Respiratory Alkalosis

What is respiratory alkalosis?

Respiratory alkalosis is a condition that happens when your blood doesn’t have enough carbon dioxide in it, making your blood pH (acid-base balance) rise. This can happen if you’re over-breathing (hyperventilating) and releasing too much carbon dioxide from your body.

Your blood pH level rises when you don’t have enough carbon dioxide. PH levels above 7.45 are considered alkalosis.

What’s the difference between respiratory acidosis and alkalosis?

Respiratory alkalosis is when your blood pH is too high. Respiratory acidosis is when your pH is too low (below 7.35).

What are the symptoms of respiratory alkalosis?

Symptoms of respiratory alkalosis include:

• Dizziness.
• Confusion.
• Feeling lightheaded.
• Numbness or tingling (paresthesia).
• Chest tightness.
• Nausea.
• Fatigue.

What causes respiratory alkalosis?

Any condition that causes hyperventilation can lead to respiratory alkalosis. Here’s why: Respiratory alkalosis happens when you don’t breathe in enough carbon dioxide. This leads to low levels of carbon dioxide in your blood, changing your blood’s acid-base balance.

Your blood pH should be between 7.35 and 7.45. This means your blood is slightly basic on a typical pH scale (where neutral pH is 7), but it’s the normal acid-base balance for your body. Your lungs, kidneys and a buffering system (your body’s naturally occurring acids and bases) work to maintain this pH by balancing:

• Carbon dioxide (CO₂).
• Water (H₂O).
• Bicarbonate ions (HCO₃).
• Hydrogen ions (H⁺).

If this balance is off, your blood pH can go up or down. In respiratory alkalosis, your level of HCO₃ is too high compared to your level of carbon dioxide, causing your pH levels to rise.

What conditions cause respiratory alkalosis?

Conditions that affect your respiratory center — the part of your brain that controls your breathing — can cause hyperventilation, which can lead to alkalosis. These include:

• Anxiety or panic attacks.
• Pain.
• Fever.
• Pregnancy.
• Sepsis.
• Liver failure.
• Hyperthyroidism.
• Tumors.
• Excessive use of certain medications, like aspirin and other salicylates.
• Head injury.
• Nicotine use.
• Mechanical ventilation.
• Respiratory conditions. Conditions like acute respiratory distress syndrome (ARDS), pulmonary embolism, pulmonary edema and pneumonia can cause hypoxia, which can lead to hyperventilation and alkalosis.

How is respiratory alkalosis diagnosed?

Healthcare providers can diagnose respiratory alkalosis with an arterial blood gas test (ABG). This measures the levels of oxygen and carbon dioxide in your blood.

Your provider may use other tests to help diagnose the cause of alkalosis. These include:

• Pulse oximetry (pulse ox), which measures the level of oxygen in your blood with a small device on your finger.
• Pulmonary function tests.
• Additional blood tests, like a basic metabolic panel (BMP) or complete blood count (CBC).
• Chest x-rays or CT scans (computed tomography scans).

How is respiratory alkalosis treated?

Providers treat respiratory alkalosis by identifying and treating the underlying condition. For instance, you might need antibiotics to treat an infection or anticoagulants (blood thinners) to treat a blood clot.

If you find yourself hyperventilating, you can try breathing into a paper bag so that you’ll breathe in more carbon dioxide. If you experience anxiety or panic attacks frequently, you may need medications to reduce your risk of respiratory alkalosis from hyperventilation.

Can respiratory alkalosis be prevented?

You can reduce your risk of respiratory alkalosis by:

• Managing underlying conditions like anxiety and stress.
• Not smoking, vaping or using products that contain nicotine.
• Washing your hands, getting vaccinated and taking other steps to protect yourself against infectious diseases.

What can I expect if I have respiratory alkalosis?

Respiratory alkalosis isn’t dangerous on its own. Most causes are treatable, but some — like sepsis and pulmonary embolisms — are very serious. Your outlook (prognosis) depends on what’s causing alkalosis.

When should I see my healthcare provider?

See a healthcare provider if you have symptoms of respiratory alkalosis or find yourself hyperventilating frequently. They can help you manage the cause and reduce your risk of alkalosis.

When should I go to the ER?

Go to an emergency room or call 911 if you experience:

• Seizures.
• Altered mental state.
• Blue skin, lips or nails.
• Severe weakness.
• Loss of consciousness (fainting).

What questions should I ask my doctor?

It might be helpful to ask a healthcare provider:

• What caused this?
• How do I prevent it from happening again?
• What are my treatment options?