Definition

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

Causes, incidence, and risk factors

The lungs and kidneys regulate the acid/base status of the body. Decreased carbon dioxide (an acid) or increased bicarbonate (a base) levels make the body too alkaline, a condition called alkalosis.

Causes of alkalosis:

• Respiratory alkalosis is caused by low carbon dioxide levels. Being at a high altitude or having a disease that reduces oxygen in the blood can cause you to breathe faster (hyperventilate), which lowers carbon dioxide levels.
• Metabolic alkalosis is caused by too much bicarbonate in the blood.
• Hypochloremic alkalosis is caused by an extreme lack or loss of chloride, which can occur with prolonged vomiting.
• Hypokalemic alkalosis is caused by the kidneys' response to an extreme lack or loss of potassium, which can occur when people take certain diuretic medications.
• 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

• Confusion (can progress to stupor or coma)
• Hand tremor
• Light-headedness
• Muscle twitching
• Nausea, vomiting
• Numbness or tingling in the face or extremities
• Prolonged muscle spasms (tetany)

Signs and tests

Tests of pH can show whether you have alkalosis or acidosis. Carbon dioxide and bicarbonate tests indicate whether the cause of alkalosis or acidosis is respiratory (breathing-related) or metabolic (kidney-related).

• Arterial blood gas (or venous blood gas)
• Chem-20
• Litmus paper (urine dipstick tests)
• Urinalysis
• Urine pH

Treatment

Treatment of alkalosis depends on finding the specific cause.

For alkalosis caused by hyperventilation, breathing into a paper bag causes you to retain more carbon dioxide. You may receive oxygen.

Some people need medications to correct chemical loss (such as chloride and potassium). Your health care provider will monitor your vital signs (temperature, pulse, rate of breathing, blood pressure).

Support Groups

Expectations (prognosis)

Most cases of alkalosis respond well to treatment.

Complications

• Arrhythmias
• Coma
• Electrolyte imbalance (such as hypokalemia)

Calling your health care provider

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

A visit to the emergency room or call to the local emergency number (such as 911) is warranted for:

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

Prevention

Prevention depends on the cause of the alkalosis. Normally, people with healthy kidneys and lungs do not significantly experience alkalosis.

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