Comprehensive Respiratory System Disorders Q 45

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A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

  

     A. Nausea or vomiting

     B. Abdominal pain or diarrhea

     C. Hallucinations or tinnitus

     D. Lightheadedness or paresthesia

    

    

Correct Answer: D. Lightheadedness or paresthesia

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The patient with respiratory alkalosis may complain of lightheadedness or paresthesia (numbness and tingling in the arms and legs). The exact history and physical exam findings are highly variable as there are many pathologies that induce the pH disturbance. These may include acute onset dyspnea, fever, chills, peripheral edema, orthopnea, weakness, confusion, light-headedness, dizziness, anxiety, chest pain, wheezing, hemoptysis, trauma, history of central line catheter, recent surgery, history of thromboembolic disease, history of asthma, history of COPD, acute focal neurological signs, numbness, paresthesia, abdominal pain, nausea, vomiting, tinnitus, or weight loss.

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Option A: Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Following a performance predominantly relying on anaerobic glycolysis, systemic acidosis may cause vomiting as a physiological response to drain H + and thereby allow the stomach to add bicarbonate to the body

Option B: Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea. In pathologies with profuse watery diarrhea, bicarbonate within the intestines is lost through the stool due to increased motility of the gut. This leads to further secretion of bicarbonate from the pancreas and intestinal mucosa, leading to net acidification of the blood from bicarbonate loss.

Option C: Hallucinations and tinnitus are associated with respiratory alkalosis or any other acid-base imbalance. Respiratory alkalosis in itself is not life-threatening; however, the underlying etiology may be. Always look for and treat the source of the illness. Interventions to reduce pH directly are typically not necessary as there is no mortality benefit to this therapy.

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