How is alkalosis treated?

The treatment again distinguishes between respiratory and metabolic alkalosis. If necessary, the patient can be sedated if the panic attack does not subside on its own. In any case, the patient should be sedated so that he/she no longer hyperventilates and breathing can normalise.

This is done by substituting NaCl (in case of volume deficiency and normal potassium concentration) or potassium (hypokalemia). In severe cases, hydrochloric acid can also be substituted to treat the alkalosis. Alkalosis caused by medication (e.g. loop diuretics) must be treated immediately by stopping the medication.

A potassium-sparing diuretic can then be prescribed to help relieve the potassium deficiency. – Respiratory alkalosis caused by hyperventilation is not life-threatening and does not require active lowering of the pH. Rather, the aim is to achieve CO2 rebreathing and reduce the respiratory minute volume. – Metabolic alkaloses, on the other hand, are metabolically corrected by correcting the pH value.

At what point is an alkalosis dangerous?

Alkalosis caused by hyperventilation is in most cases harmless and can be easily remedied (e.g. by bag breathing). However, in more severe cases, one can lose consciousness, which can be dangerous. Metabolic alkalosis, on the other hand, can lead to an undersupply of the tissue due to a permanently elevated pH value.

If the body does not manage to compensate for this undersupply, organs can also suffer damage, as they are not sufficiently supplied. Hypokalemia can also lead to life-threatening cardiac arrhythmia, which must be treated by a doctor. If chronic vomiting is the cause of alkalosis, for example anorexia or bulimia, this can also be life-threatening.

Often a psychologist has to be consulted, with whom one tries to fight the disease together. A longer lasting disturbance of the acid-base balance should always be clarified by a doctor and treated accordingly. Hypokalemia can also lead to life-threatening cardiac arrhythmia, which must be treated by a doctor.

If chronic vomiting is the cause of alkalosis, for example anorexia or bulimia, this can also be life-threatening. Often a psychologist has to be consulted, with whom one tries to fight the disease together. A longer lasting disturbance of the acid-base balance should always be clarified by a doctor and treated accordingly.

Consequences / Risks

Respiratory alkalosis is in most cases not life-threatening and does not entail long-term consequences or risks. By normalizing breathing, the acid-base balance can often be regulated and the pH value stabilizes again. In severe cases, however, muscle cramps (hyperventilation tetany) or unconsciousness may occur.

In strong, longer lasting alkaloses, on the other hand, there can be danger to life, as organs can be damaged and cardiac arrhythmia can occur. The volume deficit can lead to hypotension (drop in blood pressure), which is often associated with weakness. Neurological abnormalities such as paresthesias, cramps or confusion may occur. In summary, the following consequences of metabolic alkalosis can be mentioned:

Neurological changes (disturbance of consciousness, neurological abnormalities)
Cardiac arrhythmia
Left shift of the O2 dissociation curve with aggravated O2 release in tissue
Alveolar hypoventilation with hypoxemia (lack of oxygen in the blood)
Hypokalemia