Thursday, August 12, 2010

CONSULT ROUNDS: Resp Alkalosis

Here is an ABG:  7.71/17/118 and on Room Air and Hco3 is 22.

At a glance this is respiratory and metabolic alkalosis.  This can be possible especially in someone on Peritoneal Dialysis. The compensation of Resp Alkalosis is dumping bicarbonate in the urine; but if you don't make urine and are on PD- more alkaline fluid:- this is very possible.

Lets review the causes of Resp Alkalosis:  Four major causes that can include the rest
Stimulation of the resp center, Hypoxemia, Pulmonary or cardiac disease and finally ventilators.
So a complete list would be CNS disorders, endotoxins( sepsis), Anxiety, fever, ASA toxicity, anything that increases A-a gradient( pulm embolism, edema, Pneumonia), cardiac disease( MI), pregnancy, liver disease, progesterone, and some toxins ( medications).

A ph >7.6 puts an increase risk of seizures.  Treat the underlying cause but try to suppress the resp drive with anxiolytics, sedatives or bagging or if need be Intubation.

What other situations you get a met alk and resp alk together?
Liver disease with diuretics; Pregnancy with vomiting  are other examples

1 comment:

  1. Agreed. Anyone who has been more than 7months pregnant and tried to walk up a moderate hill at a brisk pace has experienced the resp alkalosis of pregnancy!!


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