View source for Respiratory alkalosis

{{short description|Increase in blood pH due to rapid breathing}}
{{Infobox medical condition (new)
| name          = Respiratory alkalosis
| image         = Davenport Fig 11.jpg
| caption       = [[Davenport diagram]] outlines pH and bicarbonate levels|
| pronounce     =
| field         = Pulmonology, Anaesthesia
| synonyms      = Alkalosis - respiratory<ref name=nih/>
| symptoms      = Tetany, palpitation<ref name=web/>
| complications =
| onset         =
| duration      =
| types         =
| causes        = Hyperventilation,<ref name=nih/> Pulmonary disorder<ref name=emed/>
| risks         =
| diagnosis     = Chest x-ray, Pulmonary function tests<ref name=nih/>
| differential  =
| prevention    =
| treatment     = Detect underlying cause<ref name=nih/>
| medication    =
| prognosis     =
| frequency     =
| deaths        =
}}

'''Respiratory alkalosis''' is a medical condition in which [[Tachypnea|increased respiration]] elevates the blood [[pH]] beyond the normal range (7.35–7.45) with a concurrent reduction in arterial levels of [[carbon dioxide]].<ref name="nih">{{Cite web |title=Respiratory alkalosis: MedlinePlus Medical Encyclopedia |url=https://www.nlm.nih.gov/medlineplus/ency/article/000111.htm |url-status=live |archive-url=https://web.archive.org/web/20160705124453/https://www.nlm.nih.gov/medlineplus/ency/article/000111.htm |archive-date=2016-07-05 |access-date=2016-02-12 |website=www.nlm.nih.gov}}</ref><ref>{{Cite journal |last=Singh |first=Virendra |last2=Khatana |first2=Shruti |last3=Gupta |first3=Pranav |date=2013-01-01 |title=Blood gas analysis for bedside diagnosis |journal=National Journal of Maxillofacial Surgery |volume=4 |issue=2 |pages=136–141 |doi=10.4103/0975-5950.127641 |issn=0975-5950 |pmc=3961885 |pmid=24665166 |doi-access=free}}</ref> This condition is one of the four primary disturbances of [[acid–base homeostasis]].<ref>{{Cite web |title=The Four Primary Disturbances of Acid-Base Balance |url=http://www.lumen.luc.edu/lumen/meded/MEDICINE/PULMONAR/physio/f2iiic.htm |url-status=live |archive-url=https://web.archive.org/web/20240519142424/https://www.lumen.luc.edu/lumen/meded/medicine/pulmonar/physio/f2iiic.htm |archive-date=2024-05-19 |access-date=2022-06-10 |website=www.lumen.luc.edu}}</ref>

[[Respiratory compensation]] is also a condition where increased respiration reduces carbon dioxide sometimes to level below the normal range. In this case it is a physiological response to low pH from metabolic processes and not the primary disorder.

==Signs and symptoms==
{{Listen|filename=Premature ventricular contractions, recorded on cardiac event monitor.ogg|title=PVC (a type of palpitation) recording|description=An audio clip recording of a [[Premature ventricular contraction|PVC]] symptom, made with a cardiac event monitor.|format=[[Ogg]]}}
Signs and symptoms of respiratory alkalosis are as follows:<ref name="web">{{Cite book |last=Porth |first=Carol |url=https://books.google.com/books?id=FFg88IaReBwC |title=Essentials of Pathophysiology: Concepts of Altered Health States |date=2011-01-01 |publisher=Lippincott Williams & Wilkins |isbn=9781582557243 |page=205 |language=en |access-date=2016-02-12 |archive-url=https://web.archive.org/web/20240519142449/https://books.google.com/books?id=FFg88IaReBwC |archive-date=2024-05-19 |url-status=live}}</ref>
* [[Palpitation]]
* [[Tetany]]
* [[Convulsion]]
* [[Sweating]]

==Causes==
Respiratory alkalosis may be produced as a result of the following causes:
{{columns-list|colwidth=30em|
* [[Stress (medicine)|Stress]]<ref name=nih/>
* [[Pulmonary]] disorder<ref name=emed/>
* Thermal insult<ref>{{Cite book |last=Feld |first=Leonard G. |url=https://books.google.com/books?id=CDu3BAAAQBAJ |title=Fluid and Electrolytes in Pediatrics: A Comprehensive Handbook |last2=Kaskel |first2=Frederick J. |date=2009-12-15 |publisher=Springer Science & Business |isbn=9781603272254 |page=280 |language=en |access-date=2016-02-12 |archive-url=https://web.archive.org/web/20240519142422/https://books.google.com/books?id=CDu3BAAAQBAJ |archive-date=2024-05-19 |url-status=live}}</ref>
* [[High altitude]] areas<ref name="nih2">{{Cite web |title=Alkalosis: MedlinePlus Medical Encyclopedia |url=https://www.nlm.nih.gov/medlineplus/ency/article/001183.htm |url-status=live |archive-url=https://web.archive.org/web/20240519142426/https://medlineplus.gov/ency/article/001183.htm |archive-date=2024-05-19 |access-date=2016-02-12 |website=www.nlm.nih.gov}}</ref>
* [[Salicylate poisoning]] (aspirin overdose)<ref name=nih2/>
* [[Fever]]<ref name=nih/>
* [[Hyperventilation]] (due to heart disorder or other, including improper mechanical ventilation)<ref name=nih/><ref>{{Cite web |title=Hyperventilation: MedlinePlus Medical Encyclopedia |url=https://www.nlm.nih.gov/medlineplus/ency/article/003071.htm |url-status=live |archive-url=https://web.archive.org/web/20160217012051/https://www.nlm.nih.gov/medlineplus/ency/article/003071.htm |archive-date=2016-02-17 |access-date=2016-02-12}}</ref>
* Vocal cord paralysis (compensation for loss of vocal volume results in over-breathing/breathlessness).<ref>{{Cite web |date=2018-04-05 |title=Medscape: Medscape Access |url=http://emedicine.medscape.com/article/863779-overview |url-status=live |archive-url=https://web.archive.org/web/20150508144811/http://emedicine.medscape.com/article/863779-overview |archive-date=2015-05-08 |access-date=2015-05-11 |journal=Medscape}}</ref>
* [[Liver disease]]<ref name=nih2/>
}}

==Mechanism==
[[File:Carbonic-acid-3D-balls.png|thumb|Carbonic-acid]]
The mechanism of respiratory alkalosis generally occurs when some stimulus makes a person hyperventilate. The increased breathing produces increased [[Pulmonary alveolus|alveolar]] respiration, expelling [[Carbon dioxide|CO<sub>2</sub>]] from the circulation. This alters the dynamic [[chemical equilibrium]] of carbon dioxide in the circulatory system. Circulating hydrogen ions and bicarbonate are shifted through the [[carbonic acid]] (H<sub>2</sub>CO<sub>3</sub>) intermediate to make more CO<sub>2</sub> via the enzyme [[carbonic anhydrase]] according to the following reaction: <math>\rm HCO_3^- + H^+ \rightarrow H_2CO_3 \rightarrow CO_2 + H_2O</math>

This causes decreased circulating hydrogen ion concentration, and increased [[pH]] (alkalosis).<ref>{{Cite web |title=Evaluation of respiratory alkalosis |url=http://us.bestpractice.bmj.com/best-practice/monograph/463.html |url-status=live |archive-url=https://web.archive.org/web/20160215221622/http://us.bestpractice.bmj.com/best-practice/monograph/463.html |archive-date=2016-02-15 |access-date=2016-02-12 |website=us.bestpractice.bmj.com}}</ref><ref>{{Cite book |last=Wilkins |first=Lippincott Williams & |url=https://books.google.com/books?id=D4aUypFakeoC |title=Pathophysiology: A 2-in-1 Reference for Nurses |date=2005-01-01 |publisher=Lippincott Williams & Wilkins |isbn=9781582553177 |page=102 |language=en |access-date=2016-02-12 |archive-url=https://web.archive.org/web/20240519142424/https://books.google.com/books?id=D4aUypFakeoC |archive-date=2024-05-19 |url-status=live}}</ref>

==Diagnosis==
The diagnosis of respiratory alkalosis is done via test that measure the oxygen and carbon dioxide levels (in the blood), chest x-ray and a pulmonary function test of the individual.<ref name=nih/>

The [[Davenport diagram]] is named after Horace W Davenport a teacher and [[ Physiology | physiologist ]] which allows theoreticians and teachers to graphically describe acid base chemistry. It is not used by [[Clinician | clinicians ]] who prefer a practical rather than a theoretical approach
<ref>{{Cite book |last=Albert |first=Richard K. |url=https://books.google.com/books?id=JuERMKJIuKMC |title=Clinical Respiratory Medicine |last2=Spiro |first2=Stephen G. |last3=Jett |first3=James R. |date=2008-01-01 |publisher=Elsevier Health Sciences |isbn=978-0323048255 |page=128 |language=en |access-date=2016-02-12 |archive-url=https://web.archive.org/web/20240519142425/https://books.google.com/books?id=JuERMKJIuKMC |archive-date=2024-05-19 |url-status=live}}</ref>

===Classification===
There are two types of respiratory alkalosis: [[chronic (medicine)|chronic]] and [[acute (medicine)|acute]] as a result of the 3–5 day delay in kidney compensation of the abnormality.<ref>{{Cite journal |last=Adrogué |first=HJ |last2=Madias |first2=NE |date=June 2010 |title=Secondary responses to altered acid-base status: the rules of engagement. |journal=Journal of the American Society of Nephrology |volume=21 |issue=6 |pages=920–3 |doi=10.1681/ASN.2009121211 |pmid=20431042 |doi-access=free}}</ref><ref name="emed">{{Cite web |date=2018-10-04 |title=Respiratory Alkalosis: Background, Pathophysiology, Epidemiology |url=http://emedicine.medscape.com/article/301680-overview |url-status=live |archive-url=https://web.archive.org/web/20200302045801/https://emedicine.medscape.com/article/301680-overview |archive-date=2020-03-02 |access-date=2016-02-12}}</ref>
* ''Acute respiratory alkalosis'' occurs rapidly, have a high pH because the response of the kidneys is slow.<ref name="fluid">{{Cite book |last=Metheny |first=Norma M. |url=https://books.google.com/books?id=6UNGDx4ifDcC |title=Fluid and Electrolyte Balance |date=2011-01-07 |publisher=Jones & Bartlett Publishers |isbn=9780763781644 |page=148 |language=en |access-date=2016-02-12 |archive-url=https://web.archive.org/web/20240519142926/https://books.google.com/books?id=6UNGDx4ifDcC |archive-date=2024-05-19 |url-status=live}}</ref>
* ''Chronic respiratory alkalosis'' is a more long-standing condition, here one finds the kidneys have time to decrease the bicarbonate level.<ref name=fluid/>

====pH====
* Acidemia is serum pH < 7.35.

* Alkalemia is serum pH > 7.45.

An acidosis is a physiologic process that increases hydrogen ion concentration.

An alkalosis is a physiologic process that decreases hydrogen ion concentration.
<ref>[https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/acid-base-regulation-and-disorders/acid-base-disorders Acid-Base Disorders in The Merck Manual Professional Edition] </ref>
<ref>{{Cite book |last=Klingensmith |first=Mary E. |url=https://books.google.com/books?id=RI_SCgAAQBAJ |title=The Washington Manual of Surgery |date=2015-10-28 |publisher=Lippincott Williams & Wilkins |isbn=9781496310798 |page=87 |language=en |access-date=2016-02-12 |archive-url=https://web.archive.org/web/20240519142926/https://books.google.com/books?id=RI_SCgAAQBAJ |archive-date=2024-05-19 |url-status=live}}</ref>

==Treatment==
Respiratory alkalosis is very rarely life-threatening, though pH level should not be 7.5 or greater. The aim in treatment is to detect the underlying cause. When PaCO2 is adjusted rapidly in individuals with chronic respiratory alkalosis, [[metabolic acidosis]] may occur.<ref name=emed/> If the individual is on a [[mechanical ventilator]] then preventing hyperventilation is done via monitoring ABG levels.<ref>{{Cite book |url=https://books.google.com/books?id=vCzlLiOlVeUC |title=Handbook of Medical-surgical Nursing |date=2006-01-01 |publisher=Lippincott Williams & Wilkins |isbn=9781582554457 |page=801 |language=en}}</ref>

==In popular culture==
In ''[[The Andromeda Strain]]'', one of the characters is exposed to contamination, but saves himself by increasing his respiratory rate to induce alkalosis.<ref>{{Cite web |title=AFI: Robert Wise – Andromeda Strain |url=http://www.afi.com/wise/films/andromeda_strain/androm.html |url-status=dead |archive-url=https://web.archive.org/web/20190826114502/http://www.afi.com/wisE/films/andromeda_strain/androm.html |archive-date=2019-08-26}}</ref>

==See also==
{{columns-list|colwidth=22em|
* [[Acidosis]]
* [[Alkalosis]]
* [[Arterial blood gas]]
* [[Chemical equilibrium]]
* [[Hypocalcemia]]
* [[Metabolic acidosis]]
* [[Metabolic alkalosis]]
* [[pCO2]]
* [[pH]]
* [[pKa]]
* [[Respiratory acidosis]]
}}

==References==
{{Reflist}}

==Further reading==
* {{Cite book |last=Lang |first=Florian |url=https://books.google.com/books?id=DdBJ6jCf8KgC |title=Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables |date=2009-03-19 |publisher=Springer Science & Business Media |isbn=9783540671367 |language=en}}
* {{Cite journal |last=Unwin |first=R. |last2=Stidwell |first2=R. |last3=Taylor |first3=S. |last4=Capasso |first4=G. |date=1997-11-01 |title=The effects of respiratory alkalosis and acidosis on net bicarbonate flux along the rat loop of Henle in vivo |journal=American Journal of Physiology. Renal Physiology |language=en |volume=273 |issue=5 |pages=F698–F705 |doi=10.1152/ajprenal.1997.273.5.F698 |issn=1931-857X |pmid=9374832}}
* {{Cite journal |last=LeBlanc |first=P J |last2=Parolin |first2=M L |last3=Jones |first3=N L |last4=Heigenhauser |first4=G J F |date=2002-10-01 |title=Effects of respiratory alkalosis on human skeletal muscle metabolism at the onset of submaximal exercise |journal=The Journal of Physiology |volume=544 |issue=Pt 1 |pages=303–313 |doi=10.1113/jphysiol.2002.022764 |issn=0022-3751 |pmc=2290561 |pmid=12356901}}
==External links==
{{Medical resources
|   DiseasesDB     = 406
|   ICD10          = {{ICD10|E|87|3|e|70}}
|   ICD9           = {{ICD9|276.3}}
|   ICDO           =
|   OMIM           =
|   MedlinePlus    = 000111
|   eMedicineSubj  = med
|   eMedicineTopic = 2009
|   MeshID         = D000472
}}
{{Commons}}

{{Scholia|topic}}
{{Acid-base disorders}}

[[Category:Acid–base disturbances]]