Alkalosis – Causes, Symptoms & Treatment


An alkalosis describes the deviation of the pH value to values ​​above 7.45. It can have respiratory or metabolic causes and is prevented or combated in the body over the long term by buffer systems. If the pH value remains above the healthy value for a long time or if it deviates massively for a short time, this has fatal consequences for almost all body cells.

What is alkalosis?

The topic of alkalosis takes us deep into human physiology and also a bit into chemistry. Each of the millions of body cells needs a constant environment with a pH value between 7.35 and 7.45.

Slightly alkaline, but not too alkaline and certainly not acidic. To ensure that the demanding body cells are guaranteed this environment, many so-called buffer mechanisms in the blood and tissue ensure the regulation of the pH value. If this then deviates into the alkaline (i.e. upwards), this is referred to as alkalosis – the blood becomes alkaline.

Medicine distinguishes a respiratory , ie breathing-related, from a metabolic alkalosis , the latter is caused by the metabolism and is the responsibility of the kidneys .


The main sufferers of a deviating pH value are actually always the proteins that are present in the blood and in all body cells and are necessary for a multitude of vital functions. In a normal pH environment, these proteins are in a certain functional state, but if the surrounding cell water becomes acidic or alkaline, they “denature” and can no longer function.

To prevent this, buffer systems are constantly working to keep the pH of the cell and blood plasma constant between 7.35 and 7.45. Especially during physical work, the human body accumulates a lot of acid, which is first bound in the blood via bicarbonate and transported to the lungs, where it is then exhaled in the form of carbon dioxide.

If you breathe too quickly and too much, more carbon dioxide is exhaled than necessary and the body loses more acid than originally planned – alkalosis is the result, in this case respiratory alkalosis. This happens, for example, with psychogenic hyperventilation, with a panic attack. Even serious lung diseases, such as a pulmonary embolism , can lead to the oxygen saturation of the blood being insufficient, the affected person experiencing shortness of breath, breathing faster and gasping for air, and paradoxically losing too much CO2 in the process.

Furthermore, severe pain and stays at high altitudes (mountain climbing) can cause hyperventilation . On the other hand, the kidneys are constantly working to keep the body water environment constant. Bicarbonate is constantly being filtered and reabsorbed here – the physiology of the kidneys is very complex and goes far beyond the scope here.

Let’s leave it at the statement that a disturbance in kidney function can also lead to metabolic alkalosis. An example is the exaggerated therapy with diuretics , i.e. drugs that influence the water excretion via the kidneys. A potassium deficiency can lead to alkalosis.

Furthermore, with severe or frequent vomiting , large amounts of gastric acid can be lost, leading to metabolic alkalosis.

The most common cause of alkalosis is by far psychogenic hyperventilation. The insidious thing is that the originally unnecessarily increased respiratory rate leads to exhalation of CO2 and thus to alkalosis, which then increases the feeling of panic and shortness of breath in those affected and in turn causes an increased drive to breathe. A vicious circle arises.

In truth, the blood is supplied with maximum oxygen and only the acid-base balance is out of balance. Breathing back into a bag helps: carbon dioxide accumulates in the bag and is directly inhaled again in the next breath. Calming down the hyperventilating is the most important thing to do next. A hospital admission is then usually no longer necessary after a few minutes.

Symptoms, Ailments & Signs

Symptoms of respiratory alkalosis include muscle cramps, hyperventilation , and dizziness . It can also lead to tachycardia and other cardiovascular problems. These symptoms are often accompanied by panic attacks and anxiety attacks . Externally, there is an increase in the pH value due to the “pawed position”, in which the fingers and wrist cramp involuntarily.

Other typical signs are discomfort in the hands and feet, signs of paralysis and occasionally also slight, indefinable pain in the limbs. Metabolic alkalosis has similar symptoms: cardiac arrhythmia, cramps and muscle weakness. In addition, there may be sensory disturbances on the skin and signs of hypotension.

Many sufferers suffer from general weakness , confusion and difficulty concentrating as a result of a shift in the pH value . In the case of severe metabolic and respiratory alkalosis, the affected person may lose consciousness. Both forms are often expressed by sweating , changes in skin color and blood pressure fluctuations.

A chronic illness can manifest itself through gastrointestinal complaints and a decrease in physical and mental performance. Alkalosis can usually be unequivocally diagnosed on the basis of these symptoms.

Diagnosis & History

Other symptoms of respiratory alkalosis are muscle tingling and spasms such as the typical ” pawed position” of the fingers. A subjective feeling of shortness of breath and chest tightness almost always occurs and fatally causes the person concerned to breathe even faster.

In the case of metabolic alkalosis, on the other hand, very shallow and slow breathing often occurs as a compensation in order to keep as much CO2 in the body as possible. Muscle tremors or cardiac arrhythmia can also occur here.

In the clinic, alkalosis is diagnosed using a blood gas analysis: A small drop of capillary blood from the ear or finger is sufficient for this.


Alkalosis is a serious symptom that must always be treated by a doctor. The change in the pH value usually causes tingling in the muscles and also cramps in the muscles. Patients often complain of tightness in the chest and therefore breathe in and out more.

The heart rhythm is disturbed and the muscles tremble. In the worst cases, alkalosis can initially lead to fainting and eventually death if left untreated. In most cases, an operation is necessary. If the treatment is carried out quickly enough, there will be no further complications.

However, the patient must be examined by the doctor more often in the future in order to avoid alkalosis in the future. In the case of acute alkalosis, potassium can also be given, which temporarily blocks the symptom. If alkalosis occurs after vomiting, there are usually no complications. Here the symptom will go away on its own if the vomiting also stops and does not persist.

When should you go to the doctor?

In any case, alkalosis has a very negative effect on the health of those affected and must therefore be treated in any case. In the worst case, large long-term deviations can result in death. A doctor should be consulted if symptoms of alkalosis occur. These include tingling in the muscles and pain or tightness in the chest and breathing. Breathing is usually difficult for the patient and shortness of breath occurs.

In acute emergencies, an ambulance should be called. Likewise, a doctor should be consulted or informed immediately in the event of muscle tremors or cardiac arrhythmia. Urgent treatment is necessary in case of severe convulsions or epileptic seizures. Furthermore, the affected person may faint due to the difficulty in breathing. Outsiders must ensure that loss of consciousness does not result in injuries in the event of a fall. Alkalosis often leads to sweating or panic attacks. In this case, treatment by a psychologist can be useful.

Treatment & Therapy

Alkalosis is always treated primarily for the underlying disease. In the case of a pulmonary embolism, this means immediate blood thinning and intensive medical monitoring, and in rare cases an intervention or even surgery.

Pain should be adequately treated with painkillers so that the person concerned can breathe more easily again. If a potassium deficiency caused the alkalosis as a side effect of diuretic therapy, the drug must be discontinued immediately and, if necessary, replaced with a potassium-sparing diuretic. In the short term, if the symptoms are severe, the pH value can be corrected with infusions of sodium chloride and potassium.

Potassium is a trick that indirectly succeeds in shifting acid from the cells into the extracellular space and balancing out the alkalosis there. However, since this does not change anything in principle in the overall “base excess” situation, therapy for the underlying disease must follow.

Hyperventilation, the main cause of alkalosis symptoms, can be completely eliminated by rebreathing the bag.

Outlook & Forecast

The alkalosis primarily causes severe breathing difficulties for the patient. Those affected suffer from acute shortness of breath , which can also lead to panic attacks or fear of death. There is also a lack of potassium, which has a negative effect on the overall health of the patient.

The affected person feels weak and tired and the patient’s resilience drops drastically. Normal activities or sports can therefore no longer be carried out easily due to the alkalosis. Cramps can also occur in various parts of the body, which make everyday life of the person affected significantly more difficult.

Patients often have trouble concentrating . Sometimes it is no longer possible for the patient to think and act. Heart problems can also occur, so that in the worst case the patient dies of cardiac death.

Treatment of alkalosis can be carried out with the help of drugs and infusions. There are no further complications. The symptoms usually disappear relatively quickly and the patient’s general condition improves.


There is actually no specific prophylaxis for alkalosis due to the very wide variety of underlying diseases. In general, of course, the sense and purpose of taking any medication should always be weighed against the risk of side effects.

If diuretic therapy is nevertheless necessary from these points of view, a blood gas analysis should be carried out regularly by the doctor so that an emerging alkalosis is noticed in good time. The same applies to all diseases that are associated with a tendency to alkalosis.


In most cases, direct follow-up care is not possible or necessary for alkalosis. The sufferer of this condition needs treatment to avoid further discomfort and compilations. If the alkalosis is not treated, the patient dies in most cases. For this reason, early diagnosis and treatment of alkalosis have a very positive effect on the further course of the disease.

If the alkalosis is treated by surgery, the patient must rest after such an operation and take care of his body. You should therefore refrain from strenuous activities or sporting activities. Potassium can also be taken to relieve the symptoms of alkalosis. The patient should ensure that it is taken regularly.

If the alkalosis is triggered by a drug, it is advisable to discontinue this drug. This is the only way to fully treat the disease. However, stopping medication should only be done after consulting a doctor. In some cases, the alkalosis also leads to a reduced life expectancy of the patient. However, this depends heavily on the underlying disease that is responsible for the alkalosis.

You can do that yourself

What patients can do themselves depends on the causes of the alkalosis. If this is due to the excessive use of diuretics , such preparations should only be taken after consulting a doctor. Any abuse as part of a reduction diet must be stopped immediately.

If the alkalosis is due to a lack of potassium , a balanced diet and the consumption of mineral water containing potassium will help. Avocados , bananas , kiwis , grapes and strawberries are also good sources of the mineral . Since heavy sweating is associated with an increased loss of potassium, it can be useful for athletes to take dietary supplements. However, this should not be done without consulting your doctor.

If the pH value is too high because too much CO2 is exhaled, as is often the case with psychogenic hyperventilation, for example, the patient can initially take preventive measures. Situations that trigger a panic attack must be avoided as much as possible. With the help of relaxation techniques such as yoga or autogenic training , those affected can learn to control themselves better in stressful situations. In an acute attack, breathing into a paper bag helps, as the excreted CO2 is immediately returned to the body and a further rise in pH is avoided.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.