From the Guidelines
The treatment of respiratory alkalosis secondary to pneumonia should focus on addressing the underlying pneumonia with empiric antimicrobial treatment, initiated as soon as possible, while supporting respiratory function and managing fluid balance. The choice of antimicrobial treatment should follow an approach according to the individual risk of mortality, taking into account general patterns of expected pathogens, regional and local patterns of microbial resistance, and considerations of tolerability and toxicity of antimicrobial agents in the individual patient 1.
Key Considerations
- Antibiotics are the cornerstone of treatment, with the specific regimen guided by the severity of pneumonia and local resistance patterns.
- Supplemental oxygen should be provided to maintain oxygen saturation above 92%, but excessive ventilation should be avoided.
- Fluid management is important, with isotonic fluids like normal saline helping to correct any volume depletion.
- The respiratory alkalosis itself typically resolves as the pneumonia improves and the respiratory drive normalizes.
Management Approach
- Initiate empiric antimicrobial treatment as soon as possible, following guidelines that consider the severity of pneumonia and individual patient factors 1.
- Monitor and manage respiratory function, avoiding excessive ventilation that can worsen alkalosis.
- Use controlled breathing techniques or sedation in severe cases with significant alkalemia, though these interventions are rarely needed.
- Focus on treating the underlying pneumonia, as resolution of the infection typically corrects the respiratory alkalosis without specific interventions targeted at the acid-base disturbance.