Respiratory alkalosis

As I have already briefed, respiratory alkalosis refers to the alkalosis with an acute reduction of carbon-dioxide followed by a proportionate reduction in plasma bicarbonate.

Etiology: Hyperventilation (whether it is caused by hypoxia, anxiety, panic attacks, fever, salicylate intoxication, exercise, or excessive mechanical ventilation) is the primary cause of respiratory alkalosis.

Symptoms: Patient's may develop paresthesia; air hunger; dry oral mucosa; numbness or tingling of the nose, circumoral area, or extremities; muscle twitching; tetany and hyperreflexia; light-headed; inability to concentrate; mental confusion and agitation; lethargy; or coma.

Treatment: Therapy is given for the underlying cause. In acute Hyperventilation produced by panic or anxiety, treatment includes coaching a patient to breathe in a slow, controlled, and relaxed fashion by providing reassurance and support

Patient care: Preventive measures are taken, such as having the hyperventilating patient breathe in a slow, controlled fashion, using cues provided by caregivers. The respiratory therapist prevents or corrects respiratory alkalosis in patients receiving mechanical ventilation by increasing dead space or decreasing volume. Arterial blood gas values, vital signs, and neurological status are monitored. In severe cases, serum potassium level is monitored for hypokalemia and cardiac status for dysrhythmias. Prescribed therapy is administered to treat the cause. The patient is reassured, and a calm, quiet environment is maintained during periods of extreme stressors and to learn coping mechanisms and anxiety-reducing techniques, such as guided imagery, controlled breathing, or meditation.

Metabolic alkalosis

As described earlier, any process in which plasma bicarbonate is increased is referred to as metabolic alkalosis. This is usually the result of increased loss of acid from the stomach or kidney, potassium depletion accompanying diuretic therapy, excessive alkali intake, or severe adrenal gland hyperactivity.

Symptoms: There are no specific signs or symptoms, but if the alkalosis is severe, there may be apathy, confusion, stupor, and tetany as evidenced by a positive Chvostek's sign.

Treatment: Therapy for the primary disorder is essential. Saline solution should be administered intravenously and  in patients with hypokalemia due to diuretic therapy, potassium solution is to be administered. Only rarely will it be necessary to administer acidifying agents IV.

Patient care: Arterial blood gas values, serum potassium level, and fluid balance are monitored. The patient is assessed for anorexia, nausea and vomiting, tremors, muscle hypertonicity, muscle cramps, tetany, Chvostek's sign, seizures, mental confusion progressing to stupor and coma, cardiac dysrhythmia due to hypokalemia, and compensatory hypoventilation with resulting hypoxia. Prescribed oxygen, oral or IV fluids, sodium chloride or ammonium chloride, and potassium chloride if hypokalemia is a factor, along with therapy prescribed to correct the cause, are administered. Seizure precautions are observed; a safe environment and reorientation as needed are provided for the patient with altered thought processes. The patient's response to therapy is evaluated, and the patient is taught about the dangers of excess sodium bicarbonate intake if that is a factor. The ulcer patient is taught to recognise signs of metabolic alkalosis, including anorexia, weakness, lethargy, and a distaste for milk. If potassium-wasting diuretics or potassium chloride supplements are prescribed, the patient's understanding of the regimen's purpose, dosage, and possible adverse effects is ascertained.

Alkalosis: Types

1. Altitude alkalosis: Alkalosis resulting from the increased respiratory rate associated with exposure to the decreased oxygen content of air at high altitudes. This causes respiratory alkalosis explained below.

2. Respiratory alkalosis: Alkalosis with an acute reduction of carbon-dioxide followed by a proportionate reduction in plasma bicarbonate.

3. Compensated alkalosis: Alkalosis in which the pH of body fluids has been returned to normal. Compensatory mechanisms maintain the normal ratio of bicarbonate to carbonic acid (approx. 20:1) even though the bicarbonate level is increased.

4. Hypochloremic alkalosis: Metabolic alkalosis due to loss of chloride; produced by severe vomiting, gastric tube drainage, or massive diuresis.

5. Hypokalemia alkalosis: Metabolic Alkalosis associated with an excessive loss of potassium. It may be caused by diuretic therapy.

6. Metabolic Alkalosis: Any process in which plasma bicarbonate is increased. This is usually the result of increased loss of acid from the stomach or kidney, potassium depletion accompanying diuretic therapy, excessive alkali intake, or severe adrenal gland hyperactivity.

Alkalosis : Introduction

Alsalosis as a term refers to an actual or relative increase in blood alkalinity due to an accumulation of alkalies or reduction of acids.

Thank you for reading.