From the Research
The correct answer is (c) respiratory alkalosis. Respiratory alkalosis is an early sign of sepsis, characterized by an increase in respiratory rate (tachypnea) and depth of breathing, which leads to excessive elimination of carbon dioxide from the body. This hyperventilation occurs as part of the systemic inflammatory response to infection, often triggered by inflammatory mediators and cytokines. The body attempts to compensate for the developing metabolic demands by increasing oxygen delivery through faster breathing. As sepsis progresses, patients typically develop metabolic acidosis due to tissue hypoperfusion and lactic acid production, but respiratory alkalosis is often the initial acid-base disturbance observed. This early respiratory change can be a valuable clinical indicator for healthcare providers to recognize developing sepsis before more severe manifestations appear.
Key Points
- Respiratory alkalosis is often the first acid-base disturbance in sepsis, as the body attempts to increase oxygen delivery through hyperventilation 1.
- Metabolic acidosis, including lactic acidosis and high anion gap metabolic acidosis, is a common complication of sepsis, particularly in severe cases 2, 3.
- The presence of metabolic alkalosis has been associated with increased ICU length of stay, but not with mortality 4.
- Early recognition of sepsis and prompt treatment are crucial to reducing morbidity and mortality 1, 5.
Clinical Implications
- Healthcare providers should be aware of the potential for respiratory alkalosis as an early sign of sepsis, and monitor patients closely for signs of metabolic acidosis as the condition progresses.
- Aggressive fluid resuscitation and treatment with antibiotics and vasopressors may be necessary to manage sepsis and prevent organ dysfunction 2, 1.
- The choice of fluid for resuscitation should be carefully considered, as chloride-associated acidosis is a potential complication of fluid resuscitation with 0.9% saline 2, 5.