Respiratory alkalosis resident survival guide: Difference between revisions
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{{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | ||
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{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Ask the following questions regarding Metabolic effects'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Ask the following questions regarding [[Metabolic]] effects'''<br> | ||
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❑Ask if they have experienced perioral [[tingling sensation|tingling sensations]]<br> ❑[[Tetany]]<br> ❑Ask about any symptoms of mild hyponatremia, [[hypokalemia]], and [[hypophosphatemia]]</div>}} | ❑Ask if they have experienced perioral [[tingling sensation|tingling sensations]]<br> ❑[[Tetany]]<br> ❑Ask about any symptoms of mild hyponatremia, [[hypokalemia]], and [[hypophosphatemia]]</div>}} | ||
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{{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> '''Vital signs'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> '''[[Vital]] signs'''<br> | ||
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❑Decreased blood pressure([[hypotension]]) due to [[hypoxemia]] <br> ❑Increased heart rate due to [[fever]], [[anxiety]]<br> ❑Increased [[temperature]] due to [[infection]] or [[sepsis]] <br> | ❑Decreased blood pressure([[hypotension]]) due to [[hypoxemia]] <br> ❑Increased heart rate due to [[fever]], [[anxiety]]<br> ❑Increased [[temperature]] due to [[infection]] or [[sepsis]] <br> | ||
❑[[Tachypnea]] due to [[Arrhythmias]], [[hypoxemia]], [[pulmonary disease]]<br> ❑Orthostatic changes due to reduced plasma volume<br> </div>}} | |||
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{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
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{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> '''Examination of respiratory system'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> '''Examination of respiratory system'''<br> | ||
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❑Inspiratory crackles if patient has Pulmonary edema<br> ❑Inspiratory ronchi and crackles in patient with Pulmonary fibrosis<br> ❑ | ❑Inspiratory [[crackles]] if patient has Pulmonary edema<br> ❑Inspiratory [[ronchi]] and [[crackles]] in patient with [[Pulmonary fibrosis]]<br> ❑ | ||
Tachypnea, pulmonary rub Pulmonary embolism<br> ❑Prolonged expiratory wheezing in patient with Asthma<br> </div>}} | [[Tachypnea]], pulmonary rub in [[Pulmonary embolism]]<br> ❑Prolonged expiratory [[wheezing]] in patient with [[Asthma]]<br> </div>}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
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{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Examination of Cardiovascular System'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Examination of Cardiovascular System'''<br> | ||
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❑Irregular rhythm may be seen<br>❑palpable P2, right ventricular heave may be seen if patient has Pulmonary hypertension<br> </div>}} | ❑Irregular rhythm may be seen<br>❑palpable P2, right ventricular heave may be seen if patient has [[Pulmonary hypertension]]<br> </div>}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
{{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | ||
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{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Examination of Abdomen'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Examination of Abdomen'''<br> | ||
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❑[[Ascites]] in [[Liver disease]]<br>❑[[Gravid|Gravid uterus]] in pregnany woman<br> </div>}} | |||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
{{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Examination of the Extremities'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Examination of the [[Extremities]]'''<br> | ||
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❑[[Cyanosis]] due to [[hypoxemia]]<br> </div>}} | |||
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{{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | ||
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{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Examination of Central Nervous System'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 10em; width: 30em; padding:1em;"> '''Examination of Central Nervous System'''<br> | ||
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❑[[Tremor]], [[paresthesias]]<br>❑ Muscle weakness [[Hypokalemia]], [[hypophosphatemia]] | |||
<br> | <br>❑[[Chvostek's Sign|Chvostek’s]] and [[Trousseau's sign|Trousseau’s]] signs due to Low ionized Ca2+<br> </div>}} | ||
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{{Family tree | | | | | | | B01 | | | |B01= Do following tests}} | {{Family tree | | | | | | | B01 | | | |B01= Do following tests}} | ||
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{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 25em; width: 30em; padding:1em;"> '''Serum Chemistry'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 25em; width: 30em; padding:1em;"> '''Serum [[Chemistry]]'''<br> | ||
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❑Persistent hyponatremia, hypokalemia, hypophosphatemia, and low ionized | ❑Persistent hyponatremia, hypokalemia, hypophosphatemia, and low ionized | ||
Ca2+<br> ❑Increased WBC if there is any infection<br> ❑Decreased Hemoglobin if there is anemia <br> ❑ Increased Hematocrit which is suggestive of exposure to high altitude<br> ❑Abnormal liver function | Ca2+<br> ❑Increased WBC if there is any infection<br> ❑Decreased Hemoglobin if there is [[anemia]] <br> ❑ Increased [[Hematocrit]] which is suggestive of exposure to [[high altitude]]<br> ❑Abnormal [[liver function test]]s in [[liver disease]] <br> ❑Increased T3 and T4 and low [[TSH]] in a patient of [[hyperthyroidism]]<br> ❑Positive urine β-human chorionic hormone if patient is [[pregnant]]<br> ❑When both [[respiratory alkalosis]] and high [[Anion gap]] [[metabolic acidosis]] are present—suspect [[salicylate]] intake</div>}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> '''Do [[Arterial Blood Gas]] (ABG)'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> '''Do [[Arterial Blood Gas]] (ABG)'''<br> |
Revision as of 17:46, 26 October 2020
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
Common Causes
- Central Nervous System related causes:[1]
- 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:
- Extrinsic Causes(deliberate or iatrogenic):
- Excessive minute ventilation during mechanical ventilation
Diagnosis
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 ❑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 ❑Tetany ❑Ask about any symptoms of mild hyponatremia, hypokalemia, and hypophosphatemia | |||||||||||||||||||||||||
Do complete physical examination | |||||||||||||||||||||||||
Vital signs ❑Decreased blood pressure(hypotension) due to hypoxemia ❑Orthostatic changes due to reduced plasma volume | |||||||||||||||||||||||||
Examination of respiratory system ❑Inspiratory crackles if patient has Pulmonary edema ❑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 Central Nervous System ❑Tremor, paresthesias ❑Chvostek’s and Trousseau’s signs due to Low ionized Ca2+ | |||||||||||||||||||||||||
Do following tests | |||||||||||||||||||||||||
Serum Chemistry ❑Persistent hyponatremia, hypokalemia, hypophosphatemia, and low ionized Ca2+❑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 | |||||||||||||||||||||||||
Do Chest X-ray | |||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ "Respiratory Alkalosis - StatPearls - NCBI Bookshelf".
- ↑ Hasan, Ashfaq (2009). "Respiratory Alkalosis": 207–212. doi:10.1007/978-1-84800-334-7_9.
- ↑ Reddi, Alluru S. (2018). "Respiratory Alkalosis": 441–448. doi:10.1007/978-3-319-60167-0_33.