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  • Causes of Respiratory, Metabolic Acidosis and Alkalosis by Mechanism

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    Cristian Rajagukguk
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    This document outlines various causes of respiratory acidosis and alkalosis classified by their mechanism. For respiratory acidosis, the causes are inadequate alveolar ventilation due to central nervous system issues, nerve or muscle disorders, lung/chest wall defects, airway disorders, or external factors. Additional causes are an overproduction of carbon dioxide or increased intake of carbon dioxide. For respiratory alkalosis, the causes are central issues affecting the respiratory center, hypoxemia, pulmonary issues, or excessive controlled ventilation.

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    This document outlines various causes of respiratory acidosis and alkalosis classified by their mechanism. For respiratory acidosis, the causes are inadequate alveolar ventilation due to central nervous system issues, nerve or muscle disorders, lung/chest wall defects, airway disorders, or external factors. Additional causes are an overproduction of carbon dioxide or increased intake of carbon dioxide. For respiratory alkalosis, the causes are central issues affecting the respiratory center, hypoxemia, pulmonary issues, or excessive controlled ventilation.

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    11 views4 pages

    Causes of Respiratory, Metabolic Acidosis and Alkalosis by Mechanism

    Uploaded by

    Cristian Rajagukguk
    This document outlines various causes of respiratory acidosis and alkalosis classified by their mechanism. For respiratory acidosis, the causes are inadequate alveolar ventilation due to central nervous system issues, nerve or muscle disorders, lung/chest wall defects, airway disorders, or external factors. Additional causes are an overproduction of carbon dioxide or increased intake of carbon dioxide. For respiratory alkalosis, the causes are central issues affecting the respiratory center, hypoxemia, pulmonary issues, or excessive controlled ventilation.

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    of 4

    Causes of Respiratory Acidosis (classified by Mechanism)

    A: Inadequate Alveolar Ventilation

    Central Respiratory Depression & Other CNS Problems

     Drug depression of resp. center (eg by opiates, sedatives, anaesthetics)


     CNS trauma, infarct, haemorrhage or tumour
     Hypoventilation of obesity (eg Pickwickian syndrome)
     Cervical cord trauma or lesions (at or above C4 level)
     High central neural blockade
     Poliomyelitis
     Tetanus
     Cardiac arrest with cerebral hypoxia

    Nerve or Muscle Disorders

     Guillain-Barre syndrome
     Myasthenia gravis
     Muscle relaxant drugs
     Toxins eg organophosphates, snake venom
     Various myopathies

    Lung or Chest Wall Defects

     Acute on COAD
     Chest trauma -flail chest, contusion, haemothorax
     Pneumothorax
     Diaphragmatic paralysis or splinting
     Pulmonary oedema
     Adult respiratory distress syndrome
     Restrictive lung disease
     Aspiration

    Airway Disorders

     Upper Airway obstruction


     Laryngospasm
     Bronchospasm/Asthma

    External Factors

     Inadequate mechanical ventilation

    B: Over-production of Carbon Dioxide


    Hypercatabolic Disorders

     Malignant Hyperthermia

    C: Increased Intake of Carbon Dioxide

    Rebreathing of CO2-containing expired gas

    Addition of CO2 to inspired gas

    Insufflation of CO2 into body cavity (eg for laparoscopic surgery)

    Causes of Respiratory Alkalosis


    1. Central Causes (direct action via respiratory centre)

     Head Injury
     Stroke
     Anxiety-hyperventilation syndrome (psychogenic)
     Other 'supra-tentorial' causes (pain, fear, stress, voluntary)
     Various drugs (eg analeptics, propanidid, salicylate intoxicati
     on)
     Various endogenous compounds (eg progesterone during pregnancy, cytokines during sepsis,
    toxins in patients with chronic liver disease)

    2. Hypoxaemia (act via peripheral chemoreceptors)

     Respiratory stimulation via peripheral chemoreceptors

    3. Pulmonary Causes (act via intrapulmonary receptors)

     Pulmonary Embolism
     Pneumonia
     Asthma
     Pulmonary oedema (all types)

    4. Iatrogenic (act directly on ventilation)

     Excessive controlled ventilation

    Causes of Metabolic Acidosis (classified by Anion Gap)

    A: High Anion-Gap Acidosis


    1. Ketoacidosis

     Diabetic ketoacidosis
     Alcoholic ketoacidosis
     Starvation ketoacidosis
    2. Lactic Acidosis

     Type A Lactic acidosis (Impaired perfusion)


     Type B Lactic acidosis (Impaired carbohydrate metabolism)

    3. Renal Failure

     Uraemic acidosis
     Acidosis with acute renal failure

    4. Toxins

     Ethylene glycol
     Methanol
     Salicylates

    B : Normal Anion-Gap Acidosis (or Hyperchloraemic acidosis)

    1. Renal Causes

     Renal tubular acidosis


     Carbonic anhydrase inhibitors

    2. GIT Causes

     Severe diarrhoea
     Uretero-enterostomy or Obstructed ileal conduit
     Drainage of pancreatic or biliary secretions
     Small bowel fistula

    3. Other Causes

     Recovery from ketoacidosis


     Addition of HCl, NH4Cl

    A Common Hybrid Classification of 'Causes' of Metabolic Alkalosis


    A: Addition of Base to ECF

     Milk-alkali syndrome
     Excessive NaHCO3 intake
     Recovery phase from organic acidosis (excess regeneration of HCO3)
     Massive blood transfusion (due metabolism of citrate)

    B: Chloride Depletion

     Loss of acidic gastric juice


     Diuretics
     Post-hypercapnia
     Excess faecal loss (eg villous adenoma)
    C: Potassium Depletion

     Primary hyperaldosteronism
     Cushing’s syndrome
     Secondary hyperaldosteronism
     Some drugs (eg carbenoxolone)
     Kaliuretic diuretics
     Excessive licorice intake (glycyrrhizic acid)
     Bartter's syndrome 1

     Severe potassium depletion

    D: Other Disorders

     Laxative abuse 2,3,4

     Severe hypoalbuminaemia 5

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