Overview of Respiratory Alkalosis
Respiratory alkalosis is a pathophysiological state in which arterial blood carbon dioxide partial pressure is lower than normal due to pulmonary hyperventilation, which is mainly manifested by hyperventilation and accelerated respiration, and may be accompanied by increased neuromuscular excitability, etc. It is caused by physiological factors, environmental factors, pathologic factors, and medical factors, etc. Mild cases can be cured on their own. Most patients can be cured by timely treatment; when the primary disease is more serious, it may be life-threatening.
What is respiratory alkalosis?
Definition
Respiratory alkalosis is a pathophysiologic condition in which the lungs are hyperventilated for a variety of reasons, resulting in a lower-than-normal arterial partial pressure of carbon dioxide (PaCO2).
The pH of the blood can be elevated or normal.
Classification
Classification according to the course of the disease is as follows.
Acute respiratory alkalosis
Rapid decrease in PaCO2 within 24 hours, resulting in an increase in blood pH.
Most often occurs with hyperventilation, hyperthermia and hypoxia caused by artificial ventilators.
Chronic respiratory alkalosis
Decrease in PaCO2 for more than 24 hours, resulting in an increase in blood pH.
Commonly occurs in chronic cranial disease, lung disease, liver disease, hypoxia and when ammonia excites the respiratory center.
Questions you may be concerned about
What is the cause of tingling in hands and feet after getting angry?
When you are angry, you may have a rapid respiratory rate leading to hyperventilation, which can cause respiratory alkalosis, dyspnea, shortness of breath, and tingling of the hands and feet.
Hyperventilation means that carbon dioxide is discharged faster than it is produced, the carbon dioxide in the blood decreases, and the pH of the arterial blood rises, a condition known as respiratory alkalosis.
At this time, you can slow down your breathing or take deep breaths to relax yourself, and the numbness in your hands and feet can be gradually relieved. If this is not possible, you should seek medical attention.
Can respiratory alkalosis resolve on its own without treatment?
Some patients can recover spontaneously.
Respiratory alkalosis is mainly caused by hyperventilation of the lungs, such as stress, anger, anxiety, or strenuous exercise, resulting in excessive CO2 exhalation. It can be improved by relaxation and calm breathing. Or put a paper tube, paper bag, etc. around their mouth to suck back the exhaled CO2.
If symptoms of respiratory alkalosis such as shortness of breath, numbness of lips and limbs, muscle tremors, dizziness, fainting, blurred vision occur, it is recommended to go to the emergency department of the hospital in time.
Is respiratory alkalosis harmful?
Respiratory alkalosis is relatively harmful and life-threatening in severe cases. It mainly includes:
The appearance of shortness of breath, numbness of the lips and limbs, muscle tremors.
Prolonged respiratory alkalosis can cause dizziness and in severe cases, convulsions.
When fainting and convulsions occur, you may fall and get injured.
If the primary disease is severe, the patient’s life can be in danger.
Once shortness of breath, numbness of lips and limbs, muscle tremors, dizziness, fainting, and blurred vision occur, seek medical attention.
Causes
Causes
Mainly caused by pulmonary hyperventilation.
Physiological factors
Psychological factors such as mental tension, anger, anxiety, etc., diving, strenuous exercise, pregnancy, etc. leading to hyperventilation can cause this disease.
Environmental factors
Oxygen deficient environments such as plateaus and high ambient temperatures can lead to hyperventilation and cause the disease.
Pathologic factors
Lung diseases
Pneumonia, interstitial lung disease, bronchial obstruction, emphysema, etc. can lead to hyperventilation and cause the disease.
Extrapulmonary diseases
Cerebrovascular accident, hepatic encephalopathy affecting respiratory function, pleurisy, trauma due to pain dare not exhale; cardiac failure hypoxia, mental illness, etc. can appear hyperventilation, causing the disease.
Other diseases that can cause hyperthermia or acidosis can also cause this disease.
Medical factors
Drugs
Salicylate, paraldehyde poisoning, or the use of progesterone can lead to hyperventilation, causing the disease.
Mechanical ventilation
Improper use of mechanical ventilation can cause the disease.
Surgery
After thoracic or abdominal surgery, the pain caused by the surgical wound and the fear to exhale forcefully can lead to hyperventilation and cause this disease.
Pathogenesis
Various causes lead to hyperventilation, carbon dioxide (CO2) is expelled faster than it is produced, CO2 in the blood decreases, PaCO2 decreases, the pH of arterial blood increases, alkalosis occurs, and corresponding symptoms are caused.
Symptoms
Main Symptoms
Respiratory abnormalities: may be characterized by hyperventilation and accelerated breathing.
In addition to respiratory abnormalities, the following symptoms may occur.
When the disease is mild, symptoms such as numbness and tingling of the lips and limbs, and muscle tremor may occur.
In more severe cases, symptoms such as vertigo, fainting, blurred vision, and convulsions may occur.
It may be accompanied by symptoms such as chest tightness, chest pain, dry mouth and abdominal distension.
Other symptoms
Symptoms of common primary diseases:
Lung disease, may present with symptoms such as coughing, coughing up sputum, and dyspnea.
Cerebrovascular accident, may present with symptoms such as hemiplegia, speech impediment, dizziness.
Infection, may appear fever, headache, weakness and other symptoms.
Heart failure, symptoms such as lower limb edema and palpitation may occur.
Consultation
Department of Medicine
Emergency Department
For symptoms such as shortness of breath, numbness of lips and limbs, muscle tremors, dizziness, fainting, blurred vision, etc., it is recommended to consult a doctor promptly.
Preparation for medical treatment
Preparing for your visit: registering, preparing your documents, and common problems.
Tips for seeking medical treatment
It is recommended to prepare a list of recent medications for the doctor’s reference.
Preparation List
Symptom list
Pay special attention to the time of onset of symptoms, special manifestations, etc.
Are there any symptoms such as numbness around the mouth, rapid breathing, etc.?
Are there any symptoms such as dizziness, difficulty in seeing, chest pain, chest tightness, etc.? How long have these symptoms been present?
List of medical history
Any previous chest disease (e.g., pneumonia, asthma), hysteria, cerebral infarction, etc.?
Any other recent illnesses such as trauma, surgery, etc.?
Was there any agitation, nervousness, anxiety, etc., prior to the onset of symptoms?
Has there been prolonged exposure to high temperatures?
Checklist
Test results of the last six months, which can be brought to the doctor’s office
Laboratory tests: blood routine, blood biochemistry, blood gas analysis
Imaging tests: cranial CT, cranial magnetic resonance test
Medication list
Medications used in the last 3 months, if available, bring along the box or package to the doctor
Analgesics: Ibuprofen, Tramadol
Others: Progesterone
Diagnosis
Diagnosis based on
medical history
Behaviors such as nervousness, anger, anxiety, diving, and strenuous exercise.
Prolonged exposure to high altitude or high temperatures.
Suffers from lung disease, cerebrovascular disease, heart failure, etc.
Has had chest trauma.
Use of medications such as salicylates, paraldehyde and progesterone.
Undergoes chest and abdominal surgery.
Clinical manifestations
Symptoms such as hyperventilation, accelerated breathing, numbness or tingling of lips and limbs, muscle tremor, vertigo, fainting, blurred vision and convulsions.
Laboratory Tests
Arterial blood gas analysis
Oxygen saturation, partial pressure of oxygen, partial pressure of carbon dioxide, bicarbonate (HCO3-), pH, standard bicarbonate (SB), and actual bicarbonate (AB) can be checked in arterial blood.
Decreased partial pressure of carbon dioxide and normal or elevated pH may be found.
Precautions
Draw arterial blood from the radial artery (wrist) or femoral artery (thigh root).
After drawing blood, pressure should be applied to the area where the blood was drawn until the vessel stops bleeding.
If localized skin bulging, blood flow, etc. is found, inform the doctor promptly while increasing the pressure.
Blood routine, blood biochemistry, etc.
The cause of the disease and the severity of the original disease can be clarified.
Note: Before blood biochemistry test in outpatient clinic, fasting is required, i.e., fasting for at least 8 hours; no fasting is required for emergency examination.
Imaging
Mostly used to clarify the cause of the disease or the severity of the original disease.
Head or chest CT, magnetic resonance imaging (MRI)
Can clarify the presence of cerebrovascular, lung and other tissue or organ lesions, as well as the severity of the lesions.
Precautions
Remove jewelry or metal objects, such as necklaces, earrings, or studs, from the area being examined before the CT examination; remove clothing made of metal.
Before MRI examination, remove items containing metal materials, as well as electronic products, magnetic cards, etc.; if the body is equipped with medical devices such as steel plates, implantable pacemakers, etc., the doctor should be informed in advance.
Diagnostic Criteria
Primary respiratory alkalosis can be diagnosed if the following conditions are met at the same time.
Arterial pH>7.43.
PaCO2<40mmHg.
Differential Diagnosis
Differential Diagnosis of Causes
A variety of factors can cause respiratory alkalosis, so it is necessary to clarify the cause of the disease by combining the history, clinical manifestations, laboratory tests, and imaging tests.
Defining the cause can provide information for defining the treatment method, improve the treatment effect and promote the patient’s recovery.
Finding the primary cause of respiratory alkalosis
Bronchial asthma attack
Bronchial asthma can be triggered by pollen, dust, cold air, food, etc. Symptoms such as coughing may also be present, and most of the patients have a history of bronchial asthma, which can be relieved with the use of medications that dilate the bronchial tubes. It can be clarified by history, clinical manifestations, blood gas analysis and pulmonary function tests.
Stroke
Stroke is characterized by numbness and weakness of one side of the limb, and there may be symptoms such as slurred speech and slanting of the corners of the mouth. It can be clarified by clinical manifestations, blood gas analysis, head CT and other examinations.
Seizures
Most patients with seizures have a history of epilepsy, and some of them are unable to recall what happened during the seizure when they are awake at the end of the seizure. It can be identified by history, clinical manifestations, blood gas analysis, EEG and other examinations.
Treatment
Treatment principle: remove the cause as soon as possible, improve respiratory function, correct alkalosis.
General treatment
Treatment of primary disease
Treat pulmonary diseases, cerebrovascular diseases, hepatic encephalopathy, chest trauma, pleurisy, heart failure, mental diseases and other diseases.
Improvement of mood
Relieve anxiety, tension and other emotions, slow down the breathing rate and reduce the amplitude of breathing.
Improvement of mood can be achieved by diversion of attention, etc.
Family members should comfort the patient appropriately and avoid verbal or behavioral stimulation.
Adjusting breathing
Patients with spontaneous breathing
Use a paper bag to cover the nose and mouth at the same time to improve breathing by inhaling the exhaled carbon dioxide.
Control the breathing rhythm by holding the breath several times.
Patients with ventilator-assisted ventilation
Adjust the parameters of the ventilator to improve breathing.
Patients on non-invasive ventilators should cooperate with the doctor in using the ventilator.
Improving the environment
Patients who are in the plateau area should gradually move to the plains.
Remove from high temperature environment.
Others
Promptly stop or change drugs that affect respiratory function.
Medication
Adjustment of respiration
Used in patients with prolonged duration to slow respiratory rate.
Analgesia
Used for patients with severe pain after surgery to relieve painful symptoms.
Medications that may be used include ibuprofen and tramadol.
Sedation
Used for patients with severe conditions to temporarily maintain normal respiratory function by suppressing spontaneous respiration through sedation while using endotracheal intubation and ventilator-assisted ventilation.
Drugs that may be used are isoproterenol, etc.
Other treatments
Tracheal intubation and ventilator-assisted ventilation are used in more severe cases.
Prognosis
Cure
Those caused by physiologic and environmental factors may recover spontaneously by improving mood, rest, and removal from high altitude or high temperature environments.
In most patients, respiratory alkalosis can be relieved or cured with timely treatment while the primary disease is in remission or cured.
Hazards
It can cause numbness or tingling of the lips and limbs, vertigo, fainting, convulsions and other symptoms that affect life.
When fainting and convulsions occur, you may fall and get hurt.
If the primary disease causing respiratory alkalosis is severe, the patient’s life can be in danger.
Daily routine
Work and rest management
Rest in bed and avoid exertion.
Get enough sleep and avoid staying up late.
Dietary management
Ensure that your diet is nutritious and well-balanced.
Drink water according to the doctor’s requirements, in small amounts and several times, avoid drinking too much at one time.
If you can’t eat, you can choose nasal food, and the food should be stirred before injecting into the nasal feeding tube.
Avoid spicy and stimulating foods or drinks, such as raw onion, ginger, garlic, chili pepper, strong tea, coffee and alcohol.
Exercise management
When resting in bed, elevation, flexion and extension can be done.
If you can get out of bed, you should move slowly to avoid falling. At the beginning, you can use walking aids, crutches and other aids, or be assisted by others.
If physical strength has been recovered, you can choose activities such as slow walking, fast walking, jogging, etc., or choose the activity program according to the doctor’s advice.
Exercise intensity should be gradual.
If you feel tired or uncomfortable during exercise, stop exercising immediately.
Emotion management
Emotions such as tension and anxiety can be relieved by listening to soft music and reading books.
Family members should communicate with the patient and help him/her to relieve his/her emotions.
Follow-up and review
Follow the doctor’s instructions for regular review.
If symptoms do not subside or worsen, or new symptoms appear, consult a doctor promptly.
Prevention
Pay attention to emotion management and avoid tension, anger and anxiety.
Avoid traveling to highland areas, or being in a hot environment for a long time.
Pay attention to safety and avoid trauma.
Actively treat primary diseases such as pneumonia, cerebrovascular accident, liver disease, heart disease and so on.
Use medication according to the doctor’s requirements; if there is any discomfort during the use of medication, stop the medication immediately and consult the doctor in time.
When using non-invasive ventilator to assist breathing, it should be used according to the doctor’s requirements, avoiding self-adjustment of parameters or changing the time of use; if there is any discomfort during use, the doctor should be informed in time.
You should relax after undergoing thoracic or abdominal surgery. You can relieve the pain by diverting your attention, or follow the doctor’s instructions for analgesic treatment.