Alkalosis

alkalosis

1. ALKALOSIS
•BY: Syed Hassnain Shah
•TO: Mam Katerina

2. Alkalosisis the result of a process
reducinghydrogen
ionconcentration ofarterialblood
plasma(alkalemia).
In contrast toacidemia(serum pH
7.35 or lower)
alkalemia occurs when the serum
pH is higher than normal (7.45 or
higher).

3. TYPES OF ALLALOSIS
Respiratory alkalosis
Metabolic alkalosis

4. RESPIRATORY ALKALOSIS
Respiratory alkalosisis a medical condition
in which increased respiration elevates the
bloodpHbeyond the normal range (7.35–
7.45) with a concurrent reduction in arterial
levels ofcarbon dioxide.
This condition is one of the four basic
categories of disruption ofacid–base
homeostasis.

5. Signs and symptoms
Signs and symptoms of respiratory
alkalosis are as follows:
[4]
Palpitation
Tetany
Convulsion
Sweating

6. CAUSES
Respiratory alkalosis may be produced as a result of
the following causes:
Stress
Pulmonarydisorder
Thermal insult
High altitudeareas
Salicylate poisoning(aspirin overdose)
Fever
Hyperventilation(due to heart disorder or other,
including improper mechanical ventilation)
Vocal cord paralysis (compensation for loss of vocal
volume results in over-breathing/breathlessness).
Liver disease

7. MECHANISM
The mechanism of respiratory alkalosis generally occurs
when some stimulus makes a person hyperventilate.
The increased breathing produces
increasedalveolarrespiration.
ExpellingCO
2from the circulation. This alters the
dynamicchemical equilibriumof carbon dioxide in the
circulatory system.
Circulating hydrogen ions and bicarbonate are shifted
through thecarbonic acid(H
2CO
3) intermediate to make
more CO
2
This causes decreased circulating hydrogen ion
concentration, and increasedpH(alkalosis).

8. 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 acidosismay
occur.
[2]
If the individual is on amechanical
ventilatorthen preventing hyperventilation is
done via monitoring ABG levels.

9. METABOLIC ALKALOSIS
Metabolicalkalosisis ametaboliccondition in which
thepHof tissue is elevated beyond the normal range
(7.35–7.45). This is the result of decreasedhydrogen
ionconcentration, leading to increasedbicarbonate, or
alternatively a direct result of
increasedbicarbonateconcentrations. The condition
typically cannot last long if the kidneys are functioning
properly.

10. SIGNS AND SYMPTOMS
Mild cases of metabolic alkalosis often causes no
symptoms. Typical manifestations of moderate to
severe metabolic alkalosis includeabnormal
sensations, neuromuscular
irritability,tetany,abnormal heart rhythms(usually
due to accompanyingelectrolyteabnormalities
such aslow levels of potassium in the
blood),coma,seizures, andtemporary waxing and
waning confusion.

11. COMPENSATIONS
There are two types of compensations :
Lung compensation
Renal compensation

12. LUNG COMPENSATION
Compensation for metabolic alkalosis occurs
mainly in the lungs, which retaincarbon
dioxide(CO
2) through slower breathing,
orhypoventilation(respiratory
compensation). CO
2is then consumed
toward the formation of thecarbonic
acidintermediate, thus decreasing pH.

13. RENAL COMPENSATION
Renal compensationfor metabolic alkalosis,
less effective than respiratory
compensation, consists of increased
excretion of HCO3−(bicarbonate), as the
filtered load of HCO3−exceeds the ability of
the renal tubule to reabsorb it.

14. TREATMENT
To effectively treat metabolic alkalosis, the
underlying cause(s) must be corrected. A
trial of intravenous chloride-rich fluid is
warranted if there is a high index of
suspicion for chloride-responsive metabolic
alkalosis caused by loss of gastrointestinal
fluid (e.g., due to vomiting).