Respiratory Alkalosis Treatment & Management

Updated: Sep 28, 2022
  • Author: Ranjodh Singh Gill, MD, FACP, CCD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Medical Care

The 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 PaCO2 is corrected rapidly in patients with chronic respiratory alkalosis, metabolic acidosis may develop due to the renal compensatory drop in serum bicarbonate.

In mechanically ventilated patients who have respiratory alkalosis, the tidal volume and/or respiratory rate may need to be decreased. Inadequate sedation and pain control may contribute to 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. [4]

In patients presenting with hyperventilation, a systematic approach should be used to rule out potentially life-threatening, organic causes first before considering less serious disorders.



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.