Shock, Seizures, and Coma with Alkalosis During Mechanical Ventilation

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Abstract
Severe alkalosis was associated with anxiety, myoclonus, shock and seizures in addition to confusion, tremors, asterixis and coma in 11/81 patients who were treated for acute respiratory failure by controlled ventilation. Eight of these elderly men had emphysema and 3 had bronchitis. Hypercapnia was only mild to moderate before O2 was administered. Differentiation of alkalosis due to hyperventilation from acidosls produced by hypoventilation necessitates measurement of arterial blood pH because the neurologic dysfunctions associated with acidosis and alkalosis are similar. Serum chloride levels were low and bicarbonate levels were elevated in such patients so that they often became severely alkalotic when CO2 tensions were reduced to normal. Chloride supplementation may be needed to restore concentrations and improve renal excretion of bicarbonate. The neurologic dysfunction of these well oxygenated hyocapnlc alkalotic patients resembles that of patients with cerebral hypoxia. Cerebral vascular insufficiency, reduced cardiac output, obstruction to blood flow in the lungs and low blood volume appear to augment the cerebral signs of alkalosis.