Alkalosis

What is Alkalosis?

Alkalosis is a medical condition where there are too many alkali, or base substances, in the body. This can lead to a higher than normal blood pH level (anything over 7.45), which is called alkalemia. This is one type of the conditions caused by an imbalance of acid and base substances in our body.

Generally, this happens because either there’s a loss of hydrogen ions (symbols as ‘H’) or an excess amount of bicarbonate ions (symbols as ‘OH’). Various factors can create these conditions.

Compared to acidosis, which is a similar condition but with too much acid, alkalosis is generally less threatening. However, serious imbalances in the body’s electrolytes (minerals that help balance the amount of water in your body and the acidity level of your blood) can occur due to alkalosis. This can lead to rare, yet severe health disorders.

Alkalosis can be caused by lung (respiratory) or metabolic (digestive) issues, but is most often due to metabolic reasons.

What Causes Alkalosis?

Alkalosis, a condition where your body has too many basic substances, can be due to either metabolic or respiratory issues:

Metabolic causes:

1. An excess loss of hydrogen ions: This mainly happens due to loss from the stomach, such as from prolonged or severe vomiting or due to certain health conditions like pyloric stenosis or congenital chloridorrhea.

2. A rise in bicarbonate levels in the body: This can occur when too much bicarbonate or alkali is consumed orally (milk-alkali syndrome) or injected into the body. It can also occur when the kidneys absorb too much bicarbonate, such as due to severe low potassium levels, primary hyperaldosteronism, Cushing syndrome, Bartter syndrome, Gitelman syndrome, excessive consumption of licorice, or overuse of certain diuretics.

3. Diuretic-induced alkalosis: Certain types of diuretics (medications that help your body get rid of salt and water) block the body’s reabsorption of sodium and chloride, which can cause an increase in bicarbonate absorption. This leads to a higher concentration of bicarbonate in the blood, a condition also known as contraction alkalosis.

Respiratory causes:

1. Low levels of carbon dioxide production: This often happens in severe, coma-like conditions, particularly when a patient is on a ventilator.

2. Loss of too much carbon dioxide from the lungs: This leads to alkalosis when the body’s carbon dioxide levels are normal. This could be due to breathing too quickly or deeply (psychogenic hyperventilation), breathing assistance by a ventilator or extracorporeal membrane oxygenation (a procedure that uses a machine to take over the work of the lungs), or in the early stages of an overdose of salicylates (a type of pain reliever) because it overstimulates the part of your brain that controls how you breathe.

Risk Factors and Frequency for Alkalosis

Metabolic alkalosis and respiratory alkalosis are both acid-base disorders that often happen in hospitalized patients. Metabolic alkalosis is especially common and occurs in about 51% of these patients. Respiratory alkalosis is also frequent, with about 22.5% to 44.7% of hospitalized patients in the United States experiencing this condition. An Italian study found that 24% of patients had respiratory alkalosis at the time of admission. Additionally, about 29% of patients are estimated to have a mix of respiratory and metabolic alkalosis.

Generally, these conditions affect both men and women fairly equally. The one exception to this is a condition called infantile pyloric stenosis, which is associated with alkalosis and is much more common in male babies.

Signs and Symptoms of Alkalosis

Alkalosis is a condition that can display various signs and symptoms depending on its cause. There are two main types of alkalosis: respiratory and metabolic. Each kind has different effects on the body.

Metabolic alkalosis can cause confusion, and in severe cases, can even lead to a coma. It can also cause nerve symptoms like tremors, tingling, and numbness, as well as muscle weakness and spasms. It may also result in abnormal heart rhythms, especially when it is accompanied by low levels of potassium and calcium in the blood. Another type of metabolic alkalosis, called nonhypochloremic metabolic alkalosis, is usually caused by too much mineralocorticoid (a type of hormone). This type often goes hand in hand with high blood pressure, a large amount of fluid in the body, and low potassium levels. One of the key signs of a condition called pyloric stenosis is constant and strong, non-green vomiting in an otherwise healthy infant who is between two to six weeks old.

On the other hand, respiratory alkalosis can cause fainting and symptoms of hyperventilation, as well as chest pain and difficulty breathing.

• Metabolic Alkalosis Symptoms:
  • Confusion or coma in severe cases
  • Nerve symptoms like tremors, tingling, and numbness
  • Muscle weakness and spasms
  • Abnormal heart rhythms, especially when paired with low potassium and calcium levels
  • High blood pressure, increased bodily fluids, and low potassium levels (for nonhypochloremic metabolic alkalosis)
  • Persistent, strong vomiting in healthy infants two to six weeks old (for pyloric stenosis)
• Respiratory Alkalosis Symptoms:
  • Fainting
  • Symptoms of hyperventilation
  • Chest pain
  • Difficulty breathing

Testing for Alkalosis

To confirm whether you have alkalosis – a condition that occurs when your body fluids have too much base (alkali) – and to find out whether it is metabolic or respiratory in origin, your doctor may need to conduct a blood test called a blood gas analysis, preferably using an arterial sample. In addition to that, other blood tests may be necessary, including full serum chemistries comprising of electrolytes, blood urea nitrogen, and creatinine.

Though a high bicarbonate concentration in your blood might suggest the possibility of metabolic alkalosis, it doesn’t confirm it as the carbon dioxide concentration and the concentration of H+ ions also play a role. Therefore, your doctor may also need to evaluate the blood gas estimate of pH and pCO2 levels. However, if there are mixed acid-base disorders, more intricate calculations may be required to find out whether there are multiple disturbances, and if they are primary abnormalities or compensatory responses.

It’s also essential to spot any associated abnormalities in your electrolytes, including hypochloremia (low chloride), hypokalemia (low potassium), and hypocalcemia (low calcium). You might need an EKG, an electrocardiogram, to check for any irregular heart rhythms. Additionally, urine tests are vital to understand how your kidney is responding to alkalosis.

If you have high blood pressure, the doctor will assess it and might also run tests for a condition called hyperaldosteronism, especially if it is required. They will also check if you have a coexisting condition of volume depletion, which is a reduction of volume in the amount of blood plasma in your body.

In cases where alkalosis is associated with low levels of oxygen in the blood (hypoxia) or an increased alveolar-arterial (A-a) gradient, the source of hypoxia needs to be identified. Moreover, respiratory alkalosis can sometimes be caused by a pulmonary embolism – a blockage in one of the pulmonary arteries in your lungs – that may occur without associated hypoxia. Therefore, this condition needs to be ruled out before attributing hyperventilation to pain or anxiety.

Treatment Options for Alkalosis

The right way to treat alkalosis, a condition where the body’s fluids become too alkaline, depends on correctly figuring out the main cause and the type of alkalosis (whether it’s metabolic, respiratory, or a mix of both). Certain underlying conditions like pyloric stenosis, which is a narrowing of the opening from the stomach into the intestines, will need surgical treatment, while if the alkalosis is due to consuming too many alkaline substances, you’ll need to start limiting intake.

Alkalosis that is linked with conditions that lead to an excess of the hormone aldosterone might require hormonal treatment or replacement, along with managing any associated high blood pressure. Alkalosis that is responsive to chloride and caused by a lack of body fluids can be corrected by restoring these fluids.

Electrolyte disturbances, like low potassium (hypokalemia) and low calcium (hypocalcemia), that occur alongside alkalosis can cause a patient’s condition to worsen and should be corrected to avoid severe complications. In emergency situations, slow administration of acids or dialysis (a treatment that helps filter the blood when the kidneys can’t do it) with low bicarbonate solutions might be necessary.

For respiratory alkalosis, where the body becomes too alkaline due to breathing too quickly, the key focus of treatment is to manage the quick breathing (whether it’s a direct symptom or due to medical intervention). Factors such as anxiety and pain should also be addressed. In some cases, it may be necessary to adjust a patient’s mechanical ventilator settings to increase the level of carbon dioxide in the blood.

What else can Alkalosis be?

Alkalosis, a medical condition with many different symptoms, can be tricky for doctors to diagnose precisely. This is because the signs of this condition can vary greatly. Also, other related conditions, such as low levels of different electrolytes in the body, might muddle the diagnosis. These can include:

• Hypochloremia (low chloride levels)
• Hypokalemia (low potassium levels)
• Hypocalcemia (low calcium levels)

What to expect with Alkalosis

Alkalosis, whether related to the respiratory system or metabolism, is generally balanced by the body’s natural defenses in the early stages. However, if the alkalosis is not corrected or becomes long-term, these defenses can become overwhelmed. This might lead to a poorer outcome for patients. The outcome depends on related issues such as dehydration, imbalances in electrolytes or hormones, and the specific cause of the alkalosis.

Patients with metabolic alkalosis, a condition where there’s too much bicarbonate in the blood, often stay longer in the ICU, spend more days on a ventilator, and have a higher chance of dying in the hospital. An increase of 5-mEq/L (milliequivalents per Liter, a way to measure the concentration of substances in blood) in the bicarbonate level over 30 mEq/L has been associated with a 1.21 times greater risk of death in the hospital. This connection between metabolic alkalosis and hospital deaths happens regardless of the cause of the alkalosis.

Possible Complications When Diagnosed with Alkalosis

Alkalosis, a condition where your body fluids have too many bases, can cause severe heart rhythm problems, particularly if it comes with low levels of potassium and calcium. These related imbalances in bodily salts can also result in spasms in hands and feet, weakness in muscles, and changes in mental state.

Main Issues Caused By Alkalosis:

• Severe heart rhythm problems
• Spasms in hands and feet
• Muscle weakness
• Changes in mental state
• Potential life-threatening situations

Preventing Alkalosis

It’s important for patients and their families to learn about the serious implications of a health condition known as severe alkalosis, as well as the main cause of their alkalosis. Alkalosis is when the body’s fluids become overly alkaline or basic, which can be dangerous. Patients and families need to understand the relationship between various triggers for alkalosis, such as anxiety disorders, severe vomiting or consuming too much substances that are alkaline. These conditions can all lead to alkalosis.