Alkalosis (Alkaloses)

Alkalosis describes a condition in which there is an excess amount of base or alkali in the body fluids and tissues.

Alkalosis results from the following process: biochemical.

Presentation

Metabolic alkalosis

The manifestations of this condition are linked to the patient's history such as in cases with vomiting or diarrhea. Also, electrolyte deficiencies are associated with specific clinical features. For example, hypokalemia results in weakness, polyuria, myalgia, and serious sequelae such as cardiac arrhythmias while hypocalcemia produces remarkable findings that include altered mental status, tetany, Trousseau sign, Chvostek sign, and possibly seizures. Additionally, volume changes are characterized by signs of dehydration such as orthostatic hypotension, dry mucous membranes, decreased urine output, etc.

Respiratory alkalosis

The symptoms reflect the etiology, duration of the alkalosis, and its degree. Hyperventilation leads to acute hypocapnia, which in turn decreases cerebral perfusion. Therefore, patients experience confusion, lightheadedness, loss of consciousness, and seizures. Also, patients with hyperventilation syndrome develop dyspnea, chest pain, paresthesia, and tetany [7].

Common features on the exam include tachypnea, tachycardia, and arrhythmias. Signs of hypocalcemia may also develop [8].

Patients with chronic respiratory alkalosis do not usually exhibit symptoms.

Skin
Ulcer
  • In adults it may be due to scarring from previous benign ulceration related to peptic ulcer disease, or to encroachment of the pyloric canal by a tumor, most commonly distal gastric cancer.[surgstudent.org]
  • This acid is secreted by the parietal cells of the stomach. 9 This acid can sometimes cause peptic ulcer to the stomach mucosa due to its corrosive nature.[wikihow.com]
  • This revealed resolving duodenal ulcers and also the presence of a vitamin bottle cap that the patient recalled accidentally swallowing.[acutecaretesting.org]
  • For example, for most people, in conditions of hyperventilation, stomach and urinary pH become too low (too acidic), promoting development of gastritis and ulcers, or urinary stones. pH of saliva can be also out of norms for people with low body oxygen[normalbreathing.com]
  • The combination of Betaine HCl and these drugs could increase the risk of ulcers.[moondragon.org]
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  • musculoskeletal
    Muscle Cramp
    • ., muscular weakness, muscle pain , and muscle cramps (from disturbed function of the skeletal muscles), and muscle spasms (from disturbed function of smooth muscles).[en.wikipedia.org]
    • People may have irritability, muscle twitching, muscle cramps, or even muscle spasms.[merckmanuals.com]
    • Symptoms of Diabetic Metabolic Alkalosis Symptoms of diabetic metabolic alkalosis include: light-headedness and dizziness; nausea and vomiting; mental confusion; numbness or tingling in the face and extremities; muscle weakness; myalgia; muscle cramps[battlediabetes.com]
    • Metabolic alkalosis, on the other hand, can cause irritability, muscle cramps and twitches.[mainlinehealth.org]
    Muscle Twitch
    • People may have irritability, muscle twitching, muscle cramps, or even muscle spasms.[merckmanuals.com]
    • The general symptoms related to metabolic alkalosis include: Weakness Irregular heartbeats Ileus (complete arrest of intestinal movements) Muscle twitching Dehydration Seizures (rare) Causes Vomiting Oral administration of alkali, like bicarbonate Administration[petmd.com]
    • Other symptoms cited by the National Institutes of Health include hand tremors, involuntary muscle twitching and sensations of numbness or tingling in the face, arms or legs.[livestrong.com]
    • Symptoms of alkalosis can include any of the following: Confusion (can progress to stupor or coma) Hand tremor Lightheadedness Muscle twitching Nausea, vomiting Numbness or tingling in the face, hands, or feet Prolonged muscle spasms (tetany) The doctor[medlineplus.gov]
    • Symptoms Symptoms of alkalosis can include any of the following: Confusion (can progress to stupor or coma) Hand tremor Lightheadedness Muscle twitching Nausea, vomiting Numbness or tingling in the face, hands, or feet Prolonged muscle spasms (tetany)[uihc.org]
    Carpopedal Spasm
    • spasm Shift 02 dissociation curve to the left (Alkalosis) (Increased affinity of Hb for O2) Correction Treat underlying cause Re-breather mask Emergency physician with a passion for medical informatics and medical education/textbooks .[lifeinthefastlane.com]
    • spasm Type 1 Excludes hysterical tetany ( F44.5 ) neonatal tetany ( P71.3 ) parathyroid tetany ( E20.9 ) post-thyroidectomy tetany ( E89.2 ) alkalosis E87.3 ICD-10-CM Codes Adjacent To E87.3 E85.9 Amyloidosis, unspecified E86.9 Volume depletion, unspecified[icd10data.com]
    • : rapid shift in arterial pCO2 is almost immediately transmitted throughout the total body water (including the intracellular fluid compartment, the brain, and the cerebrospinal fluid) - this accounts for the characteristic symptoms of paresthesias, carpopedal[mdnxs.com]
    Muscle Weakness
    • Muscle weakness and neuromuscular irritability may occur especially in Gitelman's syndrome.[patient.info]
    • Symptoms of Diabetic Metabolic Alkalosis Symptoms of diabetic metabolic alkalosis include: light-headedness and dizziness; nausea and vomiting; mental confusion; numbness or tingling in the face and extremities; muscle weakness; myalgia; muscle cramps[battlediabetes.com]
    • .  Aggravation of arrhythmia and hypoxemia in COPD may also be seen  Symptoms of hypokalemia like muscle cramps, myalgia and muscle weakness may also be seen  Symptoms of hypocalcemia (eg, jitteriness, perioral tingling, muscle spasms) may be present[slideshare.net]
    Myalgia
    • Symptoms of Diabetic Metabolic Alkalosis Symptoms of diabetic metabolic alkalosis include: light-headedness and dizziness; nausea and vomiting; mental confusion; numbness or tingling in the face and extremities; muscle weakness; myalgia; muscle cramps[battlediabetes.com]
    • .  Aggravation of arrhythmia and hypoxemia in COPD may also be seen  Symptoms of hypokalemia like muscle cramps, myalgia and muscle weakness may also be seen  Symptoms of hypocalcemia (eg, jitteriness, perioral tingling, muscle spasms) may be present[slideshare.net]
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  • gastrointestinal
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  • respiratoric
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  • neurologic
    Dizziness
    • You are dizzy, confused, or lose consciousness.[drugs.com]
    • Symptoms of Diabetic Metabolic Alkalosis Symptoms of diabetic metabolic alkalosis include: light-headedness and dizziness; nausea and vomiting; mental confusion; numbness or tingling in the face and extremities; muscle weakness; myalgia; muscle cramps[battlediabetes.com]
    • Call 911 or go to the nearest emergency room if you experience any of these symptoms: dizziness difficulty breathing confusion stupor coma Diagnosing alkalosis The symptoms of alkalosis mimic symptoms of other conditions.[healthline.com]
    • Symptoms of intravascular volume depletion, such as lightheadedness, dizziness, decreased oral intake, syncope or palpitations should be elicited.[clinicaladvisor.com]
    • Symptoms include vertigo, dizziness, anxiety, euphoria, clumsiness, forgetfulness, hallucinations, and seizure. [44] Perkin GD, Joseph R.[us.bestpractice.bmj.com]
    Stroke
    • Hyperventilation-induced alkalosis can be seen in several deadly central nervous system diseases such as strokes or Rett syndrome . [2] Metabolic alkalosis can be caused by repeated vomiting, [2] resulting in a loss of hydrochloric acid in the stomach[en.wikipedia.org]
    • […] symptoms: failure to ventilate, suppression of breathing, disorientation, weakness, coma causes: lung disease blocking gas diffusion (e.g. emphysema, pneumonia, bronchitis, asthma); depression of respiratory center by drugs, cardiopulmonary arrest, stroke[quizlet.com]
    • During hypercapnia, the mean CI ( Figure 1 ) and stroke volume index increased by 13% and 15%, respectively.[anesthesiology.pubs.asahq.org]
    • Unilateral somatic symptoms have also been reported, including partial seizures, migraines, or stroke-like symptoms.[us.bestpractice.bmj.com]
    Paresthesia
    • Respiratory Alkalosis : rapid shift in arterial pCO2 is almost immediately transmitted throughout the total body water (including the intracellular fluid compartment, the brain, and the cerebrospinal fluid) - this accounts for the characteristic symptoms of paresthesias[mdnxs.com]
    • Peripheral manifestations include tetany and paresthesias.[us.bestpractice.bmj.com]
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  • Face, Head & Neck
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  • Entire body system
    Weakness
    • […] noun Medicine An excessively alkaline condition of the body fluids or tissues that may cause weakness or cramps.[en.oxforddictionaries.com]
    • ., muscular weakness, muscle pain , and muscle cramps (from disturbed function of the skeletal muscles), and muscle spasms (from disturbed function of smooth muscles).[en.wikipedia.org]
    • Muscle weakness and neuromuscular irritability may occur especially in Gitelman's syndrome.[patient.info]
    • -symptoms -causes -treatment CO2 increases, pH decreases symptoms: failure to ventilate, suppression of breathing, disorientation, weakness, coma causes: lung disease blocking gas diffusion (e.g. emphysema, pneumonia, bronchitis, asthma); depression of[quizlet.com]
    • Symptoms of Diabetic Metabolic Alkalosis Symptoms of diabetic metabolic alkalosis include: light-headedness and dizziness; nausea and vomiting; mental confusion; numbness or tingling in the face and extremities; muscle weakness; myalgia; muscle cramps[battlediabetes.com]
    Pain
    • ., muscular weakness, muscle pain , and muscle cramps (from disturbed function of the skeletal muscles), and muscle spasms (from disturbed function of smooth muscles).[en.wikipedia.org]
    • Causes Stimulated respiratory drive CNS CVA, ICH, psychogenic Hypermetabolic Thyrotoxicosis Pregnancy (Progesterone)(Secondary to reduced FRC) Sepsis (fever) (often before metabolic acidosis) DT, anxiety, pain DKA and aspirin OD Environmental HYPERthermia[lifeinthefastlane.com]
    • By KAREN BARROW Photo Credit Patient Voices: Hemophilia From weekly treatments to long-term joint pain to changing attitudes on the disease, hemophilia affects everyone slightly differently.[nytimes.com]
    • If your rapid breathing is caused by pain, then treating the pain will help bring your respiratory rate back to normal and improve your symptoms.[healthline.com]
    • This rapid, deep breathing could happen because of low oxygen levels in the blood, pain, or anxiety and stress.[study.com]
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  • Workup

    Clinical assessment consists of a detailed history including that of medication use, a full physical exam, and the appropriate studies.

    Metabolic alkalosis

    The key tests include arterial blood gas (ABG) and a complete metabolic panel to evaluate electrolytes, renal function, etc. If the diagnosis is inconclusive, then the urinary chloride concentration should be measured.

    Respiratory alkalosis

    On ABG, a pH greater than 7.45 indicates alkalemia. If the PaCO2 level is below 35 mm Hg, this reveals a respiratory origin. Also, acute episodes reveal a reduction in bicarbonate levels.

    A complete blood cell count (CBC) must be obtained to investigate if sepsis is present. Furthermore, the clinician should obtain cultures of blood, urine, and sputum to rule out infection.

    Further tests such as complete metabolic panel and screening for salicylate and theophylline should be performed.

    Other diseases associated with hyperventilation should be excluded. Hence, a chest x-ray is crucial to evaluate underlying lung pathologies. Moreover, computerized tomography (CT) studies are obtained if radiography findings are unclear or if lung disease needs to be evaluated further.

    Laboratory

    Serum
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  • ECG

    QT, RR, ST Intervals
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  • Treatment

    Metabolic alkalosis

    The management of metabolic alkalosis consists of targeting the underlying etiology and rehydration with intravenous isotonic saline in chloride-responsive patients. Also, electrolyte replacement is paramount.

    Additionally, vomiting should be treated with antiemetics and diuretics may be reduced in dose or discontinued if possible. Specific drugs such as potassium-sparing diuretics, carbonic anhydrase inhibitors, hydrochloric acid (HCl), and others may be of benefit [9]. Also, hemodialysis can be performed in cases of severe alkalosis and volume overload in the context of pre-existing kidney disease [10].

    Respiratory alkalosis

    The main approach to the management of this acid-base disorder aims at the treatment of the underlying condition. Also, patients should be encouraged to try breathing techniques to address the hyperventilation. Furthermore, mechanical ventilation settings may need to be adjusted.

    Prognosis

    The outcomes of metabolic and respiratory alkalosis are influenced by the causes and the contributing comorbidities.

    Specifically, an arterial blood pH equivalent to 7.55 is associated with a 45% mortality rate, which dramatically increases to 80% when the pH is above 7.65 [5] [6].

    Complications

    Tetany
    • (due to) R29.0 ICD-10-CM Diagnosis Code R29.0 Tetany 2016 2017 2018 Billable/Specific Code Applicable To Carpopedal spasm Type 1 Excludes hysterical tetany ( F44.5 ) neonatal tetany ( P71.3 ) parathyroid tetany ( E20.9 ) post-thyroidectomy tetany ( E89.2[icd10data.com]
    • Stimulated respiratory drive CNS CVA, ICH, psychogenic Hypermetabolic Thyrotoxicosis Pregnancy (Progesterone)(Secondary to reduced FRC) Sepsis (fever) (often before metabolic acidosis) DT, anxiety, pain DKA and aspirin OD Environmental HYPERthermia (Heat tetany[lifeinthefastlane.com]
    • If severe, it may cause tetany .[en.wikipedia.org]
    • -symptoms -causes -treatment CO2 decreases, pH increases symptoms: increased rate and depth of breathing, numbness, light-headedness, tetany causes: hyperventilation because of anxiety, hysteria, fever, exercise; reaction to drugs such as salicylate,[quizlet.com]
    • More severe alkalaemia increases protein binding of ionized Ca , leading to hypocalcaemia and subsequent headache, lethargy, and neuromuscular excitability, sometimes with delirium, tetany, and seizures.[pathology.leedsth.nhs.uk]
    Hypocalcemia
    • Once again, hypocalcemia is another common cause of this collection of symptoms, so a diagnosis of alkalosis should only be declared following the appropriate blood tests.[livestrong.com]
    • […] curve Cardiovascular consequences: Decreased cardiac output due to decreased contractility Arrhythmias Neurological consequences Neuromuscular overexcitability Decreased cerebral blood flow due to cerebral vasoconstriction Seizures Electrolyte changes Hypocalcemia[derangedphysiology.com]
    • Initial assessment revealed: acute kidney injury (serum creatinine 9.28 mg/dL (820 mmol/L) but within normal range a few months previously); hypokalemia (potassium 3.0 mmol/L); hypocalcemia (ionized calcium 0.75 mmol/L); severe hypochloremia (chloride[acutecaretesting.org]
    • Chronic respiratory alkalosis induces renal PTH-resistance, hyperphosphatemia, and hypocalcemia in humans.[us.bestpractice.bmj.com]
    • Many of the symptoms present in persons with respiratory alkalosis are related to hypocalcemia. [ 2 ] Hyponatremia and hypochloremia may also be present.[emedicine.medscape.com]
    Rett Syndrome
    • Hyperventilation-induced alkalosis can be seen in several deadly central nervous system diseases such as strokes or Rett syndrome . [2] Metabolic alkalosis can be caused by repeated vomiting, [2] resulting in a loss of hydrochloric acid in the stomach[en.wikipedia.org]
    Stroke
    • Hyperventilation-induced alkalosis can be seen in several deadly central nervous system diseases such as strokes or Rett syndrome . [2] Metabolic alkalosis can be caused by repeated vomiting, [2] resulting in a loss of hydrochloric acid in the stomach[en.wikipedia.org]
    • […] symptoms: failure to ventilate, suppression of breathing, disorientation, weakness, coma causes: lung disease blocking gas diffusion (e.g. emphysema, pneumonia, bronchitis, asthma); depression of respiratory center by drugs, cardiopulmonary arrest, stroke[quizlet.com]
    • During hypercapnia, the mean CI ( Figure 1 ) and stroke volume index increased by 13% and 15%, respectively.[anesthesiology.pubs.asahq.org]
    • Unilateral somatic symptoms have also been reported, including partial seizures, migraines, or stroke-like symptoms.[us.bestpractice.bmj.com]
    Peptic Ulcer
    • In adults it may be due to scarring from previous benign ulceration related to peptic ulcer disease, or to encroachment of the pyloric canal by a tumor, most commonly distal gastric cancer.[surgstudent.org]
    • This acid is secreted by the parietal cells of the stomach. 9 This acid can sometimes cause peptic ulcer to the stomach mucosa due to its corrosive nature.[wikihow.com]
    • In the beginning of the 20th century, excessive intake of milk or cream was a component of a cocktail (Sippy diet) prescribed as treatment for peptic ulcer disease.[clinicaladvisor.com]
    • Before the advent of H2-receptor antagonists, milk-alkali syndrome was observed in patients who ingested large amounts of milk and antacids as treatment for peptic ulcers.[emedicine.medscape.com]
    • Alkalosis is often the result of excessive intake of alkaline drugs, such as sodium bicarbonate (baking soda) for the treatment of gastritis or peptic ulcers.[moondragon.org]
    Central Nervous System Disorder
    • Common Causes of Acid-Base Disorders Respiratory acidosis Reduced CO 2 elimination Decreased breathing rate (respiratory drive) due to drugs or central nervous system disorders Impaired breathing and lung movement (respiratory mechanics) due, for example[labtestsonline.org]
    Hypercalcemia
    • Examples include the following: Alkali-loading alkalosis Hypercalcemia Intravenous penicillin Hypoproteinemic alkalosis Milk-alkali syndrome comprises hypercalcemia, renal insufficiency, and metabolic alkalosis.[emedicine.medscape.com]
    • In patients with milk-alkali or calcium-alkali syndrome, the presence of hypercalcemia may prompt additional testing to ensure that alternative etiologies of hypercalcemia are ruled out.[clinicaladvisor.com]
    • (see Hypercalcemia ) Mechanism : hypercalcemia enhances renal hydrogen ion secretion Hypokalemia (see Hypokalemia ) Mechanisms Hypokalemia causes potassium to shift from cells to the extracellular fluid space - hydrogen ions move into cells to maintain[mdnxs.com]
    • Loss of hydrogen ions - Vomiting or nasogastric suction Primary mineralocorticoid excess Renal Hydrogen Loss - Primary mineralocorticoid excess Loop or thiazide diuretics Posthypercapnic alkalosis Hypercalcemia and the milk-alkali syndrome Shift of hydrogen[path.upmc.edu]
    • .  Renal origin • Diuretcs • Posthypercapnic stage • Hypercalcemia/hypoparathyroidism • Recovery from lactic acidosis or ketoacidosis • Delivery of nonreabsorbable anions including Penicillin, Carbenicilline • Hypomagnesemia • Bartter’s syndrome • Gitelman[slideshare.net]
    Acid-Base Imbalance
    • "Neurologic presentations of acid-base imbalance, electrolyte abnormalities, and endocrine emergencies".[en.wikipedia.org]
    • Next, check the P CO2 to see if this is the cause of the acid-base imbalance.[amy47.com]
    • As described in Renal Response to Acid-Base Imbalance , the kidneys respond to alkalosis by excreting bicarbonate, thus reducing the ECF bicarbonate concentration.[pathwaymedicine.org]
    • There are also known genetic abnormalities prevent normal metabolic pathways from functioning perfectly and can cause acid-base imbalance, usually acidosis.[labtestsonline.org.au]
    • The primary tests used to identify, evaluate, and monitor acid-base imbalances are: Blood gases Electrolytes Blood gases are a group of tests performed together, usually on an arterial blood sample (blood obtained from an artery instead of a vein).[labtestsonline.org]
    Anxiety
    • ‘When this occurs, it may result in a state of alkalosis which can cause conditions from weakness and fatigue to headaches and anxiety.’[en.oxforddictionaries.com]
    • Hyperventilation : - Anxiety/ P anic Attack. - P ul Embolus, - P ul.[fprmed.com]
    • Causes Stimulated respiratory drive CNS CVA, ICH, psychogenic Hypermetabolic Thyrotoxicosis Pregnancy (Progesterone)(Secondary to reduced FRC) Sepsis (fever) (often before metabolic acidosis) DT, anxiety, pain DKA and aspirin OD Environmental HYPERthermia[lifeinthefastlane.com]
    • If you have rapid breathing caused by anxiety, taking slow, deep breaths can often improve symptoms and regulate your oxygen level.[healthline.com]
    Inspiration
    • Hyperventilation may be voluntary, caused by poorly adjusted ventilators, or may occur in High Altitude as a response to the low levels of inspired oxygen.[pathwaymedicine.org]
    • The desired PaCO 2 and pH were achieved by varying the inspired CO 2 .[nature.com]

    Etiology

    Metabolic alkalosis can occur secondary to diuretic use, loss of gastric acid (due to emesis, diarrhea, or nasogastric suction) [1], excessive antacid intake, and other causes.

    Respiratory alkalosis develops as a consequence of tachypnea and/or hyperventilation, which may emerge secondary to hypoxia, metabolic acidosis, or stressed states such as with fever. This type of alkalosis arises from both pulmonary and extrapulmonary diseases [2].

    Causes

    Epidemiology

    Acid-base disorders are prevalent in hospitalized patients with metabolic alkalosis being the most predominant. Additionally, respiratory alkalosis is the most common in critically ill individuals [3] and in those with high-risk acute heart failure [4].

    Sex distribution
    Age distribution

    Pathophysiology

    Metabolic alkalosis

    This increase in serum bicarbonate develops in response to 1) loss of acid, 2) consumption of alkali, 3) intracellular shift of hydrogen ions or 4) contraction alkalosis.

    Metabolic alkalosis mainly affects the renal and gastrointestinal systems. Once metabolic alkalosis manifests, hypokalemia, a common feature, maintains the alkalosis through various mechanisms.

    Respiratory alkalosis

    Alveolar hyperventilation causes PaCO2 to drop below the bicarbonate concentration. In acute episodes or respiratory alkalosis, the pH is basic whereas chronic cases are characterized by a normal or close to normal pH due to metabolic compensation. This condition can affect all organs as it leads to electrolyte and mineral abnormalities.

    Prevention

    Clinicians caring for hospitalized patients should be aware of how common these acid-base disorders are and take the proper measures to prevent them or manage them early.

    Summary

    Alkalosis is a condition that is just the opposite of acidosis. It results due to an excess of alkali while acidosis occurs to increased acid level. The imbalance is classified as metabolic and respiratory, which emerges from different causes due to separate processes. The diagnosis is made through assessment of the history, physical exam, and important laboratory tests. Management includes treatment of the underlying disease and the physiological manifestations.

    Patient Information

    What is alkalosis?

    This is a condition in which the blood is alkaline due to the loss of acid or increased amount of bicarbonate. It can also be caused by breathing quickly or deeply. Alkalosis is a very common condition in hospitalized and ill patients.

    What are the symptoms?

    The symptoms depend on the underlying disease that led to the alkalosis. Patients may experience:

    How is it diagnosed?

    The doctor will ask questions about the patient's health, perform a physical exam, and order blood tests.

    How is it treated?

    The treatment depends on the cause of the alkalosis as underlying diseases should be managed. Also, patients will be treated with fluids, electrolytes, and the appropriate medications.

    Other symptoms

    No Muscle Weakness
    • Muscle weakness and neuromuscular irritability may occur especially in Gitelman's syndrome.[patient.info]
    • Symptoms of Diabetic Metabolic Alkalosis Symptoms of diabetic metabolic alkalosis include: light-headedness and dizziness; nausea and vomiting; mental confusion; numbness or tingling in the face and extremities; muscle weakness; myalgia; muscle cramps[battlediabetes.com]
    • .  Aggravation of arrhythmia and hypoxemia in COPD may also be seen  Symptoms of hypokalemia like muscle cramps, myalgia and muscle weakness may also be seen  Symptoms of hypocalcemia (eg, jitteriness, perioral tingling, muscle spasms) may be present[slideshare.net]
    Intermediate
    • Compensatory mechanisms for this would include increased dissociation of the carbonic acid buffering intermediate into hydrogen ions , and the related excretion of bicarbonate , [ citation needed ] both of which lower blood pH .[en.wikipedia.org]
    • Many cardiac and pulmonary disorders can manifest with respiratory alkalosis as an early or intermediate finding.[emedicine.medscape.com]
    Electrolytes Abnormal
    • "Neurologic presentations of acid-base imbalance, electrolyte abnormalities, and endocrine emergencies".[en.wikipedia.org]
    • The electrolyte abnormalities resemble those caused by thiazide diuretics.[emedicine.medscape.com]
    Severe Metabolic Acidosis
    • Severe metabolic acidosis was found (pH 6.940 0.178 vs 7.403 0.012) with reduced [HCO 3 ] (4.1 3.3 vs 24.2 1.7 mmol/l) due to increased [XA ] (34 5 vs 9 3 mmol/l).[link.springer.com]
    • metabolic acidosis. [ 5 ] Prognosis The prognosis of respiratory alkalosis is variable and depends on the underlying cause and the severity of the underlying illness.[emedicine.medscape.com]

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    References

    1. Rimmer JM, Gennari FJ. Metabolic alkalosis. Journal of Intensive Care Medicine. 1987;2:137–50.
    2. Foster GT, Vaziri ND, Sassoon CS. Respiratory alkalosis. Respiratory Care. 2001;46(4):384-91.
    3. DuBose TD, Jr. Acidosis and Alkalosis. Kasper DL, Braunwald E, Fauci AS, et al ,eds. Harrison's Principles of Internal Medicine. 16th. New York, NY: McGraw-Hill; 2005. 270-1.
    4. Park JJ, Choi DJ, Yoon CH, et al. The prognostic value of arterial blood gas analysis in high-risk acute heart failure patients: an analysis of the Korean Heart Failure (KorHF) registry. European Journal of Heart Failure. 2015; 17 (6):601-11.
    5. Anderson LE, Henrich WL. Alkalemia-associated morbidity and mortality in medical and surgical patients. Southern Medical Journal. 1987; 80(6):729-733.
    6. Wilson RF, Gibson D, Pereinal MA, et al. Severe alkalosis in critically ill surgical patients. Archives of Surgery. 1972; 105 (2):197-203.
    7. Phillipson EA, Duffin J. Hypoventilation and Hyperventilation Syndromes. Mason RJ, Broaddus VC, Murray JF, Nadel JA, eds. Murray and Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2005. Vol 2: 2069-70, 2080-84.
    8. Effros RM, Wesson JA. Acid-Base Balance. Mason RJ, Broaddus VC, Murray JF, Nadel JA, eds. Murray and Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2005. Vol 1: 192-93.
    9. Gennari FJ. Pathophysiology of metabolic alkalosis: a new classification based on the centrality of stimulated collecting duct ion transport. American Journal of Kidney Diseases. 2011. 58(4):626-36.
    10. Renaud CJ, Ng WP. Conventional bicarbonate haemodialysis in postgastrectomy metabolic alkalosis. Singapore Medical Journal. 2008;49(5):e121–2.

    • Fatal hypokalaemic alkalosis with tetany during liquorice and PAS therapy - NJ Roussak - British Medical Journal, 1952 - bmj.com
    • Age, gender, and vasopressin affect survival and brain adaptation in rats with metabolic encephalopathy - AI Arieff, E Kozniewska, TP Roberts - American Journal of , 1995 - Am Physiological Soc
    • Endocrine myopathies. - RL Ruff, J Weissmann - Neurologic clinics, 1988 - ukpmc.ac.uk
    • 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care - AD CPR - 2005 - worddocx.com
    • Chest Pain - K Knuti, SJ Hambidge - Berman's Pediatric Decision Making, 2011 - books.google.com
    • EcG in non cardiac Disorders - S Ambar - MeDicine, 2005 - apiindia.org
    • Exercise induced muscle cramp - S Bentley - Sports Med, 1996 - pdfs.journals.adisonline.com
    • [Arterial blood gas abnormalities during attacks of dizziness] - C Kalkişim, MD Ozkul, I Cukurova - Kulak burun bogaz , 2007 - ukpmc.ac.uk
    • Depressive state and paresthesia dramatically improved by intravenous MgSO4 in Gitelman's syndrome - M Enya, Y Kanoh, T Mune, M Ishizawa, H Sarui - Internal medicine, 2004 - J-STAGE
    • ATP utilization and provision in fast-twitch skeletal muscle during tetanic contractions - LL Spriet - American Journal of Physiology-Endocrinology , 1989 - Am Physiological Soc
    • A new syndrome: angiotensin-converting enzyme dysfunction syndrome: differential diagnosis and pathogenesis—case reports - S Umeki, A Terao, T Sawayama - Angiology, 1988 - ang.sagepub.com
    • A case of Bartter's syndrome associated with nephrocalcinosis presenting with tetany - B Ataş, H Çaksen, O Tuncer, E Kırımi, Ş Arslan - Journal of Pediatric , 2004 - IOS Press
    • A Case of Nephrotic Syndrome with Gitelman's Syndrome - DB Pandey, SJ Pednekar, SA Chavan, D Korivi - JAPI, 2010 - japi.org
    • . Acid-Base Disorders - JL Zimmerman - American College of Chest Physicians, editors. , 2004 - 173.193.11.217

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