American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the expected correlation between chronic respiratory alkalosis and serum bicarbonate levels?

Increase in bicarbonate
No change in bicarbonate
Decrease in bicarbonate
Fluctuating levels in bicarbonate

The correct answer is: Decrease in bicarbonate

In chronic respiratory alkalosis, the body compensates for decreased carbon dioxide levels (hypocapnia) due to hyperventilation by adjusting bicarbonate levels. As chronic respiratory alkalosis develops, the kidneys compensate by excreting bicarbonate to balance the decreased acidity in the blood. This means that the serum bicarbonate levels are expected to decrease as a result of this renal compensation. In chronic conditions, the kidneys have sufficient time to adjust bicarbonate levels through increased bicarbonate loss, which leads to a net decrease in serum bicarbonate. Therefore, under persistent respiratory alkalosis, the anticipated outcome is a reduction in serum bicarbonate levels to help restore a more normal acid-base balance in the body.