Alkalosis refers to the deviation of the pH to values above 7.45. It can have respiratory or metabolic causes and is prevented or combated in the body by buffer systems in the long term. If the pH remains above the healthy value for a long time or deviates massively in the short term, this has fatal consequences for almost all body cells.
What is alkalosis?
Alkalosis refers to the deviation of the pH value in the body to values above 7.45. The topic of alkalosis takes us deep into human physiology and also a bit into chemistry. Each of the body’s millions of cells needs a constant environment with a pH value between 7.35 and 7.45. Slightly alkaline, in other words, but not too alkaline and certainly not acidic. To ensure that the body’s demanding cells are guaranteed this environment, many so-called buffer mechanisms in the blood and tissues regulate the pH value. If this deviates then nevertheless times into the basic one (thus upward), one speaks of an alkalosis – the blood becomes alkaline. Medicine distinguishes respiratory alkalosis, i.e. caused by breathing, from metabolic alkalosis; the latter is metabolic and is the responsibility of the kidneys.
Causes
The main sufferers of a deviating pH are actually always the proteins that are present in the blood and in all body cells and are necessary for a myriad of vital functions. In a normal pH environment, these proteins are present in a certain functional state, but if the surrounding cell water becomes acidic or alkaline, they “denature” and can no longer function. To prevent this, buffer systems work constantly to keep the pH of the cell and blood plasma constant between 7.35 and 7.45. Particularly during physical work, a lot of acid is produced in the human body, which is first bound in the blood via bicarbonate and transported to the lungs, where it is then exhaled in the form of carbon dioxide. If one breathes too fast and too much, more carbon dioxide is exhaled than necessary and the body loses more acid than actually planned – alkalosis is the result, in this case respiratory alkalosis. This happens, for example, in psychogenic hyperventilation, in a panic attack. However, serious lung diseases, such as pulmonary embolism, can also lead to insufficient oxygen saturation of the blood, and the affected person becomes short of breath, breathes faster and gasps for air, paradoxically losing too much CO2. Furthermore, severe pain as well as stays at high altitude (mountain climbing) can cause hyperventilation. On the other hand, the kidney is constantly working to keep the environment of the body water constant. Bicarbonate is constantly filtered and reabsorbed here – the physiology of the kidney is very complex and far beyond the scope here. Let us leave it at the statement that a disturbance of the kidney function can also lead to a then metabolic alkalosis. One example is excessive therapy with diuretics, i.e. drugs that influence water excretion via the kidney. Potassium deficiency can lead to alkalosis. Furthermore, severe or frequent vomiting can result in the loss of a lot of gastric acid, which leads to metabolic alkalosis. By far the most common cause of alkalosis is psychogenic hyperventilation. The tricky thing is that the unnecessarily increased respiratory rate initially leads to the expiration of CO2 and thus to alkalosis, which then intensifies the feeling of panic and shortness of breath in the affected person and in turn causes an increased respiratory drive. A vicious cycle is created. In truth, the blood is maximally oxygenated and only the acid-base balance is out of balance. Breathing back into a bag helps: carbon dioxide accumulates in the bag and is inhaled again directly in the next breath. Calming the hyperventilator is the most important thing that can be done. A hospital admission is then usually no longer necessary after a few minutes.
Symptoms, complaints, and signs
In respiratory alkalosis, symptoms include muscle cramps, hyperventilation and dizziness. Palpitations and other cardiovascular symptoms may also occur. These symptoms are often accompanied by panic attacks and anxiety attacks. Externally, an increase in pH is manifested by the “paw position,” in which the fingers and wrist involuntarily cramp.Other typical signs include sensory disturbances in the hands and feet, paralysis, and occasionally mild, undefinable pain in the limbs. Metabolic alkalosis has similar symptoms: Cardiac arrhythmias, cramps and muscle weakness occur. Sensory disturbances on the skin and signs of hypotension may also occur. Many affected individuals suffer general weakness, confusion, and impaired concentration as a result of a shift in pH. In severe metabolic and respiratory alkalosis, the affected person may become unconscious. Both forms are often also manifested by sweating, changes in skin color, and fluctuations in blood pressure. A chronic disease can be manifested by gastrointestinal complaints and a decrease in physical and mental performance. Based on these symptoms, alkalosis can usually be clearly diagnosed.
Diagnosis and course
Other symptoms of respiratory alkalosis include muscle tingling and cramping, such as the typical “pawing” of the fingers. A subjective feeling of shortness of breath and chest tightness almost always occur, fatally prompting the affected person to breathe even faster. In metabolic alkalosis, on the other hand, very shallow and slow breathing often occurs as a compensatory measure in order to keep as much CO2 as possible in the body. Furthermore, muscle tremors or cardiac arrhythmias may also occur in this case. In the clinic, alkalosis is diagnosed by blood gas analysis: A small drop of capillary blood from the ear or finger is sufficient for this.
Complications
Alkalosis is a serious symptom that must always be treated by a physician. The change in pH usually causes tingling in the muscles and also cramps in the muscles. Patients often complain of a tightness in the chest and therefore breathe in and out more. Disturbances of the heart rhythm occur and likewise trembling of the muscles. In the worst case, alkalosis can lead first to fainting and eventually to death if no treatment is given. In most cases, surgical intervention is necessary. If the treatment is performed quickly enough, no further complications occur. However, the patient will need to see a doctor more often in the future to avoid alkalosis in the future. In case of acute alkalosis, potassium can also be administered, which blocks the symptom for a short time. If alkalosis occurs after vomiting, there are usually no complications. In this case, the symptom disappears again on its own if the vomiting stops as well and does not persist.
When should you go to the doctor?
Alkalosis has a very negative effect on the health of the affected person in any case and must therefore be treated in any case. In the case of large long-term deviations, this can lead to death in the worst case. A doctor should be consulted when the symptoms of alkalosis appear. These include tingling in the muscles and pain or feelings of pressure in the chest and when breathing. Breathing is usually difficult for patients and shortness of breath occurs. In acute emergencies, an ambulance should be called. Likewise, if the muscles tremble or if the heart arrhythmia occurs, a doctor should also be consulted or notified immediately. Urgent treatment is necessary in case of severe convulsions or epileptic seizures. Furthermore, the affected person may faint due to breathing difficulties. In this case, outsiders must ensure that the loss of consciousness does not lead to injuries in the event of a fall. It is not uncommon for alkalosis to lead to sweating or panic attacks. Here, treatment by a psychologist can be useful.
Treatment and therapy
Therapy of alkalosis is always primarily the underlying disease. In the case of pulmonary embolism, this means prompt blood thinning and intensive medical monitoring, and in rare cases, intervention or even surgery. Pain should be adequately treated with painkillers so that the affected person can breathe more calmly again. If potassium deficiency has caused the alkalosis as a side effect of diuretic therapy, the drug must be discontinued immediately and replaced with a potassium-sparing diuretic if necessary. Meanwhile, in the short term, if the symptoms are severe, the pH may be corrected with infusions of saline and potassium.Potassium is a trick that indirectly succeeds in shifting acid out of the cells into the extracellular space and balancing the alkalosis there. However, since in principle this does not change the overall situation of “base excess”, it is essential that the underlying disease be treated. Meanwhile, hyperventilation as the main cause of alkalosis symptomatology must be completely remedied by bag rebreathing.
Outlook and prognosis
Alkalosis primarily causes severe discomfort in the patient’s breathing. In this case, the affected person suffers from acute shortness of breath, which can also lead to panic attacks or a fear of death. Likewise, a lack of potassium occurs, which has a negative effect on the patient’s overall health. The affected person feels weak and tired and the patient’s ability to cope with stress drops drastically. Ordinary activities or sports can therefore no longer be performed easily due to the alkalosis. Likewise, cramps can occur in various parts of the body, making the affected person’s daily life much more difficult. Patients often suffer from concentration disorders. In some cases, thinking and acting are no longer possible for the patient. Complaints to the heart can also occur, so that in the worst case the patient dies of cardiac death. Alkalosis can be treated with the help of medication and infusions. This does not lead to further complications. The symptoms usually disappear relatively quickly and the patient’s general condition improves.
Prevention
There is actually no specific prophylaxis for alkalosis because of the very wide variety of underlying diseases. In general, of course, the purpose of any medication should be constantly weighed against the risk of side effects. If diuretic therapy is nevertheless necessary from these points of view, a blood gas analysis should be carried out regularly by the physician so that any developing alkalosis is noticed in good time. The same applies to all diseases that are associated with a tendency to alkalosis.
Follow-up
In most cases, no direct follow-up is possible or necessary for alkalosis. The individual with this condition is dependent on treatment to prevent further symptoms and compilations. If alkalosis is not treated, the patient will die in most cases. For this reason, early diagnosis and treatment of alkalosis have a very positive effect on the further course of the disease. If alkalosis is treated by surgical intervention, the patient must rest and take care of his body after such an intervention. Therefore, strenuous activities or sports activities should be refrained from. Furthermore, potassium can also be taken to alleviate the symptoms of alkalosis. In this case, the patient should ensure that it is taken regularly. If the alkalosis is triggered by a medication, it is recommended that this medication be discontinued. This is the only way to treat the disease completely. However, discontinuation of medication should be done only after consultation with a physician. In some cases, alkalosis also leads to a reduced life expectancy of the patient. However, this is highly dependent on the underlying disease responsible for the alkalosis.
Here’s what you can do yourself
What patients can do themselves depends on the causes of the alkalosis. If it is due to the excessive use of diuretics, such preparations should be taken only after consultation with the doctor. Any misuse in the context of a reduction diet must be stopped immediately. If the alkalosis is due to potassium deficiency, a balanced diet and the consumption of mineral water containing potassium will help. Avocados, bananas, kiwis, grapes and strawberries are also a good source of the mineral. Since heavy sweating is associated with increased potassium loss, athletes may want to take dietary supplements. However, this should not be done without consulting a doctor. If the ph value is too high because too much CO2 is exhaled, as is often the case in psychogenic hyperventilation, for example, the patient can first take preventive measures. Situations that trigger a panic attack must be avoided as far as possible.With the help of relaxation techniques such as yoga or autogenic training, sufferers can learn to better control themselves in stressful situations. In the event of an acute attack, it helps to breathe into a paper bag, as this immediately returns the excreted CO2 to the body and prevents a further rise in the ph level.