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Respiratory Alkalosis

Respiratory Alkalosis Abstract Introduction A PRIMARY reduction in the physically dissolved fraction of carbon dioxide in blood defines the state of primary respiratory alkalosis (primary hypocapnia). The quantity of physically dissolved CO2 ([H2CO3]) in blood depends on the partial pressure of CO2 (Pco2).1Arterial blood Pco2, is in equilibrium with pulmonary alveolar air Pco2, which in turn is directly proportional to alveolar air CO2 concentration (F CO2).Increase in alveolar ventilation, which defines the state of hyperventilation, results in reduction of alveolar F CO2 and therefore reduction in alveolar and arterial Pco2. A schematic demonstration of F CO2-Pco2 relationship is seen in Fig 1. Thus, primary hyperventilation results in a reduction in alveolar Pco2 and consequential reduction in arterial Pco2-the state of respiratory alkalosis. Hyperventilation. —The term "hyperventilation" should not be used to describe an accelerated rate of respiration (tachypnea), since such does not necessarily result in an increase in alveolar ventilation. Furthermore, References 1. a=the solubility factor for CO2 in mM/liter/mm Hg 2. Comroe, J.H., et al: The Lung , Chicago: The Year Book Publishers, 1955. 3. Eichenholz, A., et al: Primary Hypocapnia: A Cause of Metabolic Acidosis , J Appl Physiol 17: 283, 1962. 4. Moller, B.: The Hydrogen Ion Concentration in Arterial Blood Acta Med Scand 165( (suppl) ): 348, 1959. 5. Collip, J.B., and Backus, P.L.: The Effect of Prolonged Hyperpnea on the CO2 Combining Power of the Plasma, the Carbon Dioxide Tension of Alveolar Air and the Excretion of Acid, Basic Phosphate and Ammonia by the Kidney , Amer J Physiol 51:568, 1920. 6. Brazeau, P., and Gilman, A.: Effect of Plasma CO2 Tension on Renal Tubular Reabsorption of Bicarbonate , Amer J Physiol 33:175, 1953. 7. Relman, A.S.; Esten, B.; and Schwartz, W.B.: The Regulation of Renal Bicarbonate Reabsorption by Plasma Carbon Dioxide Tension , J Clin Invest 34:538, 1953.Crossref 8. Stanbury, W.W., and Thomson, A.E.: The Renal Response to Respiratory Alkalosis , Clin Sci 11:357, 1962. 9. Giebisch, G.; Berger, L.; and Pitts, R.F.: The Extrarenal Response to Acute Acid-Base Disturbances of Respiratory Origin , J Clin Invest 34:231, 1955.Crossref 10. Grant, S.B., and Goldman, A.: Forced Respiration: Experimental Production of Tetany , Amer J Physiol 52:209, 1920. 11. Brown, E.B., Jr.: Physiological Effects of Hyperventilation , Physiol Rev 33:445, 1953. 12. Thompson, W.P.: The Electrocardiogram in the Hyperventilation Syndrome , Amer Heart J 25: 372, 1943.Crossref 13. Yu, P.N., and Yim, B.J.: Electrocardiographic Changes in Hyperventilation Syndrome: Possible Mechanism and Clinical Implications , Trans Assoc Amer Physicians 71:129, 1958. 14. Bolka, B.; Ellis, J.P., Jr.; and Well, J.G.: Adaptive Responses to Hyperventilation , J Appl Physiol 12:269, 1958. 15. Rushmer, R.F.; Boothby, W.M.; and Hinshaw, H.C.: Some Effects of Hyperventilation With Special Reference to Aviation Medicine , Proc Mayo Clin 16:801, 1941. 16. Scow, J.; Krasno, L.R.; and Ivy, A.C.: Immediate and Accumulative Effect of Exposure to Hypoxia, High Altitudes and Hyperventilation , J Aviat Med 21:79, 1950. 17. Brill, N.Q., and Seidemann, H.: Electroencephalographic Changes During Hyperventilation in Epileptic Disorders , Ann Intern Med 16:451, 1942.Crossref 18. Bindslew, A.; Christensen, E.J.; and Wandall, H.H.: Hemolysis in Dog Blood: In Vitro Experiments , J Thorac Surg 42:55, 1961. 19. Provence, C., and Read, R.: Personal communication to the author, 1962. 20. Herman, N.P.; Kleinhenz, R.J.; and Roberts, K.E.: Glycogen Depletion in Respiratory Alkalosis , Clin Res 10:122, 1962. 21. Bartlett, R.G., Jr., and Phillips, N.E.: Hypocapnia and Erythropoiesis , Aerospace Med 33:831, 1962. 22. Eichenholz, A.; Mulhausen, R.O.; and Blumentals, A.: Unpublished observations. 23. Wynn, V.: The Clinical Significance of Blood pH and Blood Gas Measurement: Symposium on pH and Blood Gas Measurement , Boston: Little, Brown & Co., 1959. 24. Simmons, D.H.; Nicoloff, J.; and Guze, L.B.: Hyperventilation and Respiratory Alkalosis as Signs of Gram-Negative Bacteremia , JAMA 174: 2196, 1960.Crossref 25. Platt, B.S.: Discussion: Proceedings of a Conference on Beriberi , Fed Proc 17( (suppl 2) ):8, 1958. 26. Harrop, G.A., and Loeb, R.F.: Uncompensated Alkalosis in Encephalitis , JAMA 81:452, 1923.Crossref 27. Carrol, D.: Oxygen Tension and Acid-Base Adjustment in Cardiac Failure , Bull Hopkins Hosp 103:242, 1958. 28. Morse, M., and Cassels, D.E.: Arterial Blood Gases and Acid-Base Balance in Cyanotic Congenital Heart Disease , J Clin Invest 32:837, 1953.Crossref 29. Tainter, M.L., and Cutting, W.C.: Febrile, Respiratory and Some Other Actions of Dinitrophenol , J Pharmacol Exp Ther 48:410, 1933. 30. Turrell, E.S., and Robinson, S.: The Acid-Base Equilibrium of the Blood in Exercise , Amer J Physiol 137:742, 1942. 31. Callaghan, J.C., et al: " The Acid Base Aspects of Extracorporeal Circulation ," in Extracorporeal Circulation , Springfield, Ill: Charles C Thomas, Publisher, 1958, p 179. 32. Peters, J.P., and Van Slyke, D.D.: Quantitative Clinical Chemistry, Interpretations , Baltimore: Williams and Wilkins Co., 1931, vol 1, pp 868-1018. 33. Fenn, W.O., et al: Physiological Observation on Hyperventilation at Altitude With Intermittent Pressure Breathing by the Pneumolator , J Appl Physiol 1:773, 1949. 34. Rice, R.L.: Symptom Patterns of the Hyperventilation Syndrome , Amer J Med 8:691, 1950.Crossref 35. Vanamee, P., et al: Respiratory Alkalosis in Hepatic Coma , Arch Intern Med 97:762, 1956.Crossref 36. Hayward, J.N., and Boshell, B.R.: Paraldehyde Intoxication With Metabolic Acidosis , Amer J Med 23:965, 1957.Crossref 37. Mulhausen, R.O.; Eichenholz, A.; and Blumentals, A.: Unpublished observations. 38. Eichenholz, A.; Mulhausen, R.O.; and Redleaf, P.: Nature of Acid-Base Disturbance in Salicylate Intoxication , Metabolism 12:164, 1963. 39. Gordon, E.E.; Darling, R.C.; and Shea, E.: The Effects of Physical Hyperthermia Upon Blood Gas Equilibria in Man , J Appl Physiol 1:496, 1949. 40. Eichenholz, A.: Effects of Abnormal Respiration on Acid-Base Balance , Biochem Clin 4:97, 1964. 41. Dobell, A.R.C.; Gutelius, J.R.; and Murphy, D.R.: Acidosis Following Respiratory Alkalosis in Thoracic Operations With and Without Heart-Lung Bypass , J Thor Cardiov Surg 39:312, 1960. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1965 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1965.03870050053009
Publisher site
See Article on Publisher Site

Abstract

Abstract Introduction A PRIMARY reduction in the physically dissolved fraction of carbon dioxide in blood defines the state of primary respiratory alkalosis (primary hypocapnia). The quantity of physically dissolved CO2 ([H2CO3]) in blood depends on the partial pressure of CO2 (Pco2).1Arterial blood Pco2, is in equilibrium with pulmonary alveolar air Pco2, which in turn is directly proportional to alveolar air CO2 concentration (F CO2).Increase in alveolar ventilation, which defines the state of hyperventilation, results in reduction of alveolar F CO2 and therefore reduction in alveolar and arterial Pco2. A schematic demonstration of F CO2-Pco2 relationship is seen in Fig 1. Thus, primary hyperventilation results in a reduction in alveolar Pco2 and consequential reduction in arterial Pco2-the state of respiratory alkalosis. Hyperventilation. —The term "hyperventilation" should not be used to describe an accelerated rate of respiration (tachypnea), since such does not necessarily result in an increase in alveolar ventilation. Furthermore, References 1. a=the solubility factor for CO2 in mM/liter/mm Hg 2. Comroe, J.H., et al: The Lung , Chicago: The Year Book Publishers, 1955. 3. Eichenholz, A., et al: Primary Hypocapnia: A Cause of Metabolic Acidosis , J Appl Physiol 17: 283, 1962. 4. Moller, B.: The Hydrogen Ion Concentration in Arterial Blood Acta Med Scand 165( (suppl) ): 348, 1959. 5. Collip, J.B., and Backus, P.L.: The Effect of Prolonged Hyperpnea on the CO2 Combining Power of the Plasma, the Carbon Dioxide Tension of Alveolar Air and the Excretion of Acid, Basic Phosphate and Ammonia by the Kidney , Amer J Physiol 51:568, 1920. 6. Brazeau, P., and Gilman, A.: Effect of Plasma CO2 Tension on Renal Tubular Reabsorption of Bicarbonate , Amer J Physiol 33:175, 1953. 7. Relman, A.S.; Esten, B.; and Schwartz, W.B.: The Regulation of Renal Bicarbonate Reabsorption by Plasma Carbon Dioxide Tension , J Clin Invest 34:538, 1953.Crossref 8. Stanbury, W.W., and Thomson, A.E.: The Renal Response to Respiratory Alkalosis , Clin Sci 11:357, 1962. 9. Giebisch, G.; Berger, L.; and Pitts, R.F.: The Extrarenal Response to Acute Acid-Base Disturbances of Respiratory Origin , J Clin Invest 34:231, 1955.Crossref 10. Grant, S.B., and Goldman, A.: Forced Respiration: Experimental Production of Tetany , Amer J Physiol 52:209, 1920. 11. Brown, E.B., Jr.: Physiological Effects of Hyperventilation , Physiol Rev 33:445, 1953. 12. Thompson, W.P.: The Electrocardiogram in the Hyperventilation Syndrome , Amer Heart J 25: 372, 1943.Crossref 13. Yu, P.N., and Yim, B.J.: Electrocardiographic Changes in Hyperventilation Syndrome: Possible Mechanism and Clinical Implications , Trans Assoc Amer Physicians 71:129, 1958. 14. Bolka, B.; Ellis, J.P., Jr.; and Well, J.G.: Adaptive Responses to Hyperventilation , J Appl Physiol 12:269, 1958. 15. Rushmer, R.F.; Boothby, W.M.; and Hinshaw, H.C.: Some Effects of Hyperventilation With Special Reference to Aviation Medicine , Proc Mayo Clin 16:801, 1941. 16. Scow, J.; Krasno, L.R.; and Ivy, A.C.: Immediate and Accumulative Effect of Exposure to Hypoxia, High Altitudes and Hyperventilation , J Aviat Med 21:79, 1950. 17. Brill, N.Q., and Seidemann, H.: Electroencephalographic Changes During Hyperventilation in Epileptic Disorders , Ann Intern Med 16:451, 1942.Crossref 18. Bindslew, A.; Christensen, E.J.; and Wandall, H.H.: Hemolysis in Dog Blood: In Vitro Experiments , J Thorac Surg 42:55, 1961. 19. Provence, C., and Read, R.: Personal communication to the author, 1962. 20. Herman, N.P.; Kleinhenz, R.J.; and Roberts, K.E.: Glycogen Depletion in Respiratory Alkalosis , Clin Res 10:122, 1962. 21. Bartlett, R.G., Jr., and Phillips, N.E.: Hypocapnia and Erythropoiesis , Aerospace Med 33:831, 1962. 22. Eichenholz, A.; Mulhausen, R.O.; and Blumentals, A.: Unpublished observations. 23. Wynn, V.: The Clinical Significance of Blood pH and Blood Gas Measurement: Symposium on pH and Blood Gas Measurement , Boston: Little, Brown & Co., 1959. 24. Simmons, D.H.; Nicoloff, J.; and Guze, L.B.: Hyperventilation and Respiratory Alkalosis as Signs of Gram-Negative Bacteremia , JAMA 174: 2196, 1960.Crossref 25. Platt, B.S.: Discussion: Proceedings of a Conference on Beriberi , Fed Proc 17( (suppl 2) ):8, 1958. 26. Harrop, G.A., and Loeb, R.F.: Uncompensated Alkalosis in Encephalitis , JAMA 81:452, 1923.Crossref 27. Carrol, D.: Oxygen Tension and Acid-Base Adjustment in Cardiac Failure , Bull Hopkins Hosp 103:242, 1958. 28. Morse, M., and Cassels, D.E.: Arterial Blood Gases and Acid-Base Balance in Cyanotic Congenital Heart Disease , J Clin Invest 32:837, 1953.Crossref 29. Tainter, M.L., and Cutting, W.C.: Febrile, Respiratory and Some Other Actions of Dinitrophenol , J Pharmacol Exp Ther 48:410, 1933. 30. Turrell, E.S., and Robinson, S.: The Acid-Base Equilibrium of the Blood in Exercise , Amer J Physiol 137:742, 1942. 31. Callaghan, J.C., et al: " The Acid Base Aspects of Extracorporeal Circulation ," in Extracorporeal Circulation , Springfield, Ill: Charles C Thomas, Publisher, 1958, p 179. 32. Peters, J.P., and Van Slyke, D.D.: Quantitative Clinical Chemistry, Interpretations , Baltimore: Williams and Wilkins Co., 1931, vol 1, pp 868-1018. 33. Fenn, W.O., et al: Physiological Observation on Hyperventilation at Altitude With Intermittent Pressure Breathing by the Pneumolator , J Appl Physiol 1:773, 1949. 34. Rice, R.L.: Symptom Patterns of the Hyperventilation Syndrome , Amer J Med 8:691, 1950.Crossref 35. Vanamee, P., et al: Respiratory Alkalosis in Hepatic Coma , Arch Intern Med 97:762, 1956.Crossref 36. Hayward, J.N., and Boshell, B.R.: Paraldehyde Intoxication With Metabolic Acidosis , Amer J Med 23:965, 1957.Crossref 37. Mulhausen, R.O.; Eichenholz, A.; and Blumentals, A.: Unpublished observations. 38. Eichenholz, A.; Mulhausen, R.O.; and Redleaf, P.: Nature of Acid-Base Disturbance in Salicylate Intoxication , Metabolism 12:164, 1963. 39. Gordon, E.E.; Darling, R.C.; and Shea, E.: The Effects of Physical Hyperthermia Upon Blood Gas Equilibria in Man , J Appl Physiol 1:496, 1949. 40. Eichenholz, A.: Effects of Abnormal Respiration on Acid-Base Balance , Biochem Clin 4:97, 1964. 41. Dobell, A.R.C.; Gutelius, J.R.; and Murphy, D.R.: Acidosis Following Respiratory Alkalosis in Thoracic Operations With and Without Heart-Lung Bypass , J Thor Cardiov Surg 39:312, 1960.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1965

References

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