- Pulmonary Causes: severe hypoxemia, pneumonia, interstitial lung disease, pulmonary vascular disease and acute asthma.
- Nonpulmonary Causes: anxiety, fever, aspirin toxicity, metabolic acidosis, central nervous system disease, pregnancy.
- Cardiac arrhythmias
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
- May exhibit: Hypotension
- Tachycardia, irregular pulse/dysrhythmias
- May exhibit: Extreme anxiety (most common cause of hyperventilation)
- May report: Dry mouth
- May exhibit: Abdominal distension (elevating diaphragm as with ascites, pregnancy)
- 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
- 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.
- Achieve homeostatis.
- Prevent/minimize complications.
- Provide information about condition/prognosis and treatment needs as appropriate.
- Physiological balance restored.
- Free of complications.
- Condition, prognosis, and treatment needs understood.
- Plan in place to meet needs after discharge.
Care SettingThis 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.
- Plans of care specific to predisposing factors, e.g.:
- Anemias (iron deficiency, pernicious, aplastic, hemolytic)
- Cirrhosis of the liver
- Craniocerebral trauma
- Fluid and electrolyte imbalances
- Heart failure: chronic
- Pneumonia: microbial
- Ventilatory assistance (mechanical)
- Metabolic acidosis
- Metabolic alkalosis
- Impaired Gas Exchange
- Ineffective Breathing pattern
- Ineffective Tissue perfusion
- Acute confusion
- Risk for injury
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)