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Respiratory Alkalosis

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By Matt Vera BSN, R.N.

Respiratory alkalosis is a common acid-base imbalance encountered in clinical practice, primarily affecting the body’s acid-base balance through alterations in carbon dioxide (CO2) levels. It is crucial for nurses and healthcare professionals to possess a comprehensive understanding of this condition as it frequently occurs in various clinical settings, ranging from acute illness to chronic respiratory disorders. The purpose of this article is to delve into the intricacies of respiratory alkalosis, shedding light on its etiology, clinical presentation, and nursing management.

Table of Contents

What is Respiratory Alkalosis?

Respiratory Alkalosis is an acid-base imbalance characterized by decreased partial pressure of arterial carbon dioxide and increased blood pH to less than 35 mm Hg, which is due to alveolar hyperventilation. Uncomplicated respiratory alkalosis leads to decrease in hydrogen ion concentration, which results in elevated blood pH.



Signs and Symptoms

  • Cardinal Sign: Deep Rapid Breathing (40+ bpm)
  • CNS and neuromuscular disturbances: lightheadedness, agitation, circumoral and peripheral paresthesias, carpopedal spasms, twitching and muscle weakness.
  • Positive Chvostek’s sign
  • Nausea and vomiting
  • Muscle twitching



  • May report: History/presence of anemia
  • Palpitations
  • May exhibit: Hypotension
  • Tachycardia, irregular pulse/dysrhythmias


  • May exhibit: Extreme anxiety (most common cause of hyperventilation)



  • May exhibit: Abdominal distension (elevating diaphragm as with ascites, pregnancy)
  • Vomiting


  • May report: Headache, tinnitus
  • Numbness/tingling of face, hands, and toes; circumoral and generalized paresthesia
  • Lightheadedness, syncope, vertigo, blurred vision
  • May exhibit: Confusion, restlessness, obtunded responses, coma
  • Hyperactive reflexes, positive Chvostek’s sign, tetany, seizures
  • Heightened sensitivity to environmental noise and activity
  • Muscle weakness, unsteady gait


  • May report: Muscle spasms/cramps, epigastric pain, precordial pain (tightness)


  • May report: Dyspnea
  • History of asthma, pulmonary fibrosis
  • Recent move/visit to location at high altitude
  • May exhibit: Tachypnea; rapid, shallow breathing; hyperventilation (often 40 or more respirations/minute)
  • Intermittent periods of apnea


  • May exhibit: Fever


  • May report: Use of salicylates/salicylate overdose, catecholamines, theophylline
  • Discharge plan DRG projected mean length of inpatient stay: 5.4 days
  • considerations: May require change in treatment/therapy of underlying disease process/condition

Diagnostic Studies

  • CONFIRMING DIAGNOSIS: Arterial blood gas (ABG) analysis indicate PaCO2 less than 35 mmHg; pH elevated in proportion to the fall in PaCO2 (acute) or failing toward normal (chronic).
  • Arterial blood gas (ABG) studies reveal abnormal values: pH above 7.45 and partial pressure of carbon dioxide below 35 mmHg.
  • Arterial pH: Greater than 7.45 (may be near normal in chronic stage).
  • Bicarbonate (HCO3): Normal or decreased; less than 25 mEq/L (compensatory mechanism).
  • Paco2: Decreased, less than 35 mm Hg (primary).
  • Serum potassium: Decreased.
  • Serum chloride: Increased.
  • Serum calcium: Decreased.
  • Urine pH: Increased, greater than 7.0.
  • Screening tests as indicated to determine underlying cause, e.g.:
  • CBC: May reveal severe anemia (decreasing oxygen-carrying capacity).
  • Blood cultures: May identify sepsis (usually Gram-negative).
  • Blood alcohol: Marked elevation (acute alcoholic intoxication).
  • Toxicology screen: May reveal early salicylate poisoning.
  • Chest x-ray/lung scan: May reveal multiple pulmonary emboli.

Nursing Priorities

  1. Achieve homeostatis.
  2. Prevent/minimize complications.
  3. Provide information about condition/prognosis and treatment needs as appropriate.

Discharge Goals

  1. Physiological balance restored.
  2. Free of complications.
  3. Condition, prognosis, and treatment needs understood.
  4. Plan in place to meet needs after discharge.

Care Setting

This condition does not occur in isolation, but rather is a complication of a broader problem and usually requires inpatient care in a medical/surgical or subacute unit.

Other Concerns

  • Metabolic acidosis
  • Metabolic alkalosis

Nursing Diagnosis

Nursing Care Plan

Main Article: Respiratory Alkalosis Nursing Care Plan

Nursing Interventions & Considerations

  • Be alert for signs of changes in neurologic, neuromuscular or cardiovascular functions.
  • Institute safety measures for the patient with vertigo or the unconscious patient.
  • Encourage the anxious patient to verbalize fears
  • Administer sedation as ordered to relax the patient
  • Keep the patient warm and dry
  • Encourage the patient to take deep, slow breaths or breathe into a brown paper bag (inspire CO2).
  • Monitor vital signs
  • Monitor ABGs, primarily PaCO2; a value less than 35 mmHg indicates too little CO2 (carbonic acid)
Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

1 thought on “Respiratory Alkalosis”

  1. Definition
    Respiratory Alkalosis is an acid-base imbalance characterized by decreased partial pressure of arterial carbon dioxide and increased blood pH to less than 35 mm Hg, which is due to alveolar hyperventilation.

    Increased blood pH? Uh…


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