Respiratory Alkalosis Clinical Presentation

  • Author: April Lambert-Drwiega, DO; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: May 19, 2010
 

History

Clinical manifestations of respiratory alkalosis depend on its duration, its severity, and the underlying disease process. Note the following:

  • The hyperventilation syndrome can mimic many conditions that are more serious. Symptoms may include paresthesias, circumoral numbness, chest pain or tightness, dyspnea, and tetany.[4]
  • Acute onset of hypocapnia can cause cerebral vasoconstriction. Therefore, an acute decrease in PCO2 reduces cerebral blood flow and can cause neurologic symptoms, including dizziness, mental confusion, syncope, and seizures; hypoxemia need not be present.[3]
  • The first cases of spontaneous hyperventilation with dizziness and tingling leading to tetany were described in 1922 by Goldman in patients with cholecystitis, abdominal distention, and hysteria.[5]
  • Haldane and Poulton described painful tingling in the hands and feet, numbness and sweating of the hands, and cerebral symptoms following voluntary hyperventilation.[6]
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Physical

Physical examination findings in patients with respiratory alkalosis are usually nonspecific and are related to the underlying illness or cause of the respiratory alkalosis. Note the following:

  • Many patients with hyperventilation syndrome appear anxious and are frequently tachycardic. Understandably, tachypnea is a frequent finding.
  • In acute hyperventilation, chest wall movement and breathing rate increase. In patients with chronic hyperventilation, these physical findings may not be obvious.
  • Positive Chvostek and Trousseau signs may be elicited.[2]
  • Patients with underlying pulmonary disease may have signs suggestive of pulmonary disease, such as crackles and rhonchi. Cyanosis may be present if the patient is hypoxic.
  • If the underlying pathology is neurologic, the patient may have focal neurologic signs or a depressed level of consciousness.[7]
  • Cardiovascular effects of hypocapnia in healthy and alert patients are minimal, but in patients who are anesthetized, critically ill, or receiving mechanical ventilation, the effects can be more significant. Cardiac output and systemic blood pressure may fall as a result of the effects of sedation and positive-pressure ventilation on venous return, systemic vascular resistance, and heart rate.[3]
  • Cardiac rhythm disturbances may occur because of increased tissue hypoxia related to the leftward shift of the hemoglobin-oxygen dissociation curve.[3]
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Causes

The differential diagnosis of respiratory alkalosis is broad; therefore, a thorough history, physical examination, and laboratory evaluation are helpful in limiting the differential and arriving at the diagnosis.

Central nervous system causes are as follows:

Hypoxia-related causes are as follows:

  • High altitude
  • Severe anemia
  • Right-to-left shunts

Drug-related causes are as follows:

  • Progesterone
  • Methylxanthines
  • Salicylates
  • Catecholamines
  • Nicotine

Endocrine-related causes are as follows:

Pulmonary causes are as follows:

Miscellaneous causes are as follows:

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Contributor Information and Disclosures
Author

April Lambert-Drwiega, DO  Fellow, Department of Pulmonology and Critical Care Medicine, East Tennessee State University

April Lambert-Drwiega, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Osteopathic Association, American Thoracic Society, Society of Critical Care Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ryland P Byrd Jr, MD  Professor, Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, Program Director of Pulmonary Diseases and Critical Care Medicine Fellowship, James H Quillen College of Medicine, East Tennessee State University; Medical Director of Respiratory Therapy, James H Quillen Veterans Affairs Medical Center

Ryland P Byrd Jr, MD is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Oleh Wasyl Hnatiuk, MD  Program Director, National Capital Consortium, Pulmonary and Critical Care, Walter Reed Army Medical Center; Associate Professor, Department of Medicine, Uniformed Services University of Health Sciences

Oleh Wasyl Hnatiuk, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Gregg T Anders, DO  Medical Director, Great Plains Regional Medical Command , Brooke Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio

Gregg T Anders, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

References

  1. Kazmaier S, Weyland A, Buhre W, et al. Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease. Anesthesiology. Oct 1998;89(4):831-7. [Medline].

  2. Effros RM, Wesson JA. Acid-Base Balance. In: Mason RJ, Broaddus VC, Murray JF, Nadel JA, eds. Murray and Nadel's Textbook of Respiratory Medicine. Vol 1. 4th ed. Philadelphia, PA: Elsevier Saunders; 2005:192-93.

  3. DuBose TD, Jr. Acidosis and Alkalosis. In: Kasper DL, Braunwald E, Fauci AS, Hauser Sl, Longo DL, Jameson JL,eds. Harrison's Principles of Internal Medicine. 16th. New York, NY: McGraw-Hill; 2005:270-1.

  4. Phillipson EA, Duffin J. Hypoventilation and Hyperventilation Syndromes. In: Mason RJ, Broaddus VC, Murray JF, Nadel JA, eds. Murray and Nadel's Textbook of Respiratory Medicine. Vol 2. 4th ed. Philadelphia, PA: Elsevier Saunders; 2005:2069-70, 2080-84.

  5. Goldman A. Clinical tetany by forced respiration. JAMA. 1922;78:1193-95.

  6. Haldane JS, Poulton EP. The effects of want of oxygen on respiration. J Physiol. 1908;37:390-407.

  7. Kirsch DB, Jozefowicz RF. Neurologic complications of respiratory disease. Neurol Clin. Feb 2002;20(1):247-64, viii. [Medline].

  8. Gardner WN. The pathophysiology of hyperventilation disorders. Chest. Feb 1996;109(2):516-34. [Medline].

 
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