In alkalotic states, what effect does it have on ionized calcium levels?

In alkalotic states, the levels of ionized calcium in the blood decrease, leading to a condition often associated with symptoms such as tetany. This occurs due to changes in protein binding, particularly albumin. Under alkalosis, the increased binding of calcium to albumin reduces the free or ionized calcium available in the bloodstream.

The decrease in ionized calcium can cause neuromuscular excitability, resulting in symptoms such as tingling, twitching, or muscle spasms, which are characteristic of tetany. This physiological response highlights the importance of ionized calcium as a crucial regulator of neuromuscular function. Therefore, during alkalotic states, the decrease in ionized calcium can directly lead to these clinical manifestations, confirming the link between sodium bicarbonate levels in blood alkalosis and the physiological effects on calcium homeostasis.