Respiratory alkalosis resident survival guide
Synonyms and keywords: Approach to respiratory alkalosis, Respiratory alkalosis management, Respiratory alkalosis Workup

# Overview
The normal physiological pH of blood is 7.35 to 7.45. An increase above this range is known as alkalosis. Respiratory alkalosis is a state where the bodys pH is more than 7.45 secondary to some respiratory or pulmonary cause.Respiratory alkalosis is characterized by the presence of low pCO2and high pH (>7.40). Respiratory alkalosis occurs when a person breathes too quickly or too deep and carbon dioxide levels drop too low. This causes the pH of the blood to increase and become too alkaline. It is also known as the primary hypocapnia in which patients usually present with hyperventilation. The resultant alkalinization of body fluids is balanced by a decrease in serum . Secondary hypocapnia should be differentiated from primary hypocapnia, as the former occurs in response to metabolic acidosis. When respiratory alkalosis develops, a decrease in serum  occurs within a few minutes. This is due to non-bicarbonate buffering as well as H+ release from tissues. This buffering from various sources persists for several hours, and the resultant acid-base disturbance is called acute respiratory alkalosis. During acute respiratory alkalosis, the H+ secretion in both proximal tubule and cortical collecting duct is suppressed. When alkalemia persists, renal compensation starts with a decrease in both H+ secretion and basolateral exit of in the proximal tubule. This lowers more serum , due to which the pH is maintained close to normal. The complete renal compensation takes 23 days to occur, and when a new steady state is established, it is called chronic respiratory alkalosis.

# Causes

## Life-Threatening Causes
Life-threatening causes of Respiratory Alkalosis include:
- Sepsis (Cytokine mediated)

## Common Causes
- Central Nervous System related causes:
Increased Intracranial Pressure
Stroke
Head injury
CNS infection
Intracranial hemorrhage
Pontine tumors
Anxiety Hyperventilation
Voluntary Hyperventilation
Sepsis(Cytokine mediated)
Chronic Liver disease(Toxin mediated)
Drugs(Salicylates, progesterone)
Pain
- Increased Intracranial Pressure
- Stroke
- Head injury
- CNS infection
- Intracranial hemorrhage
- Pontine tumors
- Anxiety Hyperventilation
- Voluntary Hyperventilation
- Sepsis(Cytokine mediated)
- Chronic Liver disease(Toxin mediated)
- Drugs(Salicylates, progesterone)
- Pain
- Hypoxemic causes: Hypoxic stimulation leads to hyperventilation.
- Pulmonary Causes:
Pneumonia
Asthma
Pulmonary oedema
Pulmonary thromboembolism
- Pneumonia
- Asthma
- Pulmonary oedema
- Pulmonary thromboembolism
- Extrinsic Causes(deliberate or iatrogenic):
Excessive minute ventilation during mechanical ventilation
- Excessive minute ventilation during mechanical ventilation

# Diagnosis
Shown below is an algorithm summarizing the diagnosis of Respiratory Alkalosis:

# Treatment
- Respiratory alkalosis is not self-limiting.
- Correction of the primary disorder of the respiratory alkalosis is needed
- Shown below is an algorithm summarizing the treatment of Respiratory Alkalosis:

# Dos
- Patient may experience faster and deeper breathing, physician should provide reassurance and empathy which can help to get patient's breathing under control.
- Physicians should look for the underlying cause and its severity.
- A patient who suffers from regular respiratory alkalosis can seek help from a  therapist and can learn breathing exercises, meditation, and regular exercise.

# Don'ts
- Patients should not hesitate to seek help from professionals in case of recurrence of respiratory alkalosis.