Respiratory alkalosis

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Respiratory alkalosis
ICD-10 E87.3
ICD-9 276.3
DiseasesDB 406

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2] Priyamvada Singh, M.D. [3]

Overview

Acid-base status of an organism is determined by the extracellular fluid (ECF) hydrogen ion concentration [H+] since pH is equal to minus log of [H+] i.e. pH = -log[H+]. Normal pH of human blood is 7.40 (7.35-7.45). Acidosis raises ECF [H+] thereby lowering pH whereas alkalosis lowers ECF [H+] thereby raising pH of the ECF. Respiratory alkalosis is an acid-base disorder, primarily a decrease in partial pressure of carbon dioxide in arterial blood means PaCo2 [normal PaCo2 is 40 mm Hg on average with range between 35-45mm Hg (4.7-6.0kPa)] with or without compensatory decrease in serum bicarbonate [HCO3-] (normal bicarbonate is 22-30mEq/L in arterial blood gas analysis) and pH being alkaline (normal pH of blood is 7.35-7.45).

Pathophysiology

Production of CO2 in body tissues by intracellular metabolic process (from oxidation of fat, carbohydrate and carbon skeleton of amino acids in normal metabolic process produces carbon dioxide and water) and elimination of CO2 through lungs are in equilibrium under normal physiology. CO2 in body tissues from normal metabolic process enters blood in the tissues because its local partial pressure in tissues is greater than the partial pressure in blood flowing through the tissues due to property of gases to diffuse from high pressure to low pressure. Flowing blood transports the CO2 to the lungs, where it diffuses into the alveoli and then to the atmosphere by pulmonary ventilation. The reversible combination of CO2 with water in the red blood cells under the influence of carbonic anhydrase enzyme forms carbonic acid (H2CO3) which dissociates into hydrogen and bicarbonate ions (H+ and HCO3−) ions. HCO3− diffuse from the red blood cells into the plasma, while chloride ions diffuse into the red blood cells to take their place (chloride shift). Hence, most of tissue CO2 is brought to lungs as plasma venous bicarbonate ions that accounts for about 70 percent of the CO2 transported from the tissues to the lungs. Remaining CO2 is transported as carbaminohemoglobin (23%) and as dissolved CO2 in fluids of blood(7%).

Respiratory alkalosis in almost all cases 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.

Compensation in respiratory alkalosis

compensation for respiratory alkalosis is mostly mediated through plasma buffers and proteins (eg. hemoglobin in RBC, plasma proteins) in acute stage and by kidneys in chronic compensatory stage.

Acute compensatory stage

Chronic compensatory stage

  • Renal mediated process where reduction in PaCO2 leads to decreased renal tubular H+ secretion. Within the renal tubular cells, CO2, under the influence of carbonic anhydrase enzyme, combines with H2O to form carbonic acid (H2CO3), which then dissociates into HCO3- and H+. Alkalosis inhibits carbonic anhydrase activity, resulting in reduced H+ secretion into the renal tubule. As a result, there is not enough H+ in the renal tubular fluid to react with all the filtered HCO3− from glomerular capillaries of the kidneys. Therefore, the HCO3− that cannot react with H+ is not reabsorbed and is excreted in the urine. This causes a decrease in urinary net acid excretion(mostly ammonium ions NH4+) and due to increased bicarbonate excretion, body's bicarbonate stores is reduced.
  • Starts after 24-36 hours and renal compensation for sustained hypocapnia is complete in 36-72 hours
  • For every PaCO2 decrease of 10 mm Hg, serum bicarbonate decreases by 5mEq/L
  • pH in chronic compensation is near normal

Classification

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

Acute respiratory alkalosis

Chronic respiratory alkalosis

  • Lasting for longer than 24-48 hours
  • 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.

Risk Factors

Common Risk Factors

Less Common Risk Factors

Causes[2]

Tissue hypoxia (hypoxemia)

Stimulation of chest receptors

Stimulators of central respiratory drive

Systemic diseases

Special considerations

Differential Diagnosis

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); DOE (dyspnea on exercise); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);


Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Acute Dyspnea Respiratory system Head and Neck,

Upper airway

Angioedema[3] - - - - - +/- + - - +/- - + Normal Normal ↓O2, ↑CO2 Normal N/A Physical exam Generalized edema
Anaphylaxis[4] +/- + - +/- - - - - +/- - - - Scattered wheezing Normal Normal Normal N/A Vital sign Type 1 hypersensitivity
Aspiration[5] - + - - +/- + - - + - - - Diminished breath sounds Normal Normal Atelectasis ↓Vt, ↑RV Bronchoscopy Choking
Croup[6] - + - +/- - + - - + - - - Stridor ↑WBC Normal Steeple sign Normal Physical exam Barking cough
Epiglottitis[7] - + - + - + - - - - - - Stridor ↑WBC Normal Thumb sign Normal Laryngoscopy Drooling
Rhinosinusitis[8] - - - + - +/- - - - - - - Normal ↑WBC Normal Air fluid level Normal Physical exam Headache
Vocal cord dysfunction[9] - - - - - +/- - - - - - - Stridor Normal Normal Normal ↓ FVC Laryngoscopy Choking sensation
Chest and Pleura,

Lower airway

Asthma attack[10] - + - - +/- + - - + - - - Wheeze ↑ Eosinophil Respiratory alkalosis Normal ↓ FEV1, PEF Physical exam and

Spirometry

Chest pain
Atelectasis - - - +/- +/- +/- - - +/- - - - Diminished breath sounds, Wheeze Normal ↓O2, Normal/↓CO2 Collapsed lung lobe, fissuresdisplacement ↓ FVC Chest CT scan Surgical procedure, Aspiration,

Mechanical ventilation

Bronchitis[11] - - - + + + - - - - - - Rhonchi  ↑WBC Normal Normal Normal Physical exam Rhonchi relieved by cough
Bronchospasm[12] +/- + - - + +/- - - + - - - Wheeze Normal ↓O2, ↑CO2 Normal ↓Vt, ↑RV Physical exam Allergic reaction
Bronchiolitis[13] - - - + +/- + - - - - - - Wheeze and Crackles ↑WBC Normal Bronchovascular markings ↓Vt Clinical assessment Respiratory syncytial virus (RSV)
COPD exacerbation[14] - + - + + + + - + +/- +/- +/- Wheeze, Rhonchi, and Crackles ↑WBC, ↑RBC Respiratory alkalosis Hyperexpansion ↓ FEV1/FVC Clinical assessment Acute exacerbations of chronic bronchitis (AECB)
Lung carcinoma[15] - - + - - + - - + + - - Wheeze and Crackles Normal Normal Mass lesion, hilar lymphadenopathy ↓Vt, ↑RV Bronchoscopy  Paraneoplastic syndromes, such as SIADH and lambert-Eaton
Pneumonia[16] - - - + + + - - - - - - Wheeze, Rhonchi, and Crackles ↑WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray and CT Scan productive cough
Pneumothorax[17] - - - - + - - - - - +/- - Diminished breath sounds Normal ↓O2, ↑CO2 Radiolucency without lung marking ↓Vt CXR and Chest CT scan Tracheal deviation
Pulmonary embolism[18] - - - - + - - +/- - - - - Normal Normal Respiratory alkalosis Normal Normal Pulmonary CT angiography Pleuritic chest pain
Rib fractures (flail chest)[19] - + - - + - - - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax
Cardiovascular system Acute myocardial ischemia[20] +/- + - +/- + - + + - - - - Normal Normal Normal Normal Normal Cardiac troponin I Nausea and vomiting, Positive pertinent risk factors, such as hypertension, diabetes, and smoking
Acute heart failure[21] +/- + - - +/- + +/- + + - + + S3 Normal Respiratory alkalosis ↑ Cardiothoracic ratio ↓Vt B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) Excessive sweating, high blood pressure
Pericardial tamponade[22] +/- - - - + - +/- +/- - - + - Muffled heart sounds Normal Normal Water bottle appearance enlarged heart Normal Echocardiography Fluid accumulation in pericardium
Tachyarrhythmia[20] +/- + - - +/- - - - - - - - High pulse rate Normal Normal Normal Normal ECG Palpitation
Pulmonary edema[23] +/- + - + + + + + + + + + Basal crackle Normal Respiratory alkalosis Bat wing pattern, air bronchograms ↓Vt, ↑RV Cardiac Catheterization Tachypnea
Central nervous system Stroke + - - +/- - - - - - - - - Normal Normal Normal Intracranial infarct or hemorrhage Normal Brain MRI Paralysis or paresthesia
Encephalitis[24] + + - + - - - - - - - - Normal ↑WBC, neutrophilia Normal Normal Normal CSF PCR Confusion
Traumatic brain injury[25] + +/- - - - - - - - - - - Normal Normal Respiratory acidosis Intracerebral hemorrhage Normal Brain CT scan Lucid interval
Toxic/Metabolic Organophosphate poisoning[26] + - - + - - - - - - - - Wheeze Normal ↓O2, ↑CO2 Normal Normal Blood test Salivation, Lacrimation, Emesis, Miosis
Salicylate poisoning[27] + - - - - - - - + - - - Normal Normal Metabolic acidosis, Respiratory alkalosis Normal Normal Blood test Vomiting, Tinnitus, Confusion, Hyperthermia
Carbon monoxide poisoning[28] + - - - + + - - + - - - Wheeze Carboxyhemoglobin ↓O2, ↑CO2 Normal N/A Carboxyhemoglobin (HbCO) level Headache, Dizziness, Weakness, Vomiting, Confusion
Diabetic ketoacidosis[29] + +/- - - - - - - - - - - Scattered wheeze, Kussmaul's respiration ↑WBC Metabolic acidosis Normal Normal Blood test (acidosis, hyperglycemia, ketonemia) Vomiting, Abdominal pain, Weakness, Confusion
Systemic Panic attack[30] +/- + - - - - - - - - - - Normal Normal Normal Normal Normal Clinical assessment Severe anxiety
Pregnancy[31] - - - - +/- - - - - - - + Normal ↑WBC, RBC ↓O2, ↑CO2 Normal ↓Vt, ↑RV βhCG Missed period, Hyperemesis
Sepsis[32] +/- - - + - - - - - - - - Normal ↑WBC, neutrophilia ↓O2, ↑CO2 Normal Normal SIRS criteria Chills, Confusion
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Chronic Dyspnea Respiratory system Head and Neck,

Upper airway

Goiter[33] - - - - - - - - - - - + Normal Normal Normal Normal Normal Blood test (TSH, T4) Weight gain
Laryngeal adenocarcinoma[34] - - + - - +/- - - - - - - Stridor Normal ↓O2, ↑CO2 Retropharyngeal tissue thickness Normal Laryngoscopy Choking sensation
Vocal cord paralysis[9] - - - - - +/- - - - - - - Stridor Normal Normal Pharyngeal constrictor muscles thinning, uvular deviation Normal Laryngoscopy Choking sensation
Tracheal stenosis[35] - - - - +/- +/- - - + + - - Stridor, Stertorous Normal ↓O2, ↑CO2 Soft tissue thickening internal to normal-appearing tracheal cartilage Normal Bronchoscopy Respiratory distress
Chest and Pleura,

Lower airway

Bronchial asthma[10] - + +/- - +/- + - - + + - - Wheeze ↑ Eosinophil Respiratory alkalosis, Metabolic acidosis Pulmonary hyperinflation,

Bronchial wall thickening

↓ FEV1/FVC Spirometry before and after bronchodilator Paroxysmal respiratory distress
Bronchiectasis[11] - - - + + + - - + + - - Rhonchi, Wheezing, Crackles ↑WBC, neutrophilia ↓O2, ↑CO2 Tram-track opacities ↑ FEV1/FVC High resolution computed tomography (HRCT) Chronic productive cough
COPD[14] - - +/- - - + + + + + + +/- Expiratory wheeze ↑ RBC Respiratory alkalosis, Metabolic acidosis ↑ Bronchovascular markings, Cardiomegaly ↓ FEV1/FVC Physical exam and

Spirometry

Heavy smoking history
Emphysema[36] - - - - - +/- - - + + - - Expiratory wheeze, Hyperinflation Normal Respiratory alkalosis, Metabolic acidosis Flattening of diaphragm, vertical heart ↓ FEV1/FVC Physical exam and

Spirometry

Barrel chest
Pulmonary hypertension[37] - - - - +/- +/- - - +/- +/- + + Accentuated S2 Normal Hypoxia and acidosis Enlarged pulmonary arteries ↑Physiologic RV Cardiac catheterization Syncope,

Ascites, Pleural effusion

Interstitial lung disease[38] - - - - + + - - + + - - Rhonchi, Wheezing, Crackles Normal ↓O2, ↑CO2 Peripheral pulmonary infiltrative opacification ↑ FEV1/FVC High resolution computed tomography (HRCT) Pneumoconiosis
Sarcoidosis[39] - - +/- - +/- + - - + - - - Crackles Normal ↓O2, ↑CO2 Hilar adenopathy ↑ FEV1/FVC High resolution computed tomography (HRCT) Hypercalcemia, high ACE
Alveolitis[40] - - - + + + - - - - - - Basal crackle ↑WBC, neutrophilia Normal  Basal reticulonodular opacification   ↑ FEV1/FVC High resolution computed tomography (HRCT) Dry cough
Bronchiolitis obliterans[13] - - - + + + - - + + - - Expiratory wheeze ↑WBC ↓O2, ↑CO2 Hyperinflation, Reticulonodular opacities ↓ FEV1/FVC Lung biopsy Complication of allogeneic hematopoietic stem cell transplantation
Cystic fibrosis[41] - - + + - +/- - - + + - - Rhonchi, Wheezing, Crackles Normal Metabolic alkalosis Thick-walled bronchiectasis ↓ FEF75%/FVC Sweat test Absent vas deferens
Pleural effusion[42] - +/- + - + - +/- - - - +/- +/- Egophony ("E-to-A" change) Normal Normal Blunting of the costophrenic and cardiophrenic angle ↓Vt, ↑RV Light's criteria ↓Tactile fremitus, Asymmetrical chest expansion
Pulmonary right-to-left shunt[43] - - - - +/- + - - + + - - Diminished breath sounds Normal ↓O2, ↑CO2, Respiratory acidosis Normal ↓Vt, ↑RV

(physiological)

Pulmonary CT angiography Chronic hypoxemia
Diaphragmatic paralysis[44] - - - +/- +/- +/- - - - - - - Normal Normal Normal Unilateral or bilateral diaphragmatic flattening ↓Vt, ↑RV

(anatomical)

CXR confirmed by fluoroscopic sniff test Respiratory insufficiency
Tuberculosis[45] - - + + + + - - +/- - - - Rhonchi, Wheezing, Crackles ↑WBC ↓O2, ↑CO2 Patchy consolidation or poorly defined linear and nodular opacities Restrictive, obstructive, or mixed IFN-γ release assay (IGRA)

Acid-fast staining

Night sweat
Cardiovascular system Constrictive pericarditis[22] - - - - + - + + - - + - Muffled heart sounds Normal Normal Calcifications  Normal Chest CT scan Syncope
Restrictive cardiomyopathy[46] - - - - + - + + - - - +/- Normal Normal Normal Dilatation of the inferior vena cava and right atrium Normal Right ventricular biopsy Weight gain,

Nausea

Valvular heart disease[20] - - - - + - +/- + - - - - Cardiac murmur Normal Normal Dilatation of heart chambers Normal Echocardiography Syncope, Palpitation
Bradyarrhythmia[47] - - - - - - - - - - - - Normal Normal Normal Normal Normal ECG Syncope, Palpitation
Pericardial effusion[48] - - - +/- + + +/- +/- - - + - Muffled heart sounds Normal Normal Fluid density around the heart Normal M-mode and 2-dimensional Doppler echocardiography Hoarseness, Palpitation
Coronary heart disease[20] - +/- - - + - + + - - - - Normal Normal ↓O2 Normal Normal Cardiac troponin I Nausea, Lightheadedness, Sweating
Intracardiac shunt[49] - - - - +/- - +/- + + + - - Cardiac continuous murmur Normal ↓O2 Dilatation of heart chambers Normal Echocardiography Syncope, Palpitation
Neuromuscular disease Amyotrophic lateral sclerosis[50] +/- - +/- - - - - - - - - - Normal ↑WBC Normal Normal ↓Vt, ↑RV Revised El Escorial criteria (clinical) Muscle weakness, Dysphagia
Polymyositis/dermatomyositis[51] - - +/- - + - - - - - - +/- Normal ↑WBC Normal Normal ↓Vt, ↑RV Muscle biopsy Muscle weakness, Heliotrope
Mitochondrial diseases[52] - - +/- - - - - - - - - - Wheeze ↓WBC, Plt Normal Normal ↓Vt, ↑RV Muscle biopsy Muscle pain
Glycolytic enzyme defects (e.g., McArdle)[53] +/- - - - - - - - - - - +/- Normal Normal Normal Normal ↓Vt, ↑RV Muscle biopsy (ragged red fibers) Myoglobinuria,

Muscle weakness

Toxic/Metabolic Metabolic acidosis[54] - - + - - - - - - - - - Normal Normal Metabolic acidosis, Respiratory alkalosis Normal Normal ABG Confusion, Vomiting
Renal failure[55] - - + - - - + + - - - + Normal ↓ RBC Metabolic acidosis Normal Normal Cr Nausea, Vomiting, Oliguria
Systemic Anemia[56] - - + - - - - +/- - - - - Normal ↓ RBC ↓O2 Normal Normal HGB, MCV Weakness, Fatigue
Anxiety[57] + + + - +/- +/- - - - - - - Normal Normal Normal Normal Normal Psychological interview Sweating, Palpitation
Ascites[58] - - - - - - - - - - - - Normal Normal Normal Peritoneal fluid accumulation ↓Vt, ↑RV Abdominal ultrasound Abdominal distention
Depression[59] - + + - - - - - - - - - Normal Normal Normal Normal Normal Psychological interview Depressed mood, Fatigue
Kyphoscoliosis[60] - - - - - - - - - - - - Wheeze Normal Normal Deviated vertebral column ↓Vt, ↑RV

(anatomical)

Standing lateral spine radiograph Low back pain
Obesity[61] - - - - - - - - - - - - Normal Normal ↓O2 Normal ↓Vt, ↑RV

(anatomical)

BMI Low stamina,

Sweating

Autoimmune Churg-Strauss syndrome[62] - - - - - + - - - - - - Scattered wheezing Normal Normal Areas of parenchymal opacification ↓Vt, ↑RV Biopsy  Fatigue,Numbness
Microscopic polyangiitis[63] - - +/- + + - - - - - - +/- Scattered wheezing ↑WBC ↓O2, ↑CO2 Normal ↓Vt, ↑RV Histological confirmation Skin lesions, Nerve damage
Wegener's granulomatosis[64] - - +/- - - + - - - - - - Wheezing, Crackles ↓ RBC ↓O2, ↑CO2 Cavitate nodules, ground-glass opacity ↓ FEV1/FVC Biopsy demonstrating a granulomatous vasculitis Chronic rhinosinusitis
Goodpasture's disease[65] - - - - - + - - - - - -  Bilateral coarse crepitations ↓ RBC, HGB, HCT Normal  Like pulmonary edema Normal Kidney biopsy Hematuria,

Hemoptysis

History and Symptoms

  • Symptoms of respiratory alkalosis depends upon duration of disease and underlying diseases. Symptoms of acute respiratory alkalosis are related to decrease blood carbon dioxide levels (PaCO2) that leads to reduced cerebral blood flow resulting from vasoconstriction of cerebral vessels. Most of the symptoms arise when PaCO2 falls below 30 mm Hg.

History

Patients with respiratory alkalosis may have a positive history of:

Common Symptoms

Common symptoms of acute respiratory alkalosis include:

  • Signs include:
    • Carpopedal spasm due to tetany as a result of decreased levels of ionized calcium in the blood (ionized calcium [Ca++] are driven inside cells in exchange for hydrogen ion [H+] as compensatory mechanism to correct pH) with no fall in total serum calcium level. Alkalosis also increases protein-bound fraction of calcium reducing free calcium.

Physical Examination

  • Physical examination findings of patients with respiratory alkalosis is related to the underlying causes.

Appearance of the Patient

  • Patients with acute respiratory alkalosis usually appear anxious in primary hyperventilation syndrome, OR are ill appearing in mechanically ventilation whereas are comfortable in chronic respiratory alkalosis.

Vital Signs

Skin

HEENT

  • HEENT examination of patients with respiratory alkalosis is usually normal.

Neck

  • Neck examination of patients with respiratory alkalosis is usually normal

Lungs

Heart

Abdomen

Hepatomegaly and right upper quadrant tenderness may be seen in cirrhosis

Back

  • Back examination of patients with respiratory alkalosis is usually normal.

Genitourinary

  • Genitourinary examination of patients with respiratory alkalosis is usually normal

Neuromuscular

  • Focal neurologic signs and depressed level of consciousness is seen in respiratory alkalosis of neurologic cause

Extremities

Approach to acid-base disorders

 
 
 
 
 
 
 
Check pH on ABG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
pH<7.35=Acidosis
 
 
 
 
 
 
 
pH>7.45=Alkalosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check PaCO2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PaCO2 > 45mm Hg = Respiratory acidosis Primary cause: hypoventilation
 
PaCO2 Normal or < 35mm Hg = Metabolic acidosis
 
 
 
 
 
Check PaCO2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PaCO2 > 45mm Hg = Metabolic alkalosis
 
PaCO2 < 35mm Hg = Respiratory alkalosis Primary cause: hyperventilation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
HCO3- > 29 eg. vomiting
 
 
Check HCO3-
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal or slight decrease = Acute respiratory alkalosis eg. fever, panic attack
 
 
 
Decreased < 24 = Chronic respiratory alkalosis eg. Anemia, CNS causes

Laboratory Findings

  • Arterial blood gas analysis(ABG):
    • It is the diagnostic test of choice for respiratory alkalosis
    • primary respiratory alkalosis has pH> 7.45, PaCO2 <35mm Hg or 4.7kPa while PaO2 is normal(>80mm Hg or 10.7kPa)
  • Serum electrolytes: Decrease in [HCO3-],[Na+], [K+] and ionized [Ca++] are seen in acute hypocapnia due to intracellular shift whereas decreased [HCO3-] and hyperphosphatemia are seen in sustained hypocapnia.[66]
  • Other laboratory test and imaging studies that may be useful in respiratory alkalosis to find out the causes includes:
    • Urine pH and urinalysis
    • CBC: elevated WBC in sepsis
    • Blood/sputum/urine C/S: for sepsis
    • EKG and ECHO: for congestive heart failure
    • Drug screening test
    • Thyroid function test: to rule out hyperthyroidism
    • Liver function test: abnormal in hepatic causes
    • pulmonary function test: to rule out chest infections
    • V/Q scan: to rule out pulmonary embolism
    • Chest X-ray: for chest infection
    • CT scan: for pulmonary embolism
    • MRI brain: to rule out CNS cause of hyperventilation

Treatment

  • Respiratory alkalosis is not a life threatening disorder, so treatment is directed at the underlying causes of the disorder.


Related Chapters

Template:WikiDoc Sources

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  10. ↑ 10.0 10.1 Hodder R, Lougheed MD, Rowe BH, FitzGerald JM, Kaplan AG, McIvor RA (2010). "Management of acute asthma in adults in the emergency department: nonventilatory management". CMAJ. 182 (2): E55–67. doi:10.1503/cmaj.080072. PMC 2817338. PMID 19858243.
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