Respiratory alkalosis resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.


The first sentence of the overview must contain the name of the disease.


Life Threatening Causes

Life-threatening causes of Respiratory Alkalosis include

Common Causes


Shown below is an algorithm summarizing the diagnosis of Respiratory Alkalosis:[2][3]

Patient with Acute Respiratory Alkalosis
Take complete history
Ask the following questions regarding CNS manifestations

❑If they felt dizzy or confused recently? Light-headedness and Confusion due to reduced cerebral blood flow
❑If they felt numbness or tingling sensation on peripheral parts of the body?

Acral paresthesia due to reduced blood flow to the skin
❑Ask if they had experienced tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings to check Asterexis
❑If there is any history of loss of consciousness
❑Ask about any event of seizues
Ask the following questions regarding Cardiovascular manifestations

❑Ask if they felt any chest discomfort or pain?

Chest pain due to vasoconstriction
❑If they felt their heart was racing? Ask about cardiac Arrythmia
Ask the following questions regarding Metabolic effects

❑Ask if they have experienced perioral tingling sensations
❑Ask about any symptoms of mild hyponatremia, hypokalemia, and hypophosphatemia
Do complete physical examination
Vital signs

❑Decreased blood pressure(hypotension) due to hypoxemia
❑Increased heart rate due to fever, anxiety
❑Increased temperature due to infection or sepsis

Tachypnea due to Arrhythmias, hypoxemia, pulmonary disease
❑Orthostatic changes due to reduced plasma volume
Examination of respiratory system

❑Inspiratory crackles if patient has Pulmonary edema
❑Inspiratory ronchi and crackles in patient with Pulmonary fibrosis

Tachypnea, pulmonary rub in Pulmonary embolism
❑Prolonged expiratory wheezing in patient with Asthma
Examination of Cardiovascular System

❑Irregular rhythm may be seen
❑palpable P2, right ventricular heave may be seen if patient has Pulmonary hypertension
Examination of Abdomen

Ascites in Liver disease
Gravid uterus in pregnany woman
Examination of the Extremities

Cyanosis due to hypoxemia
Examination of Central Nervous System

Tremor, paresthesias
❑ Muscle weakness Hypokalemia, hypophosphatemia

Chvostek’s and Trousseau’s signs due to Low ionized Ca2+
Do following tests
Serum Chemistry

❑Persistent hyponatremia, hypokalemia, hypophosphatemia, and low ionized

❑Increased WBC if there is any infection
❑Decreased Hemoglobin if there is anemia
❑ Increased Hematocrit which is suggestive of exposure to high altitude
❑Abnormal liver function tests in liver disease
❑Increased T3 and T4 and low TSH in a patient of hyperthyroidism
❑Positive urine β-human chorionic hormone if patient is pregnant
❑When both respiratory alkalosis and high Anion gap metabolic acidosis are present—suspect salicylate intake
Do Arterial Blood Gas (ABG)

❑low pCO2, low serum [HCO3−], high pH
❑In acute respiratory alkalosis, serum [HCO3−] is around 20 mEq/L, because the secondary response to hypocapnia of 20 mmHg is a decrease of 4 mEq/L from normal [[[HCO3]]−] of 24 mEq/L
❑Serum [[[HCO3]]−] from normal level of 24 mEq/L drops to

16 mEq/L in chronic respiratory alkalosis for the same hypocapnia of 20 mmHg.


  1. Respiratory alkalosis is not self-limiting.
  2. Correction of the primary disorder of the respiratory alkalosis is needed

Shown below is an algorithm summarizing the treatment of Respiratory Alkalosis:

If patient comes with Anxiety or hyperventilation syndromes
Treatment options

❑Rebreathing into a paper or plastic bag
❑mild sedation
If patient is Hypoxic
Treatment options

❑Give O2
Respiratory Alkalosis
Salicylates overdose
Treatment options

❑Urinary alkalinization
❑Forced diuresis
If patient has Hyperthyroidism
Treatment options

Antithyroid medications
If patient has Asthma
Treatment options

If patient has Pneumonia
Treatment options

If patient has Pulmonary oedema
Treatment options

❑Treatment and improvement in CHF
If patient has Pulmonary embolism
Treatment options

❑Give O2
If patient has history of going to high altitude, climbing
Treatment options

❑Give O2
Mechanical ventilation
Treatment options

❑Reduce Ventilatory rate and tidal volume
❑ Increase dead space

sedation without skeletal muscle paralysis


  • The content in this section is in bullet points.


  • The content in this section is in bullet points.


  1. "Respiratory Alkalosis - StatPearls - NCBI Bookshelf".
  2. Hasan, Ashfaq (2009). "Respiratory Alkalosis": 207–212. doi:10.1007/978-1-84800-334-7_9.
  3. Reddi, Alluru S. (2018). "Respiratory Alkalosis": 441–448. doi:10.1007/978-3-319-60167-0_33.

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