From the Research
Managing respiratory alkalosis requires addressing the underlying cause while supporting normal breathing patterns, as emphasized in the most recent study 1. The primary treatment is to slow down the breathing rate, especially in cases of anxiety-induced hyperventilation. For acute hyperventilation, having the patient breathe into a paper bag can help by increasing carbon dioxide rebreathing, though this should be done cautiously and not in patients with hypoxemia. Some key points to consider in management include:
- Anxiety-related respiratory alkalosis may require benzodiazepines such as lorazepam (0.5-2 mg orally or IV) or diazepam (2-10 mg orally) for immediate relief, as suggested by previous studies 2, 3.
- For chronic cases, treating the underlying condition is essential—this might include adjusting ventilator settings in mechanically ventilated patients, treating fever, pain, or sepsis, or addressing metabolic causes.
- Severe symptomatic cases may require acetazolamide (250-500 mg orally twice daily), a carbonic anhydrase inhibitor that increases renal bicarbonate excretion. Respiratory alkalosis is dangerous because it reduces cerebral blood flow and can cause tetany, seizures, and cardiac arrhythmias due to decreased ionized calcium, highlighting the importance of prompt and careful management 4. Monitoring arterial blood gases and electrolytes is important during treatment, as correction should be gradual to prevent overcorrection and metabolic acidosis, a principle supported by the latest research in the field 1.