Respiratory Alkalosis

Respiratory alkalosis occurs when low carbon dioxide levels disrupt your blood’s acid-base balance. It often occurs in people who experience rapid, uncontrollable breathing (hyperventilation). Treatment includes supplemental oxygen and therapies to reduce the risk of hyperventilation.


What is alkalosis?

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.


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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.

Symptoms and Causes

Who is at risk for respiratory alkalosis?

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.


Management and Treatment

How is respiratory alkalosis treated?

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.


How can I prevent respiratory alkalosis due to hyperventilation?

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.

Living With

What can I do when I feel like I’m losing control of my breathing?

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.

Medically Reviewed

Last reviewed on 08/09/2021.

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