Respiratory Alkalosis

Aka: Respiratory Alkalosis

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II. Causes

  1. Increased Central Respiratory Drive
    1. Anxiety
    2. CNS Infection
    3. Cerebrovascular Accident
    4. Brain Tumor
    5. Head Trauma
    6. Medications
      1. Salicylates
      2. Nicotine
      3. Aminophylline
      4. Progesterone
      5. Catecholamines
    7. Fever
    8. Sepsis (especially with Gram Negative Bacteria)
    9. Pregnancy
    10. Liver failure, Cirrhosis or Hepatic Encephalopathy
    11. Hyperthyroidism
  2. Increased Chemoreceptor Stimulation
    1. Anemia
    2. Carbon Monoxide Poisoning
    3. Pulmonary Edema
    4. Pneumonia
    5. Pulmonary Embolism
    6. High altitude (decreased FIO2)
    7. Restrictive Lung Disease (early)
  3. Iatrogenic with Mechanical Ventilation

III. Labs

  1. Arterial Blood Gas
    1. Arterial pH increased
    2. Serum bicarbonate decreased
    3. PaCO2 decreased
  2. Acute Respiratory Alkalosis
    1. PaCO2 decreases by 10 mmHg increases pH by 0.08
    2. Bicarbonate decreases 2 meq/L per 10 mmHg PaCO2 fall
  3. Chronic Respiratory Alkalosis
    1. PaCO2 decrease by 10 mmHg increases pH by 0.03
    2. Bicarbonate decreases 4 meq/L per 10 mmHg PaCO2 fall

IV. References

  1. Arieff (1993) J Crit Illn 8(2): 224-46 [PubMed]
  2. Narins (1982) Am J Med 72:496 [PubMed]
  3. Narins (1980) Medicine 59:161-95 [PubMed]
  4. Ghosh (2000) Fed Pract p. 23-33
  5. Rutecki (Dec 1997) Consultant, p. 3067-74
  6. Rutecki (Jan 1998) Consultant, p. 131-42

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