Alkalosis

Alkalosis – Treatment Options

Introduction
Alkalosis refers to a condition in which the blood pH rises above the normal range (7.35–7.45) due to either excess base (bicarbonate) or loss of acid. It is classified as:

• Respiratory alkalosis: Due to excessive CO₂ loss from hyperventilation (e.g., anxiety, hypoxemia, sepsis).

• Metabolic alkalosis: Due to increased bicarbonate or excessive acid loss (e.g., vomiting, diuretics, mineralocorticoid excess).
  Symptoms may include lightheadedness, confusion, tingling, muscle cramps, arrhythmias, and seizures. Treatment focuses on correcting the underlying cause and restoring acid–base balance.

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1. General Principles

• Identify and treat the underlying cause.

• Monitor arterial blood gases (ABG), electrolytes, and clinical status.

• Provide supportive care (oxygen, fluids, electrolyte correction).

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2. Respiratory Alkalosis

• Causes: Hyperventilation (anxiety, pain, fever, sepsis, hypoxemia, pulmonary embolism).

• Treatment:

  • Reassurance and breathing control (breathing into a paper bag not routinely recommended, but slowing breathing is helpful in anxiety-induced cases).

  • Treat underlying cause: Oxygen for hypoxemia, antibiotics for infection, anticoagulation for pulmonary embolism.

  • Sedation/analgesia may be needed if agitation or pain is driving hyperventilation.

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3. Metabolic Alkalosis

• Causes: Vomiting, nasogastric suction, diuretics, hypokalemia, hyperaldosteronism, excessive bicarbonate intake.

• Treatment:

  • Correct volume depletion (saline-responsive alkalosis):

    • IV normal saline + potassium chloride.

    • Restores intravascular volume and corrects hypochloremia.

  • Potassium and magnesium replacement: Corrects electrolyte imbalances sustaining alkalosis.

  • In resistant cases (saline-resistant alkalosis):

    • Treat underlying cause (e.g., hyperaldosteronism with spironolactone or eplerenone).

    • Acetazolamide (carbonic anhydrase inhibitor) promotes bicarbonate excretion.

    • Dialysis in severe, refractory cases (especially with renal failure).

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4. Severe and Life-Threatening Alkalosis (pH >7.55)

• IV hydrochloric acid infusion (rare, ICU setting) for severe metabolic alkalosis unresponsive to standard measures.

• Hemodialysis in patients with renal failure or persistent alkalosis.

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5. Long-Term Prevention

• Avoid unnecessary diuretic or alkali use.

• Treat chronic vomiting or GI suction causes.

• Manage endocrine disorders (Cushing’s, Conn’s syndrome).

• Regular monitoring in patients at risk (chronic diuretic therapy, COPD with chronic alkalosis).