Respiratory alkalosis resident survival guide

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

Overview

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

Causes

Life Threatening Causes

Life-threatening causes of Respiratory Alkalosis include

• Sepsis (Cytokine mediated)

Common Causes

• Central Nervous System related causes:
  • Increased Intracranial Pressure
  • Stroke
  • Head injury
  • CNS infection
  • Intracranial hemorrhage
  • Pontine tumors
  • Anxiety Hyperventilation
  • Voluntary Hyperventilation
  • Sepsis(Cytokine mediated)
  • Chronic Liver disease(Toxin mediated)
  • Drugs(Salicylates, progesterone)
  • Pain
• Hypoxemic causes: Hypoxic stimulation leads to hyperventilation.
• Pulmonary Causes:
  • Pneumonia
  • Asthma
  • Pulmonary oedema
  • Pulmonary thromboembolism
• Extrinsic Causes(deliberate or iatrogenic):
  • Excessive minute ventilation during mechanical ventilation

Diagnosis

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

Patient with Acute Respiratory Alkalosis

Take complete history

Ask the following questions regarding CNS manifestations ❑Light-headedness and Confusion due to reduced cerebral blood flow ❑Acral paresthesia due to reduced blood flow to the skin ❑Asterexis ❑Loss of consciousness ❑Seizues

Ask the following questions regarding Cardiovascular manifestations ❑Chest pain due to vasoconstriction ❑Cardiac Arrythmia ❑Reduced cardiac output

Ask the following questions regarding Metabolic effects ❑Perioral tingling sensations ❑Tetany ❑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 ❑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 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

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

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Don'ts

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