What causes respiratory alkalosis nursing?

Your body is continuously working to maintain the blood’s acid-base (alkali) balance. Alkalosis occurs when there’s too much alkali and not enough acid. Chemical changes in the acid-base balance can reflect changes in metabolism or breathing.

What is respiratory alkalosis?

This condition occurs when your blood doesn’t have enough carbon dioxide (hypocapnia). Your body releases carbon dioxide when you exhale. When you breathe faster, the lower carbon dioxide level in your blood can lead to respiratory alkalosis.

Respiratory alkalosis is usually caused by over-breathing (called hyperventilation) that occurs when you breathe very deeply or rapidly.

Causes of hyperventilation include:

• Anxiety or panic.
• Fever.
• Pregnancy (this is normal).
• Pain.
• Tumor.
• Trauma.
• Severe anemia.
• Liver disease.
• Overdose of certain medicines, such as salicylates or progesterone.
• Any lung disease that leads to shortness of breath can also cause respiratory alkalosis (such as pulmonary embolism and asthma).
• Neurologic conditions such as stroke.

People who experience intense bouts of stress, anxiety, panic or anger are at higher risk for respiratory alkalosis. These conditions can lead to rapid, uncontrolled breathing (hyperventilation).

People on breathing machines (mechanical ventilation) are also at risk. The machines deliver a fixed breath volume for each breath, which can lead to hyperventilation when patients breathe faster. As a critically ill person’s medical needs change, they may need higher or lower levels of breathing assistance. Ongoing monitoring helps healthcare providers determine when to adjust ventilator settings.

What are the symptoms of respiratory alkalosis?

The symptoms can affect any organ system in the body. You may experience:

• Breathlessness.
• Dizziness.
• Numbness and /or tingling in your fingertips, toes and lips.
• Irritability.
• Nausea.
• Muscle spasms or twitching.
• Fatigue.
• Dizziness/lightheadedness.
• Fainting (syncope).
• Chest discomfort.
• Shortness of breath.
• Tremors.
• Confusion.

When should I see a healthcare provider for alkalosis?

Uncontrolled breathing often needs immediate medical care in a hospital. The treatment for respiratory alkalosis depends on the underlying cause and it needs to be determined by a medical professional. If breathing is under control but you have other alkalosis symptoms, it’s important to get a timely evaluation.

If you suffer from hyperventilation caused by panic or anxiety, the symptoms of respiratory alkalosis can be frightening. This often causes faster breathing, making things worse.

Treatment for respiratory alkalosis depends on the underlying cause to reduce hyperventilation. Treating the condition is a matter of raising carbon dioxide levels in the blood.

Learning how to cope with stress, anxiety, panic and anger can help you avoid hyperventilation.

The following treatments may help you cope:

• Therapy.
• Relaxation techniques.
• Lifestyle changes.
• Medications.

You may be able to avoid stress-related respiratory alkalosis by:

• Taking antidepressants for anxiety or medications that reduce the intensity of panic attacks.
• Building a support system of trusted individuals who can help you regain control of rapid breathing before it progresses to hyperventilating.

Steps you can take include:

• Practice breathing techniques, like pushing air in and out through pursed lips.
• Using relaxation methods, including meditation, which calm your body and mind.
• Breathing into a paper bag.

A note from Cleveland Clinic

Respiratory alkalosis occurs when hyperventilation makes it hard for the lungs to get rid of excess carbon dioxide. It can also happen in people who need mechanical ventilation. The condition is not life-threatening. Nor does it have lingering effects on your health. But it’s important to seek medical care for respiratory alkalosis because it’s often a sign of another medical condition. Some people need treatment with supplemental oxygen. Addressing what’s causing you to hyperventilate lowers your risk of future episodes.

Last reviewed by a Cleveland Clinic medical professional on 08/09/2021.

References

• Merk Manual (Consumer Version). Alkalosis. (https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/acid-base-balance/alkalosis) Accessed 9/16/2021.
• National Center for Biotechnology Information (NCBI) Stat Pearls. Alkalosis. (https://www.ncbi.nlm.nih.gov/books/NBK545269/) Accessed 9/16/2021.
• National Center for Biotechnology Information (NCBI) Stat Pearls. Respiratory Alkalosis. (https://www.ncbi.nlm.nih.gov/books/NBK482117/) Accessed 9/16/2021.

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Are you studying respiratory alkalosis and need to know a mnemonic on how to remember the causes?  This article will give you a clever mnemonic and simplify the signs and symptoms and nursing interventions on how to remember respiratory alkalosis for nursing lecture exams and NCLEX.

In addition, you will learn how to differentiate respiratory alkalosis from respiratory acidosis. Don’t forget to take the respiratory acidosis and respiratory alkalosis quiz.

This article will cover:

• Sequence of normal breathing
• Patho of respiratory alkalosis
• Causes of respiratory alkalosis
• Signs and symptoms of respiratory alkalosis
• Nursing interventions for respiratory alkalosis

Lecture on Respiratory Alkalosis

Respiratory Alkalosis

What’s involved:…let’s look at normal breathing:

1. Oxygen enters through the mouth or nose
2. down through the Pharynx
3. into the Larynx (the throat)
4. then into the Trachea
5. and the Bronchus (right and left) which branches into the bronchioles and ends in alveoli sac

*The alveolar sacs are where gas exchange takes place (oxygen and carbon dioxide diffuse across the membrane). The oxygen enters into your blood stream and CARBON DIOXIDE CO2 is exhaled through your nose or mouth.

The diaphragm also plays a role in allowing lungs into inflate and deflate.

Note: if there is any problem with the patient breathing rate (too fast), alveolar sacs (damaged), hyperventilation, or a brain injury that affects the respiratory center a patient is at risk for respiratory alkalosis

*Main cause of respiratory alkalosis is tachypnea (fast respiratory rate >20 bpm which causes CO2 to decrease in the lungs)

When this happens the following lab values are affected:

• Blood pH increases (>7.45)
• Carbon dioxide levels increase (<35)
• **To compensate for this the Kidneys start to excrete bicarbonate (HCO3) to hopefully decrease the blood’s pH back to normal…..so HCO3 becomes <22.

REMEMBER (memorize) these lab values:

• pH 7.35-7.45
• PaCO2 35-45
• HCO3 22-26

Causes of Respiratory Alkalosis

Remember: TACHYPNEA (fast breathing leads to “hyperventilation” which leads to respiratory alkalosis)

Temperature increase (fever) due to increased metabolic needs of the body which causes the respiratory center (medulla and pons) to try to compensate by making the respiratory rate increased…hence exhaling too much carbon dioxide (CO2)

Aspirin toxicity: too much aspirin in the body leads to hyperventilation due to the stimulation of the respiratory center and fever

Controlled ventilation (excessive usage)…mechanical ventilation****hyperventilates the patient with too much oxygen and depletes carbon dioxide

Hyperventilation (excessive respirations) expelling too much carbon dioxide

hYsteria (anxiety) leads to rapid breathing and expelling of carbon dioxide

Pain…rapid breathing (blowing off too much carbon dioxide), Pregnancy (especially in 3rd trimester due to changes of the respiratory tract), Pneumonia

Neurological injuries from a head injury or stroke (affects the respiration system of the brain which is located in the medulla and pons)

Embolism or Edema in the lungs

Asthma due to hyperventilation (however, asthma can cause respiratory acidosis as well due to bronchospasms which is causing the alveoli to not properly deflate)

Signs and Symptoms of Respiratory Alkalosis

• ***Classic Assessment Sign is fast respiratory rate (normal for adult is 12-20) TACHYPNEA (>20 bpm)
• Neuro changes: Tired, lethargy, fast heart rate
• **Tetany, dysrhythmias, muscle cramps, positive Chvostek’s sign due to hypocalcemia and hypokalemia

Nursing Interventions for Respiratory Alkalosis

• Teach patient breathing techniques to slow down breathing, holding breath…”rebreathing into a paper bag or re-breather mask
• Watch potassium levels (hypokalemia..remember hyperkalemia in respiratory acidosis & hypocalcemia) and for signs and symptoms of low calcium and potassium levels.
• **Closely watch patients on mechanical ventilation to ensure breaths are not hyperventilating the patient

Quiz on Respiratory Alkalosis