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Respiratory Alkalosis

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Respiratory Alkalosis

Respirator Elk-loser
Respiratory alkalosis is an acid base imbalance marked by decreased levels of blood carbon dioxide with subsequent pH elevation.  The direct cause is an increase in respiratory rate, which results in the excessive loss of CO2 on exhalation.  The cause of increased respiratory rate is quite variable including high altitude, aspirin toxicity, restrictive lung disease, pulmonary embolism, pregnancy or anxiety.  Carbon dioxide is an acidic molecule which helps maintain the blood’s pH close to 7.4.  When it is excessively exhaled, this balance is disrupted leading to an increase in the blood pH. This is referred to as respiratory alkalosis.

When patients undergo hyperventilation, patients blow off an increased amount of carbon dioxide, leading to respiratory alkalosis.

High Altitude

Due to the decreased partial pressure of oxygen at high altitudes, a normal breath yields less oxygen when breathing at higher altitudes as compared to lower altitudes. This results in an increased respiratory rate to increase oxygen delivery. However, an increased respiratory rate can lead to respiratory alkalosis.


Salicylates stimulate the brain stem to increase ventilation. This can be seen in aspirin toxicity. However, salicylate toxicity can present as a mixed acid base disorder because salicylates are acidic and can cause an anion gap metabolic acidosis along with a respiratory alkalosis, creating a mixed acid base disturbance.

Restrictive Lung Disease
Restrictive-rope on Lungs

Restrictive lung disease is marked by the inability of the lungs to adequately expand. This results in the inability to efficiently acquire oxygen which causes a subsequent increase in ventilation to compensate, leading to a respiratory alkalosis.

Pulmonary Embolism
Lungs Elmo

A pulmonary embolism occludes the lung vasculature and subsequently creates extra dead space within the lung. With increased dead space, the lung is unable to adequately supply oxygen to the rest of the body. The body compensates by increasing ventilation to maximize oxygen delivery, resulting in hyperventilation.


Increased progesterone in pregnancy stimulates the brainstem to increase minute ventilation which results in sustained hyperventilation.


This hormone induces the brainstem to increase minute ventilation and can cause a respiratory alkalosis if levels are persistently elevated like in pregnancy.

Rib Fracture
Ribs Shattered

Rib fractures can result in decreased lung expansion due to pain on inspiration and pressure on the involved rib. This results in the inability to efficiently acquire oxygen which causes a subsequent increase in ventilation to compensate, leading to a respiratory alkalosis.


An acute anxiety attack can result in a rapid and severe hyperventilation respiratory response which can result in significant amounts of CO2 loss and quick onset of alkalosis.


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