By Charles A Pohl
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4. Ammonia. Respiratory alkalosis, caused by stimulation of the respiratory center by hyperammonemia, is a frequent yet subtle clue to a urea cycle disorder. 5. Sweat test. Without adequate nutritional supplementation of Na+ and Cl−, infants with cystic fibrosis can have extracellular fluid losses resulting in loss of more Cl− than HCO3. 6. Salicylate level. Overdose from salicylate ingestion can cause mixed respiratory alkalosis with metabolic acidosis (high pH, low PCO2, and low HCO3). C. Radiographic and Other Studies 1.
What disorder and test must be considered in an ill-appearing, lethargic neonate with respiratory alkalosis? VIII. Teaching Pearl: Answer. Urea cycle disorder and ammonia level must be considered; obtain serum ammonia level. REFERENCES Andreoli TE, Carpenter CJ, Bennett JC, Plum F, eds. Cecil’s Essentials of Medicine, 4th ed. Saunders, 1997:198–202, 810–811. Brewer ED. Disorders of acid-base balance. Pediatr Clin North Am 1990;37:429–447. Gennari FJ. Maxwell and Kleeman’s Clinical Disorders of Fluid and Electrolyte Metabolism.
V. Plan. Appropriate treatment depends on identifying underlying cause of the acidosis. A. Respiratory Acidosis. If patient is oversedated with narcotics or benzodiazepines, consider administration of specific antidote. Electrolyte abnormalities (eg, hypokalemia, hypophosphatemia, hypocalcemia) may lead to muscular weakness and should be rapidly corrected. If patient has a neuromuscular disorder, noninvasive ventilation, such as continuous or bilevel positive airway pressure (CPAP or BiPAP), may be helpful.