Respiratory acidosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S[2]


The mainstay of treatment for respiratory acidosis is treating the underlying disorder which is responsible for the condition.While correcting hypercapnia extra care should be taken because rapid correction of the hypercapnia can result in metabolic alkalemia and can result in seizures especially when cerebrospinal fluid (CSF) becomes alkaline.Indications for admitting the patient in intensive care unit (ICU) when a patient presents with a low pH of (< 7.25), confusion, lethargy and respiratory muscle weakness.

Medical Therapy

  • Pharmacologic medical therapy is recommended for patients who are taking sedatives.[1][2]
  • For patients who are suspected of drug overdose administration of antidote is considered when the physician think it safe.
    • Preferred regimen (1): Naloxone 0.05 mg intravenously (IV) as an initial
    • In apneic patients give Naloxone 0.2 to 1 mg as an initial dose.
    • In cardiorespiratory arrest give Naloxone  2 mg as an initial dose.
    • Preferred regimen (2): Flumazenil 0.2 mg given IV over 30 seconds as an initial dose.
    • 0.2 mg to a maximum dose of 1 mg of Flumazenil should be considered but not more than that for an initial dose in an adult.
    • Overall not more than 3 mg of flumazenil should be given.

Bag-valve mask ventilation[3]


  • In patients with severe hypoxemia it is necessary to administer oxygen to avoid life threatening complications.
  • Goals to administer oxygen:
    • 1)The primary goal is to treat hypoxemia.
    • 2) The second goal is to prevent worsening of hypercapnia.


  1. Belghiti J, Wind P, Bernades P, Fékété F (November 1987). "Acute pancreatitis associated with carcinoma of the ampulla of Vater". Br J Surg. 74 (11): 1067–8. PMID 3690240.
  2. Epstein SK, Singh N (April 2001). "Respiratory acidosis". Respir Care. 46 (4): 366–83. PMID 11262556.
  3. Belghiti J, Wind P, Bernades P, Fékété F (November 1987). "Acute pancreatitis associated with carcinoma of the ampulla of Vater". Br J Surg. 74 (11): 1067–8. PMID 3690240.
  4. Rudolf M, Banks RA, Semple SJ (September 1977). "Hypercapnia during oxygen therapy in acute exacerbations of chronic respiratory failure. Hypothesis revisited". Lancet. 2 (8036): 483–6. PMID 70692.
  5. O'Driscoll BR, Howard LS, Earis J, Mak V (June 2017). "BTS guideline for oxygen use in adults in healthcare and emergency settings". Thorax. 72 (Suppl 1): ii1–ii90. doi:10.1136/thoraxjnl-2016-209729. PMID 28507176.
  6. Durrington HJ, Flubacher M, Ramsay CF, Howard LS, Harrison BD (July 2005). "Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease". QJM. 98 (7): 499–504. doi:10.1093/qjmed/hci084. PMID 15955796.