''<br> | ||
---- | ---- | ||
❑Reduce Ventilatory rate and tidal volume<br>❑ Increase dead space<br> ❑mild | ❑Reduce Ventilatory rate and tidal volume<br>❑ Increase dead space<br> ❑mild |
Revision as of 08:55, 27 October 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.
Overview
The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes of Respiratory Alkalosis include
Common Causes
- Central Nervous System related causes:[1]
- Increased Intracranial Pressure
- Stroke
- Head injury
- CNS infection
- Intracranial hemorrhage
- Pontine tumors
- Anxiety Hyperventilation
- Voluntary Hyperventilation
- Sepsis(Cytokine mediated)
- Chronic Liver disease(Toxin mediated)
- Drugs(Salicylates, progesterone)
- Pain
- Hypoxemic causes: Hypoxic stimulation leads to hyperventilation.
- Pulmonary Causes:
- Extrinsic Causes(deliberate or iatrogenic):
- Excessive minute ventilation during mechanical ventilation
Diagnosis
Shown below is an algorithm summarizing the diagnosis of Respiratory Alkalosis:[2][3]
Patient with Acute Respiratory Alkalosis | |||||||||||||||||||||||||
Take complete history | |||||||||||||||||||||||||
Ask the following questions regarding CNS manifestations ❑If they felt dizzy or confused recently?
Light-headedness and Confusion due to reduced cerebral blood flow ❑Ask if they had experienced tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings to check Asterexis ❑If there is any history of loss of consciousness ❑Ask about any event of seizues | |||||||||||||||||||||||||
Ask the following questions regarding Cardiovascular manifestations ❑Ask if they felt any chest discomfort or pain? Chest pain due to vasoconstriction❑If they felt their heart was racing? Ask about cardiac Arrythmia | |||||||||||||||||||||||||
Ask the following questions regarding Metabolic effects ❑Ask if they have experienced perioral tingling sensations ❑Tetany ❑Ask about any symptoms of mild hyponatremia, hypokalemia, and hypophosphatemia | |||||||||||||||||||||||||
Do complete physical examination | |||||||||||||||||||||||||
Vital signs ❑Decreased blood pressure(hypotension) due to hypoxemia ❑Orthostatic changes due to reduced plasma volume | |||||||||||||||||||||||||
Examination of respiratory system ❑Inspiratory crackles if patient has Pulmonary edema ❑Prolonged expiratory wheezing in patient with Asthma | |||||||||||||||||||||||||
Examination of Cardiovascular System ❑Irregular rhythm may be seen ❑palpable P2, right ventricular heave may be seen if patient has Pulmonary hypertension | |||||||||||||||||||||||||
Examination of Central Nervous System ❑Tremor, paresthesias ❑Chvostek’s and Trousseau’s signs due to Low ionized Ca2+ | |||||||||||||||||||||||||
Do following tests | |||||||||||||||||||||||||
Serum Chemistry ❑Persistent hyponatremia, hypokalemia, hypophosphatemia, and low ionized Ca2+❑Increased WBC if there is any infection ❑Decreased Hemoglobin if there is anemia ❑ Increased Hematocrit which is suggestive of exposure to high altitude ❑Abnormal liver function tests in liver disease ❑Increased T3 and T4 and low TSH in a patient of hyperthyroidism ❑Positive urine β-human chorionic hormone if patient is pregnant ❑When both respiratory alkalosis and high Anion gap metabolic acidosis are present—suspect salicylate intake | |||||||||||||||||||||||||
Do Arterial Blood Gas (ABG) ❑low pCO2, low serum [HCO3−], high pH | |||||||||||||||||||||||||
Do Chest X-ray | |||||||||||||||||||||||||
Treatment
- Respiratory alkalosis is not self-limiting.
- Correction of the primary disorder of the respiratory alkalosis is needed
Shown below is an algorithm summarizing the treatment of Respiratory Alkalosis:
If patient comes with Anxiety or hyperventilation syndromes | Treatment options ❑Rebreathing into a paper or plastic bag ❑mild sedation ❑Reassurance | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
If patient is Hypoxic | Treatment options ❑Give O2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Respiratory Alkalosis | Salicylates overdose | Treatment options ❑Urinary alkalinization ❑Forced diuresis ❑Dialysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||
If patient has Hyperthyroidism | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
If patient has Asthma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
If patient has Pneumonia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
If patient has Pulmonary oedema | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
If patient has Pulmonary embolism | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
If patient has history of going to high altitude, climbing | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mechanical ventilation | Treatment options ❑Reduce Ventilatory rate and tidal volume | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ "Respiratory Alkalosis - StatPearls - NCBI Bookshelf".
- ↑ Hasan, Ashfaq (2009). "Respiratory Alkalosis": 207–212. doi:10.1007/978-1-84800-334-7_9.
- ↑ Reddi, Alluru S. (2018). "Respiratory Alkalosis": 441–448. doi:10.1007/978-3-319-60167-0_33.