Alkalosis

The kidneys and lungs maintain the proper balance (proper pH level) of chemicals called acids and bases in the body. Decreased carbon dioxide (an acid) level or increased bicarbonate (a base) level makes the body too alkaline, a condition called alkalosis. There are different types of alkalosis. These are described below.

Respiratory alkalosis means too much carbon dioxide is breathed causing a low carbon dioxide level in the blood. This can be due to:

• Fever
• Being at a high altitude
• Hyperventilation
• Lack of oxygen
• Liver disease
• Lung disease, which causes you to breathe faster (hyperventilate)
• Aspirin poisoning

Metabolic alkalosis means there is too much bicarbonate in the blood. It can occur due to certain kidney diseases. Two forms of metabolic alkalosis are:

Compensated alkalosis occurs when the body returns the acid-base balance and blood pH to near normal in cases of alkalosis, but bicarbonate and carbon dioxide levels remain abnormal.

Symptoms of alkalosis can include any of the following:

• Confusion (can progress to stupor or coma)
• Hand tremor
• Lightheadedness
• Muscle twitching
• Nausea, vomiting
• Numbness or tingling in the face, hands, or feet
• Prolonged muscle spasms (tetany)

Your health care provider will perform a physical exam and ask about your symptoms.

Lab tests that may be ordered include:

• Arterial or venous blood gas analysis.
• Basic metabolic panel (group of blood tests that measure sodium and potassium levels, kidney function, and other chemicals and functions) to show whether the type of alkalosis is metabolic or respiratory.

Other blood tests may be needed to determine the cause of the alkalosis.

Other tests may be needed to determine the cause of the alkalosis. These may include:

• Chest x-ray
• Urinalysis
• Urine pH

To treat alkalosis, your provider needs to first find the underlying cause.

For alkalosis caused by hyperventilation, breathing into a paper bag allows you to keep more carbon dioxide in your body, which improves the alkalosis. If your oxygen level is low, you may receive oxygen.

Medicines may be needed to correct chemical loss (such as chloride and potassium). Your provider will monitor your vital signs (temperature, pulse, rate of breathing, and blood pressure).

Most cases of alkalosis respond well to treatment.

Untreated or not treated properly, complications may include any of the following:

• Arrhythmias (heart beating too fast, too slow, or irregularly)
• Coma
• Electrolyte imbalance (such as low potassium level)

Contact your provider if you become confused, unable to concentrate, or unable to "catch your breath."

Go to the emergency room or call 911 or the local emergency number if there is:

• Loss of consciousness
• Rapidly worsening symptoms of alkalosis
• Seizures
• Severe breathing difficulties

Prevention depends on the cause of the alkalosis. People with healthy kidneys and lungs do not usually have serious alkalosis.

Metabolic alkalosis; Respiratory alkalosis

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Oh MS, Briefel G, Pincus MR. Evaluation of renal function, water, electrolytes, and acid-base balance. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 15.

Sanghavi S, Albert TJ, Swenson ER. Acid-base balance. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 12.

Seifter JL. Acid-base disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 104.

Updated by: Jacob Berman, MD, MPH, Associate Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.