Respiratory alkalosis

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Resident
Survival
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Respiratory alkalosis
ICD-10 E87.3
ICD-9 276.3
DiseasesDB 406

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]Madhu Sigdel M.B.B.S.[3]

Overview

Respiratory alkalosis results from increased alveolar respiration (hyperventilation) leading to decreased plasma carbon dioxide concentration. This leads to decreased hydrogen ion and bicarbonate concentrations.

Pathophysiology

Compensation in respiratory alkalosis

Acute compensatory stage

  • Starts within minutes to hours
  • Mediated through the plasma buffer
  • For every pCO2 decrease of 10, serum bicarbonate decreases by 2
  • Change in pH is unpredictable

Chronic compensatory stage

  • Renal mediated
  • Starts within 1-3 days
  • For every pCO2 decrease of 10, serum bicarbonate decreases by 5
  • Change in pH is unpredictable

Classification

There are two types of respiratory alkalosis: chronic and acute.

Acute respiratory alkalosis

  • Increased levels of carbon dioxide are "blown off" by the lungs, which are hyperventilating.
  • During acute respiratory alkalosis, the person may lose consciousness where the rate of ventilation will resume to normal.

Chronic respiratory alkalosis

  • For every 10 mM drop in pCO2 in blood, there is a corresponding 5 mM of bicarbonate ion drop.
  • The drop of 5 mM of bicarbonate ion is a compensation effect which reduces the alkalosis effect of the drop in pCO2 in blood. This is termed metabolic compensation.

Causes

Lung and airways

Central respiratory drive

Systemic diseases

Special considerations

Symptoms

  • Symptoms of respiratory alkalosis are related to the decreased blood carbon dioxide levels, and include peripheral paraesthesiae.
  • In addition, the alkalosis may disrupt calcium ion balance, and cause the symptoms of hypocalcaemia (such as tetany) with no fall in total serum calcium levels.

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