Respiratory Alkalosis

Caused by alveolar hyperventilation, respiratory alkalosis is a condition marked by a decrease in partial pressure of arterial carbon dioxide (Paco2,) to below 35 mm Hg. Uncomplicated respiratory alkalosis leads to a decrease in hydrogen ion concentration, which causes elevated blood pH. Hypocapnia occurs when the elimination of carbon dioxide by the lungs exceeds the production of carbon dioxide at the cellular level.

Causes

Respiratory alkalosis can result from pulmonary or nonpulmonary causes:

Pulmonary causes include pneumonia, interstitial lung disease, pulmonary vascular disease, and acute asthma.
Nonpulmonary causes include anxiety, fever, aspirin toxicity, metabolic acidosis, CNS disease (inflammation or tumor), sepsis, hepatic failure, and pregnancy.

Signs and symptoms

The cardinal sign of respiratory alkalosis is deep, rapid breathing, possibly exceeding 40 breaths/minute and much like the Kussmaul's respirations that characterize diabetic acidosis.

Such hyperventilation usually leads to CNS and neuromuscular disturbances, such as light-headedness or dizziness (from below-normal carbon dioxide levels that decrease cerebral blood flow), agitation, circumoral and peripheral paresthesias, carpopedal spasms, twitching (possibly progressing to tetany), and muscle weakness. Severe respiratory alkalosis may cause cardiac arrhythmias that fail to respond to conventional treatment, seizures, or both.

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.

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 re-breathing 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.

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