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Alkalosis: Causes, Symptoms & Treatment

Alkalosis is a condition in which the pH of the blood rises above the normal range of 7.35 to 7.45. It can be caused by breathing disorders or metabolic changes.

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Things worth knowing about "Alkalosis"

Alkalosis is a condition in which the pH of the blood rises above the normal range of 7.35 to 7.45. It can be caused by breathing disorders or metabolic changes.

What is Alkalosis?

Alkalosis is a medical condition in which the pH level of the blood rises above the normal physiological range of 7.35 to 7.45. The blood pH is regulated by a delicate balance between bicarbonate (HCO₃⁻), carbon dioxide (CO₂), and the body's various buffer systems. When this balance is disrupted, the blood becomes too alkaline. There are two main types: respiratory alkalosis and metabolic alkalosis.

Causes

Respiratory Alkalosis

Respiratory alkalosis occurs when too much carbon dioxide (CO₃) is exhaled, a process known as hyperventilation. Common causes include:

Anxiety, panic attacks, or psychological stress
High fever
High-altitude exposure (hypoxia)
Certain lung diseases
Mechanical ventilation with an excessively high respiratory rate
Pain

Metabolic Alkalosis

Metabolic alkalosis results from an excess of bases or a loss of acids in the body. Common causes include:

Prolonged vomiting (loss of stomach acid)
Excessive use of antacids or sodium bicarbonate preparations
Use of certain diuretics (water pills)
Hormonal disorders such as hyperaldosteronism
Severe potassium deficiency (hypokalemia)

Symptoms

The symptoms of alkalosis can vary depending on its severity and type. Typical symptoms include:

Tingling or numbness, especially in the hands and feet
Muscle cramps or increased muscle excitability (tetany)
Dizziness and lightheadedness
Palpitations or cardiac arrhythmias
Headaches
Confusion or impaired consciousness in severe cases
In respiratory alkalosis: rapid, shallow breathing and chest tightness

Diagnosis

Alkalosis is primarily diagnosed through an arterial blood gas (ABG) analysis, which measures the pH, CO₃ partial pressure, bicarbonate levels, and other acid-base parameters. Additional blood tests to evaluate electrolytes (potassium, calcium, chloride) and a thorough clinical examination are also performed. The patient's medical history (e.g., vomiting, medication use, breathing difficulties) provides important clues for identifying the underlying cause.

Treatment

Treatment always targets the underlying cause of the alkalosis:

Respiratory alkalosis: Calming techniques and controlled breathing for panic attacks; treatment of the underlying condition; adjustment of ventilator settings in mechanically ventilated patients
Metabolic alkalosis due to vomiting: Replacement of fluid and electrolyte losses via intravenous solutions
Diuretic-induced alkalosis: Adjustment or discontinuation of the medication and potassium supplementation
Severe metabolic alkalosis: In rare cases, administration of dilute hydrochloric acid or arginine hydrochloride under intensive care monitoring

In mild cases of alkalosis, the body can often restore the balance on its own. However, medical evaluation is always recommended if symptoms persist.

References

Pschyrembel Klinisches Wörterbuch, De Gruyter, 268th Edition (2020)
Fend, V. & Stover, J. (2006): Acid-Base Disturbances. In: Critical Care Nurse, 26(6):19–38. Available via PubMed.
World Health Organization (WHO): Electrolyte disorders and acid-base balance. Available at: https://www.who.int

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