From the Guidelines
Respiratory alkalosis is a condition that should be managed by addressing the underlying cause, with treatment focusing on reducing hyperventilation and restoring normal acid-base balance, as evidenced by the most recent study on cardiopulmonary exercise testing 1.
Causes and Symptoms
Respiratory alkalosis occurs when the lungs remove more carbon dioxide than the body produces, disrupting the body's acid-base balance. Common causes include anxiety, fever, high altitude, severe pain, lung diseases, aspirin overdose, and mechanical ventilation. Symptoms may include lightheadedness, dizziness, numbness or tingling in the extremities, confusion, and in severe cases, seizures or loss of consciousness.
- Anxiety-induced hyperventilation is a significant cause of respiratory alkalosis, as noted in a study on psychogenic disorders 1.
- Central sleep apnea with Cheyne-Stokes breathing (CSA-HCSB) is another condition associated with hyperventilation, particularly in patients with heart failure, as described in a study published in the Journal of Clinical Sleep Medicine 1.
Treatment and Management
Treatment of respiratory alkalosis focuses on addressing the underlying cause while managing acute symptoms.
- For anxiety-induced hyperventilation, breathing into a paper bag can help by increasing carbon dioxide rebreathing.
- Oxygen therapy may be necessary in some cases.
- Medications like benzodiazepines might be prescribed for severe anxiety-related hyperventilation.
- Adjusting ventilator settings is crucial for mechanically ventilated patients to prevent respiratory alkalosis.
Key Considerations
The body typically compensates for respiratory alkalosis through renal mechanisms by decreasing bicarbonate excretion, though this takes time.
- In hospital settings, careful monitoring and management of patients with respiratory alkalosis are essential to prevent complications.
- Chronic respiratory alkalosis may require ongoing management of the primary disorder, as noted in a study on cardiopulmonary exercise testing 1.
Prioritizing Morbidity, Mortality, and Quality of Life
In managing respiratory alkalosis, it is essential to prioritize the patient's morbidity, mortality, and quality of life by addressing the underlying cause and providing appropriate treatment, as supported by the most recent and highest-quality study available 1.
From the Research
Definition and Causes of Respiratory Alkalosis
- Respiratory alkalosis is an extremely common and complicated problem affecting virtually every organ system in the body 2.
- It occurs when alveolar ventilation exceeds that required to eliminate the carbon dioxide produced by tissues, resulting in concurrent decreases in Paco2, increases in pH, and compensatory decreases in blood HCO3- levels 3.
- The etiologies of respiratory alkalosis may be related to pulmonary or extrapulmonary disorders, with hyperventilation syndrome being a common etiology in the emergency department setting 2.
Effects of Respiratory Alkalosis
- Respiratory alkalosis produces multiple metabolic abnormalities, including changes in potassium, phosphate, and calcium, as well as the development of a mild lactic acidosis 2.
- It can also affect renal handling of ions, and has various cardiac effects such as tachycardia, ventricular and atrial arrhythmias, and ischemic and nonischemic chest pain 2.
- In the lungs, vasodilation occurs, and in the gastrointestinal system, there are changes in perfusion, motility, and electrolyte handling 2.
Treatment and Management
- Correction of a respiratory alkalosis is best performed by correcting the underlying etiology 2.
- Respiratory alkalosis can be used therapeutically for the treatment of elevated intracranial pressure 2.
- A systematic approach to understanding acid-base disorders, including respiratory alkalosis, is necessary to facilitate prompt identification and prevent untoward morbidity and mortality 4.