From the Research
The treatment of respiratory alkalosis should primarily focus on addressing the underlying cause while supporting the patient's respiratory function, as stated in the most recent study 1. The goal is to normalize the patient's breathing pattern and correct the acid-base disturbance. For acute respiratory alkalosis caused by anxiety or panic attacks, the first step is to calm the patient and normalize their breathing pattern. This can be achieved through:
- Reassurance
- Breathing exercises
- In some cases, having the patient rebreathe into a paper bag (though this is no longer routinely recommended due to potential risks) For anxiety-induced hyperventilation, benzodiazepines like lorazepam 0.5-1mg orally or diazepam 2-5mg may be used short-term, as suggested by 2. In mechanically ventilated patients, respiratory alkalosis can be corrected by decreasing the ventilator rate or tidal volume to reduce minute ventilation. For chronic respiratory alkalosis, treatment targets the underlying condition such as liver disease, sepsis, or pulmonary disorders. Acetazolamide 250-500mg orally 1-4 times daily may be used in specific situations to increase renal bicarbonate excretion, as mentioned in 3. It's essential to monitor arterial blood gases during treatment to avoid overcorrection, as rapid normalization of pH can lead to metabolic complications, as noted in 4. The body compensates for chronic respiratory alkalosis by decreasing renal bicarbonate reabsorption, so treatment should be gradual to allow for readjustment of these compensatory mechanisms. Overall, the treatment approach should be individualized based on the underlying cause and severity of the respiratory alkalosis, with a focus on supporting the patient's respiratory function and correcting the acid-base disturbance, as emphasized in the most recent study 1.