Respiratory Alkalosis
Unlike a metabolic alkalosis (where an additional mechanism is responsible for the maintenance of the acid-base disturbance), a respiratory alkalosis persists only as long as the inciting pathology is active.
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Respiratory Alkalosis
Contents 8.1 8.2 8.3 8.4 8.5 8.6
Respiratory Alkalosis ...................................................................................................... Electrolyte Shifts in Acute Respiratory Alkalosis .......................................................... Causes of Respiratory Alkalosis ..................................................................................... Miscellaneous Mechanisms of Respiratory Alkalosis .................................................... Compensation for Respiratory Alkalosis ........................................................................ Clinical Features of Acute Respiratory Alkalosis ...........................................................
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A. Hasan, Handbook of Blood Gas/Acid-Base Interpretation, DOI 10.1007/978-1-4471-4315-4_8, © Springer-Verlag London 2013
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8.1
8
Respiratory Alkalosis
Respiratory Alkalosis
Unlike a metabolic alkalosis (where an additional mechanism is responsible for the maintenance of the acid-base disturbance), a respiratory alkalosis persists only as long as the inciting pathology is active.
Respiratory alkalosis: decrease in CO2
Compensation: decrease in bicarbonate
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Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill; 2001. p. 615–9.
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8.2 Electrolyte Shifts in Acute Respiratory Alkalosis
8.2
Electrolyte Shifts in Acute Respiratory Alkalosis
Acute hypocapnia
Potassium shifts into intracellular compartment
Slight fall in serum potassium (for ill understood reasons, swings in K+ are not so profound in respiratory disturbances as they are in metabolic disorders).
Phosphate shifts into intracellular compartment
Increased binding of calcium to albumin
Slight fall in serum phosphate
Reduction in plasma free calcium
May also be present: Hyponatremia Hypochloremia
8 The fall in serum calcium accounts for the usual clinical manifestations of hypocapnia
Karpf R, Caduff P, Wagdi P, Stäubli M, Hulter HN. Plasma potassium response to acute respiratory alkalosis. Kidney Int. 1995;47:217–24. Wiseman AC, Linas S. Disorders of potassium and acid-base balance. Am J Kidney Dis. 2005; 45(5):941–9.
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8.3
Respiratory Alkalosis
Causes of Respiratory Alkalosis
• Increased intracranial pressure • Stroke • Intracranial hemorrhage • CNS infection Centrally mediated
• Head injury
(By stimulation of the respiratory centre)
• Pontine tumours • Pain • Anxiety hyperventilation • Voluntary hyperventilation • Sepsis (cytokine mediated) • Chronic Liver disease (toxin mediated) • Drugs (Salicylates, progesterones etc)
Hypoxemic (By stimulation of the peripheral chemoreceptors)
• All causes of hypoxemia
8 • Pneumonia Pulmonary interstitial (By stimulation of the intrapulmonary receptors)
• Asthma • Pulmonary thromboembolism • Pulmonary edema
Extrinsic (Deliberate or iatrogenic)
• Excessive minute ventilation during mechanical ventilation
8.4
8.4
Miscellaneous Mechanisms of Respiratory Alkalosis
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