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Respiratory alkalosis

Respiratory alkalosis is a condition marked by low levels of


carbon dioxide in the blood due to breathing excessively.
See also: Alkalosis
Causes
Common causes include:
Anxiety
Fever
Hyperventilation
Any lung disease that leads to shortness of breath can also cause
respiratory alkalosis.
Symptoms
The symptoms may include:
Dizziness
Light-headedness
Numbness of the hands and feet
Exams and Tests
Arterial blood gas (measures levels of oxygen and carbon
dioxide in the blood; in respiratory alkalosis, the level of
carbon dioxide is too low)
Chest x-ray
Pulmonary function test
Treatment
Treatment is aimed at the condition that causes respiratory
alkalosis. Breathing into a paper bag -- or using a mask that
causes you to re-breathe carbon dioxide -- sometimes helps
reduce symptoms.
Outlook (Prognosis)
What will happen depends on the condition that is causing the
respiratory alkalosis.
Possible Complications
Seizures may occur if the alkalosis is extremely severe. This is
very rare.
When to Contact a Medical Professional
Call your health care provider if you have any symptoms of lung
disease, such as chronic cough or shortness of breath.
Alternative Names
Alkalosis - respiratory
Alternative Names
Alkalosis - respiratory
Definition of Respiratory alkalosis:
Respiratory alkalosis is a condition marked by low levels of
carbon dioxide in the blood due to breathing excessively.
See also: Alkalosis
Causes, incidence, and risk factors:
Common causes include:
Anxiety
Fever
Hyperventilation
Any lung disease that leads to shortness of breath can also
cause respiratory alkalosis.

Respiratory system
Reviewed last on: 8/8/2009
David C. Dugdale, III, MD, Professor of Medicine, Division of
General Medicine, Department of Medicine, University of
Washington School of Medicine. Also reviewed by David
Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
References
Seifter JL. Acid base disorders. In: Goldman L, Ausiello D,
eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders
Elsevier. 2007: chap 119.
Related Articles
Hyperventilation
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professional should be consulted for diagnosis and treatment of any and all medical
conditions. Call 911 for all medical emergencies. Links to other sites are provided
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1997- 2010 A.D.A.M., Inc. Any duplication or distribution of the information
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Respiratory Alkalosis






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(See also Approach to the Patient With
Pulmonary Symptoms: Hyperventilation
Syndrome.)
Respiratory alkalosis is a primary decrease
in PCO
2
with or without compensatory
decrease in HCO
3

; pH may be high or
near normal. Cause is an increase in
respiratory rate or volume (hyperventilation)
or both. Respiratory alkalosis can be acute
or chronic. The chronic form is
asymptomatic, but the acute form causes
light-headedness, confusion, paresthesias,
cramps, and syncope. Signs include
hyperpnea or tachypnea and carpopedal
spasms. Diagnosis is clinical and with ABG
and serum electrolyte measurements.
Treatment is directed at the cause.
Etiology
Respiratory alkalosis is a primary decrease
in PCO
2
(hypocapnia) from an increase in
respiratory rate or volume
(hyperventilation), or both. Ventilation
increase occurs most often as a physiologic
response to hypoxia, metabolic acidosis,
and increased metabolic demands (eg,
fever), and as such is present in many
serious conditions. In addition, pain and
anxiety and some CNS disorders can
increase respirations without a physiologic
need.
Pathophysiology
Respiratory alkalosis can be acute or
chronic. Distinction is based on the degree
of metabolic compensation; excess
HCO
3

is buffered by extracellular
hydrogen ion (H
+
) within minutes, but more
significant compensation occurs over 2 to 3
days as the kidneys decrease H
+
excretion.
Pseudorespiratory
alkalosis: Pseudorespiratory alkalosis is
low arterial PCO
2
and high pH in
mechanically ventilated patients with severe
metabolic acidosis from poor systemic
perfusion (eg, cardiogenic shock, during
CPR). Pseudorespiratory alkalosis occurs
when mechanical ventilation (often
hyperventilation) eliminates larger-than-
normal amounts of alveolar CO
2
. Exhalation
of large amounts of CO
2
causes respiratory
alkalosis in arterial blood (hence on ABG
measurements), but poor systemic
perfusion and cellular ischemia cause
cellular acidosis, leading to acidosis of
venous blood. Diagnosis is by
demonstration of marked arteriovenous
differences in PCO
2
and pH and by elevated
lactate levels; treatment is improvement of
systemic hemodynamics.
Symptoms and Signs
Symptoms and signs depend on the rate
and degree of fall in PCO
2
. Acute respiratory
alkalosis causes light-headedness,
confusion, peripheral and circumoral
paresthesias, cramps, and syncope.
Mechanism is thought to be change in
cerebral blood flow and pH. Tachypnea or
hyperpnea is often the only sign;
carpopedal spasm may occur in severe
cases. Chronic respiratory alkalosis is
usually asymptomatic and has no distinctive
signs.
Diagnosis
ABG and serum electrolytes
If hypoxia present, cause vigorously pursued
Recognition of respiratory alkalosis and
appropriate renal compensation discussed
inAcid-Base Regulation and Disorders:
Diagnosis requires ABG and serum
electrolyte measurements. Minor
hypophosphatemia and hypokalemia from
intracellular shifts and decreased ionized
Ca
++
from an increase in protein binding
may be present.
Presence of hypoxia or an increased
alveolar-arterial (A-a) O
2
gradient (inspired
PO
2
[arterial PO
2
+
5
/
4
arterial PCO
2
])
requires search for a cause. Other causes
are often apparent on history and
examination. However, because pulmonary
embolism often presents without hypoxia
(see Pulmonary Embolism), embolism must
be strongly considered in a hyperventilating
patient before ascribing the cause to
anxiety.
Treatment
Treatment is directed at the underlying
cause. Respiratory alkalosis is not life
threatening, so no interventions to lower pH
are necessary. Increasing inspired
CO
2
through rebreathing (such as from a
paper bag) is common practice but may be
dangerous in at least some patients with
CNS disorders in whom CSF pH may
already be below normal.


Respiratory Alkalosis
Definition
Respiratory alkalosis is a condition where the amount of carbon
dioxide found in the blood drops to a level below normal range.
This condition produces a shift in the body's pH balance and
causes the body's system to become more alkaline (basic). This
condition is brought on by rapid, deep breathing called
hyperventilation.
Description
Respiratory alkalosis is an alkali imbalance in the body caused by
a lower-than-normal level of carbon dioxide in the blood. In the
lungs, oxygen from inhaled air is exchanged for carbon dioxide
from the blood. This process takes place between the alveoli (tiny
air pockets in the lungs) and the blood vessels that connect to
them. When a person hyperventilates, this exchange of oxygen
for carbon dioxide is speeded up, and the person exhales too
much carbon dioxide. This lowered level of carbon dioxide causes
the pH of the blood to increase, leading to alkalosis.
Causes and symptoms
The primary cause of respiratory alkalosis is hyperventilation. This
rapid, deep breathing can be caused by conditions related to the
lungs like pneumonia, lung disease, or asthma. More commonly,
hyperventilation is associated with anxiety, fever, drug overdose,
carbon monoxide poisoning, or serious infections. Tumors or
swelling in the brain or nervous system can also cause this type
of respiration. Other stresses to the body, including pregnancy,
liver failure, high elevations, or metabolic acidosiscan also trigger
hyperventilation leading to respiratory alkalosis.
Hyperventilation, the primary cause of respiratory alkalosis, is
also the primary symptom. This symptom is accompanied
by dizziness, light headedness, agitation, and tingling or numbing
around the mouth and in the fingers and hands. Muscle twitching,
spasms, and weakness may be noted. Seizures, irregular heart
beats, and tetany (muscle spasms so severe that the muscle
locks in a rigid position) can result from severe respiratory
alkalosis.
Diagnosis
Respiratory alkalosis may be suspected based on symptoms. A
blood sample to test for pH and arterial blood gases can be used
to confirm the diagnosis. In this type of alkalosis, the pH will be
elevated above 7.44. The pressure of carbon dioxide in the blood
will be low, usually under 35 mmHg.
Key terms
Hyperventilation Rapid, deep breathing, possibly exceeding
40 breaths/minute. The most common cause is anxiety, although
fever, aspirin overdose, serious infections, stroke, or other
diseases of the brain or nervous system.
pH A measurement of acid or alkali (base) of a solution based
on the amount of hydrogen ions available. Based on a scale of
14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the
number, the stronger the acid. A pH above 7.0 is a base; the
higher the number, the stronger the base. Blood pH is slightly
alkali with a normal range of 7.36-7.44.
Treatment
Treatment focuses on correcting the underlying condition that
caused the alkalosis. Hyperventilation due to anxiety may be
relieved by having the patient breath into a paper bag. By
rebreathing the air that was exhaled, the patient will inhale a
higher amount of carbon dioxide than he or she would
normally. Antibiotics may be used to treat pneumonia or other
infections. Other medications may be required to treat fever,
seizures, or irregular heart beats. If the alkalosis is related to a
drug overdose, the patient may require treatment for poisoning.
Use of mechanical ventilation like a respirator may be necessary.
If the respiratory alkalosis has triggered the body to compensate
by developing metabolic acidosis, symptoms of that condition may
need to be treated, as well.
Prognosis
If the underlying condition that caused the respiratory alkalosis is
treated and corrected, there may be no long-term effects. In
severe cases of respiratory alkalosis, the patient may experience
seizures or heart beat irregularities that may be serious and life
threatening.
Resources
Books
"Fluid, Electrolyte, and Acid-Base Disorders." In Family Medicine
Principles and Practices. 5th ed. New York: Springer-Verlag,
1998.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

alkalosis /alkalosis/ (alkah-losis) a pathologic condition due to
accumulation of base in, or loss of acid from, the body.
Cf. acidosis. alkalotic

altitude alkalosis increased alkalinity in blood and tissues due to
exposure to high altitudes.
compensated alkalosis a form in which compensatory
mechanisms have returned the pH toward normal.
hypochloremic alkalosis metabolic alkalosis marked by
hypochloremia together with hyponatremia and hypokalemia,
resulting from the loss of sodium chloride and hydrochloric acid
due to prolonged vomiting.
hypokalemic alkalosis metabolic alkalosis associated with a low
serum potassium level.
metabolic alkalosis a disturbance in which the acid-base status
shifts toward the alkaline side because of retention of base or loss
of noncarbonic, or fixed (nonvolatile), acids.
respiratory alkalosis a state due to excess loss of carbon
dioxide from the body, usually as a result of hyperventilation.

Dorland's Medical Dictionary for Health Consumers. 2007 by Saunders, an imprint of Elsevier,
Inc. All rights reserved.

respiratory alkalosis
n.
Alkalosis resulting from abnormal loss of carbon dioxide due to hyperventilation.
The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin
Company. Published by Houghton Mifflin Company. All rights reserved.

respiratory alkalosis,
an abnormal condition characterized by a high plasma pH
resulting from increased alveolar ventilation. The consequent
acceleration of carbon dioxide excretion lowers the plasma level
of carbonic acid, thus raising plasma pH. The hyperventilation
may be caused by pulmonary and nonpulmonary problems. Some
pulmonary causes are acute asthma, pulmonary vascular
disease, and pneumonia. Some nonpulmonary causes are aspirin
toxicity, anxiety, fever, metabolic acidosis, inflammation of the
central nervous system, gram-negative septicemia, and hepatic
failure. Compare metabolic alkalosis. See also metabolic
acidosis, respiratory acidosis.
observations Deep and rapid breathing at rates as high as 40
breaths per minute is a major sign of respiratory alkalosis. Other
symptoms are lightheadedness, dizziness, peripheral paresthesia,
tingling of the hands and feet, muscle weakness, tetany, and
cardiac arrhythmia. Confirming diagnosis is often based on a
PaCO
2
below 35 mm Hg and a pH greater than 7.45. PaO
2
may
be higher than 100. In the acute stage, blood pH rises in
proportion to the fall in PaCO
2
, but in the chronic stage it remains
within the normal range of 7.35 to 7.45. The carbonic acid
concentration is normal in the acute stage of this condition but
below normal in the chronic stage.
interventions Treatment of respiratory alkalosis concentrates on
removing the underlying causes. Severe cases, especially those
caused by extreme anxiety, may be treated by having the patient
breathe into a paper bag and inhale exhaled carbon dioxide to
compensate for the deficit being created by hyperventilation.
Sedatives may also be administered to decrease the ventilation
rate.
nursing considerations The nurse monitors neurologic,
neuromuscular, and cardiovascular functions, arterial blood
gases, and serum electrolyte levels. The patient benefits from
explanations of laboratory tests and treatment.
Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.

alkalosis (alk lsis),
n a disturbance of acid-base balance and water balance,
characterized by an excess of alkali or a deficiency of acids.
alkalosis, compensated,
n a condition in which the blood bicarbonate is usually higher than
normal but compensatory mechanisms have kept the pH level
within normal range. See also alkalosis, uncompensated.
alkalosis, hypochloremic,
n a metabolic abnormality caused by an increase in blood
bicarbonate after significant chloride loss.
alkalosis, respiratory,
n alkalemia produced by hypoventilation. Plasma bicarbonate is
therefore decreased in respiratory alkalosis but raised in
metabolic alkalosis.
alkalosis, uncompensated,
n alkalemia usually accompanied by an increased blood
bicarbonate.
Mosby's Dental Dictionary, 2nd edition. 2008 Elsevier, Inc. All rights reserved.

alkalosis
a pathological condition resulting from accumulation of base, or
from loss of acid without comparable loss of base in the body
fluids, and characterized by decrease in hydrogen ion
concentration (increase in pH). Alkalosis is the opposite
of acidosis. See also acid-base balance.

compensated alkalosis
a condition in which compensatory mechanisms have returned
the pH toward normal.
concentration alkalosis
associated with deficit in free body water, hypotonic fluid losses or
increased sodium levels.
gastric alkalosis
alkalosis due to loss of gastric fluid because of persistent
vomiting. See also hypochloremic alkalosis (below).
hypochloremic alkalosis
a metabolic alkalosis in which gastric losses of chloride are
disproportionately greater than sodium loss because of
corresponding increase in potassium loss.
hypokalemic alkalosis
a metabolic alkalosis associated with a low serum potassium
level; retention of alkali or loss of acid occurs in the extracellular
(but not intracellular) fluid compartment; although the pH of the
intracellular fluid may be below normal.
metabolic alkalosis
a disturbance in which the acid-base status shifts toward the
alkaline because of uncompensated loss of acids, ingestion or
retention of excess base, or potassium depletion. The condition
can occur with vomiting or accompany treatment with diuretics.
respiratory alkalosis
reduced carbon dioxide tension in the extracellular fluid caused by
excessive excretion of carbon dioxide through the lungs
(hyperventilation). Conditions commonly associated with
respiratory alkalosis include pain, hypoxia, fever, high
environmental temperature, poisoning, early pulmonary edema,
pulmonary embolism and central nervous system disease.
Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007 Elsevier, Inc. All rights reserved

respiratory alkalosis
Metabolism A condition characterized by pH due to excess
CO
2
excretion Etiology Hyperventilationeg, due to anxiety, pain,
panic attacks, psychosis, CVA, fever, encephalitis, meningitis,
tumor, trauma, hypoxemiasevere anemia, high altitude, right-to-
left shunt, drugsprogesterone, methylxanthines, salicylates,
catecholamines, nicotine, hyperthyroidism, pregnancy, ambient
temperature, lung diseasepneumo/hemothorax, pneumonia,
pulmonary edema, PE, aspiration, interstitial lung disease, etc
sepsis, liver failure, mechanical ventilation, heat exhaustion,
recovery from metabolic acidosis DiffDx Asthma, A Fib, flutter and
tachycardia, heatstroke, metabolic acidosis or alkalosis, acute MI,
and other causes of RA Clinical Hyperventilation, paresthesia,
twitchingpositive Chvostek and Trousseau signs, N&V, focal
neurologic signs, depressed consciousness, or coma Lab pH >
7.42, HCO
3
- < 22 mEq/Lif compensating, PaCO
2
< 35 mmHg.
See Metabolic acidosis, Metabolic alkalosis, Respiratory acidosis.

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