Respiratory Alkalosis Treatment & Management

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

Medical Care

Treatment of respiratory alkalosis is primarily directed at correcting the underlying disorder. Respiratory alkalosis itself is rarely life threatening. Therefore, emergent treatment is usually not indicated unless the pH level is greater than 7.5. Because respiratory alkalosis usually occurs in response to some stimulus, treatment is usually unsuccessful unless the stimulus is controlled. If the PCO2 is corrected rapidly in patients with chronic respiratory alkalosis, metabolic acidosis may develop due to the renal compensatory drop in serum bicarbonate.

The tidal volume and respiratory rate may be decreased in mechanically ventilated patients who have respiratory alkalosis. Inadequate sedation and pain control may be the etiology of respiratory alkalosis in patients breathing over the set ventilator rate.

In hyperventilation syndrome, patients benefit from reassurance, rebreathing into a paper bag during acute episodes, and treatment for underlying psychological stress. Sedatives and/or antidepressants should be reserved for patients who have not responded to conservative treatment. Beta-adrenergic blockers may help control the manifestations of the hyperadrenergic state that can lead to hyperventilation syndrome in some patients.[2]

In patients presenting with hyperventilation, a stepwise approach should be used to rule out potentially life-threatening, organic causes first.

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Consultations

Based on the findings from the history, physical examination, laboratory studies, and imaging modalities, the necessity for assistance from consultants such as pulmonologists, neurologists, or nephrologists can be determined.

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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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