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.

Symptoms:

• 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:

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.

Support Groups:

Expectations (prognosis):

Most cases of alkalosis respond well to treatment.

Complications:

• 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.

Prevention:

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