TAILIEUCHUNG - Chapter 048. Acidosis and Alkalosis (Part 14)

Chronic respiratory alkalosis is the most common acid-base disturbance in critically ill patients and, when severe, portends a poor prognosis. Many cardiopulmonary disorders manifest respiratory alkalosis in their early to intermediate stages, and the finding of normocapnia and hypoxemia in a patient with hyperventilation may herald the onset of rapid respiratory failure and should prompt an assessment to determine if the patient is becoming fatigued. Respiratory alkalosis is common during mechanical ventilation. The hyperventilation syndrome may be disabling. Paresthesia, circumoral numbness, chest wall tightness or pain, dizziness, inability to take an adequate breath, and, rarely, tetany may themselves be sufficiently. | Chapter 048. Acidosis and Alkalosis Part 14 Chronic respiratory alkalosis is the most common acid-base disturbance in critically ill patients and when severe portends a poor prognosis. Many cardiopulmonary disorders manifest respiratory alkalosis in their early to intermediate stages and the finding of normocapnia and hypoxemia in a patient with hyperventilation may herald the onset of rapid respiratory failure and should prompt an assessment to determine if the patient is becoming fatigued. Respiratory alkalosis is common during mechanical ventilation. The hyperventilation syndrome may be disabling. Paresthesia circumoral numbness chest wall tightness or pain dizziness inability to take an adequate breath and rarely tetany may themselves be sufficiently stressful to perpetuate the disorder. Arterial blood-gas analysis demonstrates an acute or chronic respiratory alkalosis often with hypocapnia in the range of 15-30 mmHg and no hypoxemia. Central nervous system diseases or injury can produce several patterns of hyperventilation and sustained PaCO2 levels of 20-30 mmHg. Hyperthyroidism high caloric loads and exercise raise the basal metabolic rate but ventilation usually rises in proportion so that arterial blood gases are unchanged and respiratory alkalosis does not develop. Salicylates are the most common cause of drug-induced respiratory alkalosis as a result of direct stimulation of the medullary chemoreceptor Chap. e34 . The methylxanthines theophylline and aminophylline stimulate ventilation and increase the ventilatory response to Co2. Progesterone increases ventilation and lowers arterial PaCO2 by as much as 5-10 mmHg. Therefore chronic respiratory alkalosis is a common feature of pregnancy. Respiratory alkalosis is also prominent in liver failure and the severity correlates with the degree of hepatic insufficiency. Respiratory alkalosis is often an early finding in gram-negative septicemia before fever hypoxemia or hypotension develops. The diagnosis of .

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