Respiratory acidosis overview

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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]


Respiratory acidosis or acute hypercapnia is often asymptomatic, leading to delayed diagnosis of the condition.Respiratory acidosis can be encountered in the inpatient units and emergency department , as well as in intensive care and postoperative units.Respiratory acidosis may become life-threatening if left untreated. Respiratory acidosis was discussed as early as in 1950s by Henderson–Hasselbalch, Bronsted–Lowry, Stewart. But Arrhenius was the one who defines acid for the first time.Respiratory acidosis is a clinical condition that occurs when the lungs are not able to remove enough of the carbon dioxide (CO2) produced by the body. Respiratory acidosis may be classified into two groups: Acute respiratory acidosis and Chronic respiratory acidosis.Respiratory acidosis is an result of imbalance between acid-base due to alveolar hypoventilation.The normal range is 35-45 mm Hg for PaCO2.Increase in the production of carbon dioxide due to  failure of ventilation results in sudden increase of the partial pressure of arterial carbon dioxide (PaCO2) above the normal range. Alveolar hypoventilation is one of the cause to increased PaCO2 which is is called hypercapnia. Hypercapnia and respiration acidosis occur while impairment in air flow happens and the elimination of carbon dioxide by the respiratory system is much less than the production of carbon dioxide in the tissues.Respiratory acidosis encountered in the emergency department and inpatient patients, as well as in intensive care units and postoperative patients.Common causes of respiratory acidosis include chronic obstructive pulmonary disease (COPD), neuromuscular diseases, chest wall disorders, obesity-hypoventilation syndrome, obstructive sleep apnea (OSA), the central nervous system (CNS) depression, lung, airway diseases, laryngeal and tracheal stenosisInterstitial lung disease. Respiratory acidosis seen with past history of chronic lung disease, sleep problems if any, neuromuscular disorder, smoking history, travel history and any history of recent trauma.Symptoms may include confusion, fatigue, lethargy, shortness of breath, sleepiness or daytime somnolence.The medical manifestations of respiratory acidosis are regularly the ones of the underlying disorder. Physical examination may vary, relying on the severity of the disorder and on the rate of development of hypercapnia. mild to moderate hypercapnia that develops slowly generally has minimum symptoms.Laboratory findings consistent with the diagnosis of respiratory acidosis include arterial blood gas (ABG), complete blood count(CBC), toxicology screen, thyroid function tests, creatine phosphokinase which are helpful in the diagnosis of respiratory acidosis.An x-ray may be helpful in the diagnosis of respiratory acidosis which underlying lung pathology. Findings of an x-ray suggestive respiratory acidosis include hyperinflation, diaphragmatic flattening, Infiltrates, Pneumothorax.CT scan may be helpful in the diagnosis of respiratory acidosis.MRI may be helpful in the diagnosis of respiratory acidosis.Other diagnostic studies for respiratory acidosis include pulmonary function tests, which are necessary for the diagnosis of the chronic obstructive lung disease.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), confusionlethargy and respiratory muscle weakness.Surgical intervention is not recommended for the management of respiratory acidosis.There are no established measures for the primary prevention of respiratory acidosis.There are no established measures for the secondary prevention of respiratory acidosis.