A young patient is experiencing rapid breathing and the hands show signs of hyperventilation. Which acid-base disturbance is most likely?

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Multiple Choice

A young patient is experiencing rapid breathing and the hands show signs of hyperventilation. Which acid-base disturbance is most likely?

Rapid breathing lowers arterial carbon dioxide (PaCO2) by blowing off CO2 faster than it’s produced. CO2 combines with water to form carbonic acid, which dissociates into hydrogen ions and bicarbonate. When PaCO2 falls, hydrogen ion concentration drops, pH rises, and you get respiratory alkalosis. In an acute hyperventilating patient, this is the immediate acid-base disturbance. If the body attempted to compensate, the kidneys would excrete bicarbonate to lower pH, but that takes time. Metabolic disturbances would involve changes in bicarbonate or acid load not driven by ventilation, and respiratory acidosis would occur with hypoventilation and CO2 retention, not rapid breathing.

Rapid breathing lowers arterial carbon dioxide (PaCO2) by blowing off CO2 faster than it’s produced. CO2 combines with water to form carbonic acid, which dissociates into hydrogen ions and bicarbonate. When PaCO2 falls, hydrogen ion concentration drops, pH rises, and you get respiratory alkalosis. In an acute hyperventilating patient, this is the immediate acid-base disturbance. If the body attempted to compensate, the kidneys would excrete bicarbonate to lower pH, but that takes time. Metabolic disturbances would involve changes in bicarbonate or acid load not driven by ventilation, and respiratory acidosis would occur with hypoventilation and CO2 retention, not rapid breathing.

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