" "■ concentration. Respiratory alkalosis represents hyperventila-tion and is remarkably common. The most common etiologies of respiratory alkalosis are listed in Table 28-7 and range from benign (anxiety) to life-threatening (pulmonary embol ism). Some causes of hyperventilation and respiratory acidosis are remarkably common (hypoxemia or anemia).

The symptoms produced by respiratory alkalosis result from increased irritability of the central and peripheral nervous systems. These include light-headedness, altered consciousness, distal extremity paresthesias, circumoral paresthesia, cramps, car-popedal spasms, and syncope. Various supraventricular and ventricular cardiac arrhythmias may occur in extreme cases, particularly in critically ill patients. An additional finding in many patients with severe respiratory alkalosis is hypophosphatemia, reflecting a shift of phosphate from the extracellular space into the cells. Chronic respiratory alkalosis is generally asymptomatic.

Table 28-7 Common Causes of Respiratory Alkalosis

Cen trat ner vous s y s tern disea se Pulmo nar y dlsea se

Infection Trauma Tumor Vascular

■ : : ■ I y- lesti ic tive lung disease Infection Pneumothorax Pulmonary edema Pulmonary embolism

Díuy-or tDJCln-finduoed Catecholamines Doxapram Methylphenidate Methy Xanthines Nicotine Progesterone Salicylates

Tissue hypoxia Burn injury Excessive mechanical ventilation Tevei

Hepatic failure fiypoxemia


Post metabolic acidosis Pregnancy Severe anemia Thyrotoxicosis

Psychiatric disease Anxiety

Hyperventilation Hysteria Panic disorder

'May be observed with therapeutic doses or overdoses.

It is imperative to identify serious causes of respiratory alkalosis and institute effective treatment. In spontaneously breathing patients, respiratory alkalosis is typically only mild or moderate in severity and no specific therapy is indicated. Severe alkalosis generally represents respiratory acidosis imposed on metabolic alkalosis and may improve with sedation. Patients receiving mechanical ventilation are treated with reduced minute ventilation achieved by decreasing the respiratory rate and/or tidal volume. If the alkalosis persists in the ventilated patient, high-level sedation or paralysis is effective.

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