A 23-year-old female is SOB and unable to speak. Her hands, fingers, feet and toes are contracted inward and locked in the flexed position. What acid-base disturbance should you suspect?

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Hyperventilation pushes CO2 out of the body, causing respiratory alkalosis. When the blood becomes more alkaline, more calcium binds to albumin, reducing the amount of free (ionized) calcium. That drop in ionized calcium increases neuromuscular irritability, leading to tetany and carpopedal spasms like the hands and other digits curling inward. So the scenario fits respiratory alkalosis: rapid breathing with neuromuscular symptoms from low ionized calcium.

Metabolic acidosis or respiratory acidosis would present with different pH and ventilatory patterns and are not typically associated with this kind of tetany. Hyperkalemia is an electrolyte issue, not an acid-base disturbance, and doesn’t specifically explain the carpopedal spasm in this context.