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Alkalosis is a condition of excess base (alkali) in the body fluids.

This is the opposite of excess acid ( acidosis ), and can be caused by many different conditions.

Causes, incidence, and risk factors:

The lungs and kidneys regulate the acid/base status of the body. Decreased carbon dioxide or increased bicarbonate levels create an excessive alkaline state called alkalosis. Respiratory alkalosis is caused by lower carbon dioxide levels. Hyperventilation (increased rate of breathing) causes the body to lose carbon dioxide. Altitude or a disease that causes reduced oxygen in the blood triggers the individual to breathe faster. This reduces carbon dioxide levels which results in respiratory alkalosis. Metabolic alkalosis is caused by an excess of bicarbonate in blood. Hypochloremic alkalosis is caused by an extreme lack or loss of chloride, such as may be caused by prolonged vomiting. The kidneys compensate for the chloride loss by conserving bicarbonate. Hypokalemic alkalosis is caused by the kidneys' reaction to an extreme lack or loss of potassium which may be caused by some diuretic medications. Compensated alkalosis is caused when the body has partially compensated for alkalosis, returning the acid/base balance to normal, even though bicarbonate and carbon dioxide levels remain abnormal.


Confusion (can progress to stupor or coma) Muscle twitching Hand tremor Prolonged muscle spasms (tetany) Nausea, vomiting Numbness or tingling in the face or extremities Light-headedness

Signs and tests:

Tests for pH indicate alkalosis or acidosis. Tests for carbon dioxide and bicarbonate levels indicate the cause of alkalosis or acidosis, either respiratory (breathing-related) or metabolic (kidney-related).

Some of these tests include:

Arterial blood gas (or venous blood gas) Urinalysis Litmus paper (urine dipstick tests) Urine pH Chem-20

Treatment of alkalosis depends on finding the specific cause. For alkalosis caused by hyperventilation, breathing into a paper bag causes more carbon dioxide to be retained. Oxygen may be administered. Medications to correct chemical loss (chloride, potassium, etc.) may be needed. Vital signs (temperature, pulse, rate of breathing, blood pressure) are monitored.

Expectations (prognosis):
Most cases of alkalosis respond well to treatment.


Coma Arrhythmias Electrolyte imbalance (such as hypokalemia )

Calling your health care provider:

Call your health care provider if a person becomes confused, is unable to concentrate, or if the person is unable to "catch their breath". Go to the emergency room or call the local emergency number (such as 911) if a person passes out (loses consciousness), experiences severe breathing difficulties, has seizures , or if symptoms of alkalosis occur and rapidly worsen.

The prevention depends on the cause of the alkalosis. Normally, individuals with healthy kidneys and lungs do not significantly experience alkalosis.

Acidosis is a condition caused by removal of bicarbonate or an increase in carbonic acid in blood. The net result is a disturbance in the carbonic acid-bicarbonate equilibrium to produce an excess [H+] in blood causing lower blood pH. Metabolic acidosis can occur as a result of diabetes, starvation and high fat diet all of which leads to the production of ketones in the blood. Ketones bind & remove bicarbonate. If not controlled it can be fatal [see ketoacidosis reading folder].

and diabetes in the further

Alkalosis occurs when [bicarbonate] increases forcing the equilibrium to remove protons from blood causing blood pH to rise. So pH becomes alkaline leading to vomiting, nausea, headache.

Temporary metabolic alkalosis occurs when there is an intake of sodium bicarbonate e.g. if large amounts are taken for acid in the stomach. Respiratory alkalosis can be induced by hyperventilation i.e. excessive exhalation of carbon dioxide from lungs too quickly causing too great a loss of H+ from the large reservoir. Anything that causes sustained rapid breathing can induce temporary alkalosis, e.g. hysteria (pop concert), hot baths, training. Athletes such as marathon runners learn to control breathing so as to minimise alkalosis. Sprinters and swimmers who understand biochemistry tune their bodies for maximum effort. Strenuous bursts of muscle activity produce high levels of lactic acid as glucose is broken down for energy. Lactic acid can lower the pH of blood and cause muscle cramp/fatigue. To counteract this, athletes will prepare by rapid deep breathing for 30-40 seconds before the race to hyperventilate and introduce temporary alkaline conditions that will help to neutralise the acidity arising from lactic acid.
Definition Metabolic alkalosis is a pH imbalance in which the body has accumulated too much of an alkaline substance, such as bicarbonate, and does not have enough acid to effectively neutralize the effects of the alkali. Description Metabolic alkalosis, as a disturbance of the body's acid/base balance, can be a mild condition, brought on by vomiting, the use of steroids or diuretic drugs, or the overuse of antacids or laxatives. Metabolic alkalosis can also indicate a more serious problem with a major organ such as the kidneys. Causes and symptoms Metabolic alkalosis occurs when the body has more base than acid in the system. Chemists use the term "pH" to decribe how acidic or alkaline (also called basic) a substance is. Based on a scale of 14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the number, the stronger the acid. A pH above 7.0 is alkaline; the higher the number, the stronger the alkali. Blood pH is slightly alkaline, with a normal range of 7.36-7.44. Conditions that lead to a reduced amount of fluid in the body, like vomiting or excessive urination due to use of diuretic drugs, change the balance of fluids and salts. The blood levels of potassium and sodium can decrease dramatically, causing symptoms of metabolic alkalosis. In cases of metabolic alkalosis, slowed breathing may be an initial symptom. The patient may have episodes of apnea (not breathing) that may go on 15 seconds or longer. Cyanosis, a bluish or purplish discoloration of the skin, may also develop as a sign of inadequate oxygen intake. Nausea, vomiting, and diarrhea may also occur. Other symptoms can include irritability, twitching, confusion, and picking at bedclothes. Rapid heart rate, irregular heart beats, and a drop in blood pressure are also symptoms. Severe cases can lead to convulsions and coma.

Diagnosis Metabolic alkalosis may be suspected based on symptoms, but often may not be noticeable. The condition is usually confirmed by laboratory tests on blood and urine samples. Blood pH above 7.45 confirms the condition. Levels of other blood components, including salts like potassium, sodium, and chloride, fall below normal ranges. The level of bicarbonate in the blood will be high, usually greater than 29 mEq/L. Urine pH may rise to about 7.0 in metabolic alkalosis. Treatment Treatment focuses first on correcting the imbalance. An intravenous line may be started to administer fluids (generally normal saline, a salt water solution) and allow for the quick injection of other drugs that may be needed. Potassium chloride will be administered. Drugs to regulate blood pressure or heart rate, or to control nausea and vomiting might be given. Vital signs like pulse, respiration, blood pressure, and body temperature will be monitored. The underlying cause of the metabolic alkalosis must also be diagnosed and corrected. Prognosis If metabolic alkalosis is recognized and treated promptly, the patient may have no long-term complications; however, the underlying condition that caused the alkalosis needs to be corrected or managed. Severe metabolic alkalosis that is left untreated will lead to convulsions, heart failure, and coma. Prevention Patients receiving tube feedings or intravenous feedings must be monitored to prevent an imbalance of fluids and salts, particularly potassium, sodium, and chloride. Overuse of some drugs, including diuretics, laxatives, and antacids, should be avoided. Key Terms pH A measurement of the acidity or alkalinity of a solution based on the amount of hydrogen ions available. Based on a scale of 14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the number, the stronger the acid. A pH above 7.0 is a base; the higher the number, the stronger the base. Blood pH is slightly alkaline (basic) with a normal range of 7.36-7.44. What are they? Acidosis and alkalosis are terms used to describe the abnormal conditions when a patients blood pH does not fall within the healthy range. Measuring the pH of blood is a way of determining how acidic or basic the blood is. Normal blood pH must be maintained within a narrow range of 7.35-7.45 to ensure the proper functioning of metabolic processes and the delivery of the right amount of oxygen to tissues. Many diseases or situations can cause a patients blood pH to fall outside of these limits. In the human body, normal metabolism generates large quantities of acids that must be eliminated to maintain a normal pH balance. Disruption of this balance can be caused by a buildup of acid or base or by an increased loss of acid or base (see Figure 1, below). Acidosis

occurs when blood pH falls below 7.35. Alkalosis occurs when blood pH rises above 7.45. Both of these conditions act as an alarm to the body; they trigger actions intended to restore the balance and to return the blood pH to its normal range. The major organs involved in regulating blood pH are the lungs and the kidneys. The lungs flush acid out of the body by exhaling CO2 (carbon dioxide). Within physical limits, the body can raise and lower the rate of breathing to alter the amount of CO2 that is breathed out. This can affect blood pH within seconds to minutes. The kidneys excrete some acids in the urine and the kidneys also produce and regulate the retention of HCO3- (bicarbonate), a base that increases the bloods pH. Changes in HCO3- concentration occur more slowly than changes in CO2, taking hours or days. Often, both of these processes proceed at the same time, continuing until the balance is restored or until the bodys ability to compensate is exhausted or overwhelmed. Diseases affecting either the lungs or the kidneys as well as other metabolic conditions can interfere with the regulation of blood pH.

Figure 1: Faucets and Drains

The bloods pH must remain between 7.35 and 7.45. The bodys goal is a constant balance between incoming/produced acids and bases (faucet on) and eliminated acids and bases (drain open). Imbalances lead to acidosis (acid sink overflow) or alkalosis (base sink overflow). Balance can be restored by increasing elimination (faster draining) and/or by decreasing flow (slowing down drippy faucet).

Acidosis or alkalosis can be an acute condition (develops quickly) or it may be a chronic condition. Acidosis may not cause any symptoms or it may be associated with nonspecific symptoms such as fatigue, nausea, and vomiting. Acute acidosis may also cause an increased rate and depth of breathing, confusion, and headaches, and it can lead to seizures, coma, and in some cases death. Symptoms of alkalosis are often due to associated potassium (K+) loss and may include irritability, weakness, and cramping. Acid-base disorders are divided into two broad categories. Those that affect respiration and cause changes in CO2 concentration are called respiratory acidosis (low pH) or respiratory alkalosis (high pH). Respiratory acid-base disorders are commonly due to lung diseases or

conditions that affect normal breathing. Disorders that affect HCO3- concentration are called metabolic acidosis (low pH) and metabolic alkalosis (high pH). Metabolic acid-base disorders may be due to kidney disease and a variety of other conditions. There are known genetic abnormalities that result in the impairment of normal metabolic pathways and so can cause acid-base imbalance, usually acidosis. These are called inborn errors of metabolism (or genetic-metabolic disorders) and the acid-base effect is due to deficiencies or buildups of different compounds, many of which are acidic in nature. Other disorders that can cause metabolic (non-respiratory) acid-base disorders include diabetes (diabetic ketoacidosis), severe vomiting and severe diarrhea. Common causes of acid-bases disorders Respiratory acidosis Reduced CO2 elimination Decreased respiratory drive (due to drugs or to central nervous system disorders) Hypoventilation Lung disease Respiratory muscle/nerve disease (myasthenia gravis, botulism, amyotrophic lateral sclerosis, Guillain-Barre syndrome) Respiratory alkalosis Increased CO2 elimination Hyperventilation (due to anxiety, pain, shock) Severe infection or fever Liver failure Pneumonia, pulmonary congestion or embolism Metabolic acidosis Decreased HCO3-, due to loss or to increased acid Alcoholic ketoacidosis Diabetic ketoacidosis Kidney failure Lactic acidosis Toxins overdose of salicylates (aspirin), methanol, ethylene glycol, toluene Gastrointestinal bicarbonate loss, such as from prolonged diarrhea Metabolic alkalosis Increased HCO3-, due to gain, or to loss of acid Diuretics Prolonged vomiting Severe dehydration Tests The goals of testing are to identify whether a patient has an acid-base disorder, to determine how severe the disorder is, and, to help diagnose underlying diseases or conditions (such as diabetic ketoacidosis or the ingestion of a toxin) that have caused the acid-base disorder. Testing is also done to monitor critically ill patients, as well as patients with conditions known to affect acid-base balance, such as chronic lung disease and kidney disease. The

primary tests used to identify, evaluate, and monitor acid-base disorders are blood gases and electrolytes. Blood gases are a group of tests performed together on an arterial blood sample (blood obtained from an artery instead of a vein). They are a snapshot of the bloods pH, PO2 (the amount of oxygen dissolved in the blood), and PCO2 (the amount of carbon dioxide dissolved in the blood). From these results HCO3- (the amount of bicarbonate) can be calculated. Results seen: Acid-Base H+ pH HCO3- PCO2 Body Compensation Disorder Metabolic acidosis Increased breathing rate (hyperventilation) to increase CO2 elimination Metabolic alkalosis Slowed breathing (hypoventilation) to decrease CO2 elimination Respiratory Kidney increases production of acidosis HCO3- and excretion of H+ (acid) Respiratory Decreased production of HCO3- and alkalosis excretion of H+ Electrolytes refers to a group of four tests: Na+ (sodium), K+ (potassium), Cl- (chloride) and bicarbonate (total CO2 content). An anion gap can be calculated from the electrolytes and provides a clue to the cause of the acid/base imbalance. Depending on the suspected cause, a number of other tests may be ordered: CMP (comprehensive metabolic panel), ketones in blood and urine, lactate, salicylates, ethylene glycol, and methanol, to name a few. Treatment Most acid-base disorders do not require treatment of the abnormal pH. The goal is to identify what has caused the acid-base disorder and, when necessary, treat this underlying cause. However, doctors may give intravenous HCO3- to patients with dangerously low blood pH levels.

Alkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma (alkalemia). Generally alkalosis is said to occur when pH of the blood exceeds 7.45. The opposite condition is acidosis. More specifically, alkalosis can refer to:

Respiratory alkalosis Metabolic alkalosis

The main cause of respiratory alkalosis is hyperventilation, resulting in a loss of carbon dioxide. Compensatory mechanisms for this would include increased dissociation of the carbonic acid buffering intermediate into hydrogen ions, and the related consumption of bicarbonate, both of which would raise blood pH. Metabolic alkalosis can be caused by prolonged vomiting, resulting in a loss of hydrochloric acid with the stomach content. Severe dehydration, and the consumption of alkali are other causes. Compensatory mechanism for metabolic alkalosis involve slowed breathing by the lungs to increase serum carbon dioxide, a condition leaning toward respiratory acidosis. As respiratory acidosis often accompanies the compensation for metabolic alkalosis, and visa versa, a delicate balance is created between these two conditions.

pH parturition
pH parturition is the tendency for acids to accumulate in basic fluid compartments, and bases to accumulate in acidic compartments. The reason is that acids become negatively electric charged in basic fluids, since they donate a proton. On the other hand, bases become positively electric charged in acid fluids, since they receive a proton. Since electric charge decrease the membrane permeability of substances, once an acid enters a basic fluid and becomes electrically charged, then it cannot escape that compartment with ease and therefore accumulates, and vice versa with bases. Acid-base homeostasis is the part of human homeostasis concerning the proper balance between acids and bases, in other words the pH. The body is very sensitive to its pH level. Outside the range of pH that is compatible with life, proteins are denatured and digested, enzymes lose their ability to function, and the body is unable to sustain itself.


1 Mechanism o 1.1 Buffering agents 2 Imbalance o 2.1 Causes o 2.2 Response 3 See also 4 External links

[edit] Mechanism
The kidneys maintain acid-base homeostasis by regulating the pH of the blood plasma. Gains and losses of acid and base must be balanced. The study of the acid-base reactions in the body is acid base physiology.

[edit] Buffering agents

Any substance that can reversibly bind hydrogen ions is called a buffering agent. They function to impede any change in pH. Hydrogen ions are buffered by extracellular (e.g., bicarbonate, ammonia) and intracellular buffering agents (including proteins and phosphate).

[edit] Imbalance
Imbalance has several possible causes. An excess of acid is called acidosis and an excess in bases is called alkalosis. Acidosis is much more common than alkalosis. The imbalance is compensated by negative feedback to restore normal values. There are various renal responses to acidosis and alkalosis.

[edit] Causes
Sources of acid gain: 1. Carbon dioxide (since CO2 and H2O form HCO3-, bicarbonate, and H+, a proton, in the presence of carbonic anhydrase) 2. Production of nonvolatile acids from the metabolism of proteins and other organic molecules 3. Loss of bicarbonate in faeces or urine 4. Intake of acids or acid precursors Sources of acid loss: 1. Use of hydrogen ions in the metabolism of various organic anions 2. Loss of acid in the vomitus or urine

[edit] Response

Responses to acidosis: 1. Bicarbonate is added to the blood plasma by tubular cells. o Tubular cells reabsorb more bicarbonate from the tubular fluid. o Collecting duct cells secrete more hydrogen and generate more bicarbonate. 2. Ammoniagenesis leads to increased buffer formation (in the form of NH3) Responses to alkalosis: 1. Excretion of bicarbonate in urine. o This is caused by lowered rate of hydrogen ion secretion from the tubular epithelial cells. o This is also caused by lowered rates of glutamine metabolism and ammonia excretion.

[edit] See also

Acid-base physiology Acidosis Alkalosis Mixed disorder of acid-base balance Renal physiology

In a mixed disorder of acid-base balance more than one of the following four primary acid base disorders is occurring in the patient at the same time: condition metabolic acidosis respiratory acidosis metabolic alkalosis respiratory alkalosis pH carbon dioxide compensation down down respiratory down up renal up up respiratory up down renal

(Exception: A person cannot have both a respiratory acidosis and a respiratory alkalosis at the same time.) In contrast, with a simple acid base disorder, there is only one of the four primary acid base disorders present. The patient can have an acidosis and alkosis at the same time that partially counteract each other, or there can be two different conditions effecting the pH in the same direction. The phrase "mixed acidosis", for example, refers to metabolic acidosis in conjunction with respiratory acidosis. There is actually an easy way to identify if the Acid-Base balance disorder is Metabolic or Respiratory in origin.

If the pH and Carbon dioxide levels are either both increased or decreased, then it is Metabolic.

If the pH level is opposite to that of the Carbon dioxide level or vice versa, then it is Respiratory.

Determining if it is acidosis or alkalosis depends upon the pH of the blood which is normally regulated between pH 7.35 and 7.45.

If pH is above 7.45, then an alkalemia is present - this indicates the presence of an alkalosis. If pH is below 7.35, then an acidemia is present - this indicates the presence of an acidosis. For acidosis referring to acidity of the urine, see renal tubular acidosis.

Acidosis is an increased acidity (i.e. an increased hydrogen ion concentration). If not further qualified, it refers to acidity of the blood plasma. Acidosis is said to occur when arterial pH falls below 7.35, while its counterpart (alkalosis) occurs at a pH over 7.45. Arterial blood gas analysis and other tests are required to separate the main causes. The term acidemia describes the state of low blood pH, while acidosis is used to describe the processes leading to these states. Nevertheless, physicians sometimes use the terms interchangeably. The distinction may be relevant where a patient has factors causing both acidosis and alkalosis, where the relative severity of both determines whether the result is a high or a low pH. The rate of cellular metabolic activity affects and, at the same time, is affected by the pH of the body fluids. In mammals, the normal pH of arterial blood lies between 7.35 and 7.50 depending on the species (e.g. healthy human-arterial blood pH varies between 7.35 and 7.45). Blood pH values compatible with life in mammals are limited to a pH range between 6.8 and 7.8. Changes in the pH of arterial blood (and therefore the extracellular fluid) outside this range result in irreversible cell damage (Needham, 2004).


1 Respiratory acidosis 2 Metabolic acidosis 3 See also 4 References 5 External links

[edit] Respiratory acidosis

Respiratory acidosis results from a build-up of carbon dioxide in the blood (hypercapnia) due to hypoventilation. It is most often caused by pulmonary problems, although head injuries, drugs (especially anaesthetics and sedatives), and brain tumors can also bring it on. Pneumothorax, emphysema, chronic bronchitis, asthma, severe pneumonia, and aspiration are

among the most frequent causes. It can also occur as a compensatory response to chronic metabolic alkalosis. One key to distinguish between respiratory and metabolic acidosis is that in respiratory acidosis, the CO2 is increased while the bicarbonate is either normal (uncompensated) or increased (compensated). Compensation occurs if respiratory acidosis is present, and a chronic phase is entered with partial buffering of the acidosis through renal bicarbonate retention. However, in cases where chronic illnesses which compromise pulmonary function persist, such as late-stage emphysema and certain types of muscular dystrophy, compensatory mechanisms will be unable to reverse this acidotic condition. As metabolic bicarbonate production becomes exhausted, and extraeneous bicarbonate infusion can no longer reverse the extreme buildup of carbon dioxide associated with uncompensated respiratory acidosis, mechanical ventilation will usually be applied.[1][2]

[edit] Metabolic acidosis

Metabolic acidosis is an increased production of metabolic acids, usually resulting from disturbances in the ability to excrete acid via the kidneys. Renal acidosis is associated with an accumulation of urea and creatinine as well as metabolic acid residues of protein catabolism. An increase in the production of other acids may also produce metabolic acidosis. For example, lactic acidosis may occur from 1) severe (PaO2 <36mm Hg) hypoxemia causing a fall in the rate of oxygen diffusion from arterial blood to tissues, or 2) hypoperfusion (e.g. hypovolemic shock) causing an inadequate blood delivery of oxygen to tissues. A rise in lactate out of proportion to the level of pyruvate, e.g. in mixed venous blood, is termed "excess lactate", and may also be an indicator of fermention due to anaerobic metabolism occurring in muscle cells, as seen during strenuous exercise. Once oxygenation is restored, the acidosis clears quickly. Another example of increased production of acids occurs in starvation and diabetic acidosis. It is due to the accumulation of ketoacids (ketosis) and reflects a severe shift from glycolysis to lipolysis for energy needs. Acid consumption from poisoning, elevated levels of iron in the blood, and chronically decreased production of bicarbonate may also produce metabolic acidosis. Metabolic acidosis is compensated for in the lungs, as increased exhalation of carbon dioxide promptly shifts the buffering equation to reduce metabolic acid. This is a result of stimulation to chemoreceptors which increases alveolar ventilation, leading to respiratory compensation, otherwise known as Kussmaul breathing (a specific type of hyperventilation). Should this situation persist the patient is at risk for exhaustion leading to respiratory failure. Mutations to the V-ATPase 'a4' or 'B1' isoforms result in distal renal tubular acidosis, a condition that leads to metabolic acidosis, in some cases with sensorineural deafness. Arterial blood gasses will indicate low pH, low blood HCO3, and normal or low PaCO2. In addition to arterial blood gas, an anion gap can also differentiate between possible causes. The Henderson-Hasselbalch equation is useful for calculating blood pH, because blood is a buffer solution. The amount of metabolic acid accumulating can also be quantitated by using

buffer base deviation, a derivative estimate of the metabolic as opposed to the respiratory component. In hypovolemic shock for example, approximately 50% of the metabolic acid accumulation is lactic acid, which disappears as blood flow and oxygen debt are corrected. Treatment of uncompensated metabolic acidosis is focused upon correcting the underlying problem. When metabolic acidosis is severe and can no longer be compensated for adequately by the lungs, neutralizing the acidosis with infusions of bicarbonate may be required. Alkalosis is a condition in which the body fluids have excess base (alkali). This is the opposite of excess acid (acidosis). Causes Return to top

The lungs and kidneys regulate the acid/base status of the body. Decreased carbon dioxide (an acid) or increased bicarbonate (a base) levels make the body too alkaline, a condition called alkalosis. Causes of alkalosis:

Respiratory alkalosis is caused by low carbon dioxide levels. Being at a high altitude or having a disease that reduces oxygen in the blood can cause you to breathe faster (hyperventilate), which lowers carbon dioxide levels. Metabolic alkalosis is caused by too much bicarbonate in the blood. Hypochloremic alkalosis is caused by an extreme lack or loss of chloride, which can occur with prolonged vomiting. Hypokalemic alkalosis is caused by the kidneys' response to an extreme lack or loss of potassium, which can occur when people take certain diuretic medications. Compensated alkalosis occurs when the body returns the acid/base balance to normal in cases of alkalosis, but bicarbonate and carbon dioxide levels remain abnormal. Return to top


Confusion (can progress to stupor or coma) Hand tremor Light-headedness Muscle twitching Nausea, vomiting Numbness or tingling in the face or extremities Prolonged muscle spasms (tetany) Return to top

Exams and Tests

Tests of pH can show whether you have alkalosis or acidosis. Carbon dioxide and bicarbonate tests indicate whether the cause of alkalosis or acidosis is respiratory (breathing-related) or metabolic (kidney-related). Tests for alkalosis include:

Arterial blood gas (or venous blood gas) Chem-20

Litmus paper (urine dipstick tests) Urinalysis Urine pH Return to top


Treatment of alkalosis depends on finding the specific cause. For alkalosis caused by hyperventilation, breathing into a paper bag causes you to retain more carbon dioxide. You may receive oxygen. Some people need medications to correct chemical loss (such as chloride and potassium). Your health care provider will monitor your vital signs (temperature, pulse, rate of breathing, blood pressure). Outlook (Prognosis) Return to top

Most cases of alkalosis respond well to treatment. Possible Complications

Return to top

Arrhythmias Coma Electrolyte imbalance (such as hypokalemia) Return to top

When to Contact a Medical Professional

Call your health care provider if you become confused, unable to concentrate, or unable to "catch your breath." A visit to the emergency room or call to the local emergency number (such as 911) is warranted for:

Loss of consciousness Rapidly worsening symptoms of alkalosis Seizures Severe breathing difficulties Return to top


Prevention depends on the cause of the alkalosis. Normally, people with healthy kidneys and lungs do not significantly experience alkalosis. Alkalosis is excessive blood alkalinity caused by an overabundance of bicarbonate in the blood or a loss of acid from the blood (metabolic alkalosis), or by a low level of carbon dioxide in the blood that results from rapid or deep breathing (respiratory alkalosis). Metabolic alkalosis develops when the body loses too much acid or gains too much base. For example, stomach acid is lost during periods of prolonged vomiting or when stomach acids are suctioned with a stomach tube (as is sometimes done in hospitals). In rare cases, metabolic

alkalosis develops in a person who has ingested too much base from substances such as baking soda (bicarbonate of soda). In addition, metabolic alkalosis can develop when excessive loss of sodium or potassium affects the kidneys' ability to control the blood's acidbase balance. For instance, loss of potassium sufficient to cause metabolic alkalosis may result from the use of diuretics or corticosteroids. Respiratory alkalosis develops when rapid, deep breathing (hyperventilation) causes too much carbon dioxide to be expelled from the bloodstream. The most common cause of hyperventilation, and thus respiratory alkalosis, is anxiety. Other causes of hyperventilation and consequent respiratory alkalosis include pain, cirrhosis, low levels of oxygen in the blood, fever, and aspirinSome Trade Names ECOTRIN ASPERGUM overdose (which can also cause metabolic acidosis (see Acid-Base Balance: Acidosis). Symptoms and Diagnosis Alkalosis may cause irritability, muscle twitching, muscle cramps, or no symptoms at all. If the alkalosis is severe, prolonged contraction and spasms of muscles (tetany) can develop. A sample of blood taken from an artery shows that the blood is alkaline. Treatment Doctors usually treat metabolic alkalosis by replacing water and electrolytes (sodium and potassium) while treating the underlying cause. Occasionally, when metabolic alkalosis is very severe, dilute acid in the form of ammonium chloride is given intravenously. With respiratory alkalosis, usually the only treatment needed is slowing down the rate of breathing. When respiratory alkalosis is caused by anxiety, a conscious effort to slow breathing may make the condition disappear. If pain is causing the person to breathe rapidly, relieving the pain usually suffices. Breathing into a paper (not a plastic) bag may help raise the carbon dioxide level in the blood as the person breathes carbon dioxide back in after breathing it out. Acidosis is excessive blood acidity caused by an overabundance of acid in the blood or a loss of bicarbonate from the blood (metabolic acidosis), or by a buildup of carbon dioxide in the blood that results from poor lung function or slow breathing (respiratory acidosis). If an increase in acid overwhelms the body's pH buffering systems, the blood will become acidic. As the blood pH drops, the parts of the brain that regulate breathing are stimulated to produce faster and deeper breathing, which increases the amount of carbon dioxide exhaled. The kidneys also try to compensate by excreting more acid in the urine. However, both mechanisms can be overwhelmed if the body continues to produce too much acid, leading to severe acidosis and eventually coma. Causes

Metabolic acidosis develops when the amount of acid in the body is increased through ingestion of a substance that is, or can be metabolized to, an acidsuch as wood alcohol (methanol), antifreeze (ethylene glycol), or large doses of aspirinSome Trade Names ECOTRIN ASPERGUM (acetylsalicylic acidSome Trade Names See Aspirin ). Metabolic acidosis can also occur as a result of abnormal metabolism. The body produces excess acid in the advanced stages of shock and in poorly controlled type 1 diabetes mellitus. Even the production of normal amounts of acid may lead to acidosis when the kidneys are not functioning normally and are therefore not able to excrete sufficient amounts of acid in the urine. Respiratory acidosis develops when the lungs do not expel carbon dioxide adequately, a problem that can occur in diseases that severely affect the lungs (such as emphysema, chronic bronchitis, severe pneumonia, pulmonary edema, and asthma). Respiratory acidosis can also develop when diseases of the nerves or muscles of the chest impair breathing. In addition, a person can develop respiratory acidosis if overly sedated from opioids (narcotics) and strong sleeping medications that slow respiration.

Major Causes of Metabolic Acidosis and Metabolic Alkalosis Metabolic acidosis o Kidney failure o Renal tubular acidosis (a form of kidney malfunction) o Diabetic ketoacidosis (buildup of ketones) o Lactic acidosis (buildup of lactic acid) o Poisons such as ethylene glycol, methanol, paraldehyde, acetazolamide, ammonia chloride, or aspirin overdose o Loss of bases, such as bicarbonate, through the digestive tract from diarrhea, an ileostomy, or a colostomy Metabolic alkalosis o Use of diuretics (thiazides, furosemide, ethacrynic acid)

Loss of acid from vomiting or drainage of the stomach Overactive adrenal gland (Cushing's syndrome or use of corticosteroids)

Symptoms A person with mild metabolic acidosis may have no symptoms but usually experiences nausea, vomiting, and fatigue. Breathing becomes deeper and slightly faster (as the body tries to correct the acidosis by expelling more carbon dioxide). As the acidosis worsens, the person begins to feel extremely weak and drowsy and may feel confused and increasingly nauseated. Eventually, blood pressure can fall, leading to shock, coma, and death. The first symptoms of respiratory acidosis may be headache and drowsiness. Drowsiness may progress to stupor and coma. Stupor and coma can develop within moments if breathing stops or is severely impaired, or over hours if breathing is less dramatically impaired. Diagnosis The diagnosis of acidosis generally requires the measurement of blood pH in a sample of arterial blood, usually taken from the radial artery in the wrist. Arterial blood is used because venous blood contains high levels of bicarbonate and thus is not an accurate measure of blood pH. To learn more about the cause of the acidosis, doctors also measure the levels of carbon dioxide and bicarbonate in the blood. Additional blood tests may be performed to help determine the cause. Treatment The treatment of metabolic acidosis depends primarily on the cause. For instance, treatment may be needed to control diabetes with insulinSome Trade Names HUMULIN NOVOLIN or to remove the toxic substance from the blood in cases of poisoning. The treatment of respiratory acidosis aims at improving the function of the lungs. Drugs to improve breathing may help people who have lung diseases such as asthma and emphysema. People who have severely impaired lung function, for whatever reason, may need mechanical ventilation to aid breathing (see Respiratory Failure and Acute Respiratory Distress Syndrome: Acute Respiratory Distress Syndrome (ARDS)). Acidosis may also be treated directly. If the acidosis is mild, the administration of intravenous fluids may be all that is needed. When acidosis is severe, bicarbonate may be given intravenously; however, bicarbonate provides only temporary relief and may cause harmfor instance, by overloading the body with sodium and water.

abnormally low level of acidity, or high level of alkalinity, in the body fluids, including the blood. Alkalosis may be either metabolic or respiratory in origin. Metabolic alkalosis results from either acid loss (which may be caused by severe vomiting or by the use of potent diuretics [substances that promote production of urine]) or bicarbonate gain (which may be caused