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Alkalosis, Respiratory and Metabolic, Animation

Acid base balance, respiratory and metabolic alkalosis, causes, pathophysiology, symptoms, diagnosis and treatment. This video is available for instant download licensing here:
Voice by: Ashley Fleming
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Alkalosis refers to a process that causes increased alkalinity in the blood and body’s tissues.
The body’s blood pH is maintained by the balance between acids and bases. Alkalosis occurs when bases accumulate or acids are lost. The major players are carbon dioxide and bicarbonate. Carbon dioxide acts as an acid as it combines with water to make carbonic acid, releasing hydrogen ions; while bicarbonate binds to and neutralizes hydrogen ions, acting as a base.
Normal cellular metabolism constantly produces and excretes carbon dioxide into the blood, and therefore constantly making the blood more acidic. The body keeps the blood pH within the normal range by 2 mechanisms: removal of carbon dioxide through exhalation by the lungs, and excretion of acids and RE-absorption of bicarbonate through the kidneys. Pulmonary regulation is fast, acting within minutes to hours. Renal regulation is slower, taking days to respond to pH changes.
There are 2 major types of alkalosis: respiratory and metabolic.
Respiratory alkalosis results from increased respiratory rate or volume, or hyperventilation. As carbon dioxide is excessively exhaled, the blood becomes more alkaline, its pH increases. Respiratory alkalosis is characterized by primary decrease in carbon dioxide partial pressure. Compensatory decrease in bicarbonate may or may not occur; pH may be high or near normal.
Hyperventilation is often a result of normal physiological response to low blood oxygen (hypoxia), such as at high altitude or in lung conditions; or a response to high blood acidity, or increased metabolic demand. Hyperventilation may also occur as part of a panic attack, when the body overreacts to anxiety or pain. Conditions that affect the central respiratory center may also cause hyperventilation.
Respiratory alkalosis can be acute or chronic. Apart from signs of hyperventilation, the acute form can cause light-headedness, tingling in the fingers, toes and around the lips, muscle twitching and cramps, confusion, and fainting. The chronic form may not show any symptoms because the kidneys, over the course of several days, are generally able to compensate by decreasing acid excretion.
Metabolic alkalosis may result from loss of acids, such as during prolonged vomiting; ingestion of base, such as overuse of antacids; intracellular shift of hydrogen ions, such as in hypokalemia; and impaired kidney functions that lead to excessive acid excretion or bicarbonate retention. Common factors that affect the kidneys include certain diuretics, and increased aldosterone – an adrenal hormone that stimulates excretion of potassium and hydrogen ions. Because loss of potassium often occurs concomitantly with loss of hydrogen ions, metabolic alkalosis is often associated with hypokalemia.
Metabolic alkalosis is characterized by primary increase in plasma bicarbonate, with or without secondary increase in carbon dioxide partial pressure, pH may be high or near normal.
Symptoms are not specific; they reflect the underlying condition.
Diagnostic tests for alkalosis include arterial blood gas and serum electrolyte measurements. Cause can often be determined clinically.
Treatments aim at the cause. Respiratory alkalosis itself does not usually require treatment, but hypoxia, if present, must be corrected. Pulmonary embolism may occur without hypoxia and must be differentiated from panic attack for timely treatment.
Metabolic alkalosis caused by volume depletion is usually responsive to intravenous fluid containing 0.9% sodium chloride. Severe cases of metabolic alkalosis that are chloride-unresponsive may require dialysis or slow administration of acid.


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