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Alkalosis, Emergency Medicine

Reviewed 06/2017



  • Respiratory alkalosis:

    • Elevated serum pH secondary to alveolar hyperventilation and decreased PaCO2

    • Hyperventilation occurs through stimulation of 2 receptor types:

      • Central receptors—lo...


Signs and Symptoms

  • Signs and symptoms secondary to:

    • Arteriolar vasoconstriction

    • Hypocalcemia secondary to decreased ionized calcium from increased calcium binding to albumin

    • Associated hypokalem...


Initial Stabilization/Therapy

Airway, breathing, circulation (ABCs): 
  • Early intubation and airway control for altered mental status

  • IV, oxygen, and cardiac monitor

  • Naloxone, D50W (or Accu-Chek),...



Admission Criteria

  • ICU admission if:

    • pH >7.55 or altered mental status

    • Dysrhythmias

    • Severe electrolyte abnormalities

    • Hemodynamic instability

  • Coexisting medical illness requiring admi...

Pearls and Pitfalls

  • Increased minute ventilation is the primary cause of respiratory alkalosis, characterized by decreased PaCO2 and increased pH.

    • Metabolic alkalosis is usually caused by an increase i...

Additional Reading

  • Ayers  C, Dixon  P. Simple acid-base tutorial. J Parenter Enteral Nutr.  2012;36(1):18–23.

  • Khanna  A, Kurtzman  NA. Metabolic alkalosis. J Nephrol.  2006;(suppl 9):S86–S96.

  • ...



  • 276.3 Alkalosis

  • 276.4 Mixed acid-base balance disorder


  • E87.3 Alkalosis

  • E87.4 Mixed disorder of acid-base balance


  • 21420006 Alkalosis (disorder)

  • 111378004 Respiratory alkalosis

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