Respiratory alkalosis is a disease caused by hyperventilation and manifested as arterial bloodcarbon dioxidePartial pressure decreased and blood pH increased.The common causes include respiratory diseases, nervous system diseases and improper use of respirators.People with such basic diseases have a higher risk.
The common manifestations of respiratory alkalosis areShortness of breath, increased heart rate, numbness of hands, feet, mouth and acupuncture, etc., including pale complexion, muscle tremorvertigoEtc.If the patient suffers from acute respiratory alkalosis, there may be indications of poor prognosis, or it may happen soonAcute respiratory distress syndrome。In addition, due to hypocalcemia, neuromuscular excitability increases, and tetany and other symptoms may occur.becauseAlkalosisIt can directly damage brain function, and patients may have nervous system dysfunction such as apathy and consciousness disorder.
The treatment of respiratory alkalosis should first find out the cause of the disease to prevent further deterioration of the disease.The subsequent treatment was mainly to increase the dead space of repeated breathing and regulate the water electrolyte and acid-base balance.For severe patients or tachypnea caused by central nervous system diseases, drugs can be used to block spontaneous respiration.For patients with hand and foot convulsions, intravenous injection can be usedCalcium gluconateTreat.
The prognosis of respiratory alkalosis is generally good, and most patients can recover after treatment;However, if not properly treated in time, it may affect the nervous system or cardiovascular system, leading to confusion, coma, and even death.Therefore, in case of shortness of breath, cyanosis and other symptoms, the patient should seek medical advice in time.
There are many causes of respiratory alkalosis, the most common of which is respiratory alkalosis caused by hyperventilation of patients with respiratory diseases;Secondly, central nervous system diseases, improper userespiratorIt can also lead to respiratory alkalosis.
Central nervous system diseases
HysteriaIt can cause mental hyperventilation and lead to respiratory alkalosis.
Cerebrovascular disorders, encephalitis, brain trauma or brain tumors can directly stimulateRespiratory centerCauses hyperventilation.
Some drugs such assalicylic acid、ammonium saltIt can directly excite the respiratory center to enhance ventilation and cause respiratory alkalosis.
Improper use of mechanical ventilation
Severe respiratory alkalosis can be caused by too large tidal volume or too fast ventilation frequency.
Hypermetabolism
High heatHyperthyroidism, pain and traumaGram negative bacilli septicemiaIt can stimulate the respiratory center to make it excited, resulting in hyperventilation and respiratory alkalosis.
Patients with respiratory alkalosis often present with shortness of breath, pale face, etc. at first, and then with the progress of the disease, there may be numbness around the mouth, muscle tremorvertigoEtc.
Typical symptoms
Rapid breathing and heart rate
Most patients have shortness of breath and fast heart rate, which leads to hyperventilation and respiratory alkalosis.Acute respiratory alkalosis in critical patients often indicates poor prognosis or acute respiratory distress syndrome.
Increased neuromuscular excitability
Patients with respiratory alkalosis oftenHypocalcemia, increase the excitability of nerves and muscles, numbness and tingling may occur in hands, feet and around the mouth, and muscle tremor may occur,TetanyAnd other symptoms.
Nervous system dysfunction
Patients may have dizziness, apathy, consciousness disorder and other manifestations, because alkalosis has a direct damage to brain function, in addition, it is also related to the decrease of cerebral blood flow caused by cerebral vasoconstriction caused by hypocapnia.
Accompanying symptoms
In case of respiratory alkalosis caused by respiratory system disease, the patient may have cyanosis, wheezing, chest tightness, cough and other symptoms.
In case of respiratory alkalosis caused by nervous system diseases, patients may have headache, dizziness, nausea and vomiting.
In case of respiratory alkalosis caused by hyperthyroidism, the patient may show signs of emaciation, palpitation, sweating, insomnia, etc.
Medical treatment
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Respiratory alkalosis is often an acute course of disease. If it is not treated in time, patients with severe respiratory alkalosis may lose consciousness, become unconscious and die.Therefore, once the patient has symptoms of shortness of breath and cyanosis, it is necessary to go to the hospital for treatment in time.
The patient may have shortness of breath, rapid heart rate, numbness around the mouth or sensation of acupuncture.
Laboratory examination should include chest imaging, arterial blood gas analysis, electrolyte, liver function, kidney function, etc.
The disease can be diagnosed by combining the medical history, symptoms and signs and laboratory examination of the above patients.
Relevant inspection
Blood gas analysis
PaCO2Decrease, pH increase, AB (actualBicarbonate）<SB (standard bicarbonate), after compensation, the metabolic indicators are secondary reduced, AB, SB and BB (buffer base) values are reduced, and the BE (residual base) negative value is increased.
Blood electrolyte test
It can be found that the blood calcium and potassium of the patient decrease.
Oxygen dissociation curve
Alkaline poisoning causes the oxygen dissociation curve to move to the left, and oxygen release is difficult, resulting in hypoxia and metabolic disorders.
Urine electrolyte detection
It is characterized by decreased acid secretion and HCO excretionthree-Increase, correspondingly increase potassium discharge and decrease chlorine discharge;The urine pH increased significantly with time.
treatment
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For the treatment of patients with respiratory alkalosis, first of all, the cause of alkalosis should be clarified so that the patient's condition will not further develop;After that, the main treatment was to increase the dead space of repeated breathing, water electrolyte and acid-base balance regulation.
The fluid replacement treatment needs to evaluate the electrolyte type and fluid volume that the patient needs to input according to the patient's clinical manifestations and blood gas analysis results.
Acute treatment
CO can be inhaled in patients with acute respiratory alkalosistwoThe mixed gas of may make the patient hold his or her breath repeatedly, or cover his or her mouth and nose with a paper bag (leave a breathing channel) to breathe, so as to maintain the H in the plasmatwoCOthreeConcentration.At the same time, the patient's symptoms can be quickly controlled after the above treatment.
General treatment
In case of high fever, proper cooling treatment shall be carried out, such as ice bag cooling, alcohol bath, etc.
Give psychological guidance to patients to relieve their anxiety, restlessness, irritability and pain. At the same time, oxygen should be given reasonably.
For hyperventilation caused by improper use of the ventilator, the frequency and tidal volume of the ventilator should be adjusted in time.
medication
Patients with hand and foot convulsions can be treated by intravenous injection of calcium gluconate.
For patients with mental hyperventilation, sedatives can be used as appropriate, such asdiazepam 、EstazolamEtc;For patients with hysteria, low concentration ammonia can be used to inhibit the excessive breathing of patients with hysteria and reduce the symptoms of patients with alkalosis.
If the patient's alkalinity is serious, pH>7.55, it may occurVentricular arrhythmia、ConvulsionAnd other serious fatal complications.At this time, under the support of invasive ventilation, muscle relaxants can be used for a short time as appropriate.
In case of shortness of breath caused by critical patients or central nervous system diseases, drugs can be used to block the patient's spontaneous breathing, and the ventilator can be used for appropriate auxiliary breathing.
The TCM treatment of the disease is not supported by evidence-based medical evidence, but some TCM treatment methods or drugs can alleviate symptoms, so it is recommended to go to regular medical institutions and treat under the guidance of doctors.
prognosis
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The cure rate of patients with respiratory alkalosis is high, and the prognosis of patients with respiratory alkalosis is generally good after treatment;If the patient is not treated in time, the disease will affect the nervous system orcardiovascular systemIn the light case, the patient may become unconscious, and in the severe case, the patient may die.
complication
Ventricular arrhythmia
It is common in patients with severe respiratory alkalosis, and its mechanism is that alkalosis reduces the blood potassium in patients and makes the heartElectrophysiological abnormalities, leading to fatal arrhythmia in patients.
Through timely fluid replacement treatment, the occurrence of this complication can be prevented.
Severe convulsion
It is common in patients with severe respiratory alkalosis, and its mechanism is that alkalosis makesFree calciumDownblood calciumDecrease, which leads to increased neuromuscular sensitivity and abnormal muscle twitching of the patient.
The occurrence of this complication can be prevented by timely calcium and fluid replacement.
