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Alkalosis

 

Alkalosis is a condition in which the body fluids have excess base (alkali). This is the opposite of excess acid (acidosis).

The kidneys and lungs maintain the proper balance (proper pH level) of chemicals called acids and bases in the body. Decreased carbon dioxide (an acid) level or increased bicarbonate (a base) level makes the body too alkaline, a condition called alkalosis. There are different types of alkalosis. These are described below.

Respiratory alkalosis is caused by a low carbon dioxide level in the blood. This can be due to:

  • Fever
  • Being at a high altitude
  • Lack of oxygen
  • Liver disease
  • Lung disease, which causes you to breathe faster (hyperventilate)
  • Aspirin poisoning

Metabolic alkalosis is caused by too much bicarbonate in the blood. It can also occur due to certain kidney diseases.

Hypochloremic alkalosis is caused by an extreme lack or loss of chloride, such as from prolonged vomiting.

Hypokalemic alkalosis is caused by the kidneys' response to an extreme lack or loss of potassium. This can occur from taking certain water pills (diuretics).

Compensated alkalosis occurs when the body returns the acid-base balance to normal in cases of alkalosis, but bicarbonate and carbon dioxide levels remain abnormal.

Symptoms

 

Symptoms of alkalosis can include any of the following:

  • Confusion (can progress to stupor or coma)
  • Hand tremor
  • Lightheadedness
  • Muscle twitching
  • Nausea, vomiting
  • Numbness or tingling in the face, hands, or feet
  • Prolonged muscle spasms (tetany)

 

Exams and Tests

 

The doctor will perform a physical exam and ask about your symptoms.

Laboratory tests that may be ordered include:

  • Arterial blood gas analysis
  • Electrolytes test, such as basic metabolic panel to confirm alkalosis and show whether it is respiratory or metabolic alkalosis.

Other tests may be needed to determine the cause of the alkalosis. These may include:

  • Urinalysis
  • Urine pH

 

Treatment

 

To treat alkalosis, your health care provider needs to first find the underlying cause.

For alkalosis caused by hyperventilation, breathing into a paper bag allows you to keep more carbon dioxide in your body, which improves the alkalosis. If your oxygen level is low, you may receive oxygen.

Medicines may be needed to correct chemical loss (such as chloride and potassium). Your provider will monitor your vital signs (temperature, pulse, rate of breathing, blood pressure).

 

Outlook (Prognosis)

 

Most cases of alkalosis respond well to treatment.

 

Possible Complications

 

Untreated or not treated properly, complications may include any of the following:

  • Arrhythmias (heart beating too fast, too slow, or irregularly)
  • Coma
  • Electrolyte imbalance (such as low potassium level)

 

When to Contact a Medical Professional

 

Call your provider if you become confused, unable to concentrate, or unable to "catch your breath."

Go to the emergency room or call the local emergency number (such as 911) if there is:

  • Loss of consciousness
  • Rapidly worsening symptoms of alkalosis
  • Seizures
  • Severe breathing difficulties

 

Prevention

 

Prevention depends on the cause of the alkalosis. People with healthy kidneys and lungs do not usually have serious alkalosis.

 

 

References

Gaw A, Murphy MJ, Srivastava R, Cowan RA, O'Reilly DS. Acid-base disorders. In: Gaw A, Murphy MJ, Srivastava R, Cowan RA, O'Reilly DS, eds. Clinical Biochemistry: An Illustrated Colour Text. 5th ed. Philadelphia: PA: Elsevier; 2013:chap 24.

Strayer RJ. Acid-base disorders. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 124.

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      Review Date: 11/1/2015

      Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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