Breathing, an anatomical and physiological process, occurs without a thought until something goes wrong. Respiratory acidosis or alkalosis indicate two such occasions. Inadequate ventilation leads to acidosis, and excessive ventilation causes alkalosis. Each state reflects symptoms of underlying conditions or diseases. The balance of oxygen to carbon dioxide and the ability to effectively exchange those gases within the cardiopulmonary system determines acidosis or alkalosis.
Normal Ventilation
Normally, ventilation relies on a steady rate and volume per minute of inhaled oxygen and exhaled carbon dioxide. With acidosis, alterations in rate and volume lead to poor gas exchange and retention of carbon dioxide. With alkalosis, increased rate and volume and the effect on gas exchange lead to low carbon dioxide levels.
Underlying Conditions and Diseases
Respiratory acidosis occurs as a response to severe asthma, emphysema, hypoventilation syndrome, chronic bronchitis, weakness or injury to the rib cage or muscles, deformities of the spine including severe kyphosis, scoliosis and lordosis, airway obstruction, narcotics overdose and cardiopulmonary arrest. Respiratory alkalosis occurs with anxiety, a response to pain, fear, the initial onset of asthma, with metabolic acidosis, brain injury, excessive mechanical ventilation, high oxygen content in inspired air, stroke, medication overdose and hysteria.
Determination of Acidosis or Alkalosis
Tests to determine acidosis or alkalosis include a chest X-ray, CT scan or pulmonary function test. A chest X-ray or CT scan may reflect hyperinflation, pneumonia, emphysema, pneumothorax or hemothorax. Pulmonary function tests indicate restrictive and obstructive lung diseases such as asthma and emphysema. Arterial blood gases reflect oxygen levels, carbon dioxide levels, hydrogen ion concentration, bicarbonate levels, base excess levels and metabolic disorders.
Signs and Symptoms
Symptoms of respiratory acidosis include shortness of breath, a chronic cough, extreme fatigue, use of accessory muscles, decreased stamina, insomnia, lethargy, wheezing, cyanosis, diminished or absent breath sounds and increased carbon dioxide levels. The symptoms of respiratory alkalosis include hyperventilation, tachycardia, tremors, dizziness, mental confusion, fainting, convulsions or seizures, numbness and tingling sensation, decreased breath sounds and decreased carbon dioxide levels. Signs and symptoms taken separately and collectively aid diagnosis of underlying causes.
Treatment
Acute respiratory acidosis indicates a medical emergency, so call 911 and go to the nearest emergency room immediately. Do not drive yourself. Acidosis treatment requires symptomatic relief with mechanical ventilation, bronchial dilators, oxygen therapy, antibiotics and steroids. Alkalosis requires efforts to decrease excessive ventilation by re-breathing exhaled carbon dioxide, sedation and pain medication. Secondary treatment for each state focuses on determining the cause.
Prognosis
Respiratory acidosis becomes chronic with long-term emphysema, chronic obstructive pulmonary disease, chronic bronchitis and asthma. Respiratory alkalosis, frequently a self-limiting symptom, resolves with treatment of the underlying cause. Untreated, acidosis and alkalosis can lead to acute respiratory failure, decreased organ function, shock, cardiopulmonary arrest, and death. A diagnosis of respiratory acidosis or alkalosis carries a positive warning to take action. The appropriate response alters the prognosis for these two symptoms of respiratory diseases or conditions.
