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  • • Inadequate respiration

    • Carbon dioxide accumulation

Epidemiology

  • • Etiologies include:

    • -Acute airway obstruction

      -Aspiration

      -Respiratory arrest

      -Pulmonary infections

      -Pulmonary edema

      -Over sedation

      -Chronic respiratory failure

Symptoms and Signs

  • • Somnolence

    • None if chronic and well compensated

Laboratory Findings

  • • Decreased serum pH (< 7.35)

    • Increased Pco2

  • • Causes may be neurologic, mechanical, or rarely from diffusion abnormality

    • May be acute or chronic

  • • ABG measurements

    • Plain chest film if pneumothorax is suspected or if endotracheal tube malposition or other anatomic consideration is of concern

  • • Restoration of adequate ventilation

    • Intubation, if necessary

    • Chronic-rapid correction may lead to severe metabolic alkalosis (post-hypercapneic metabolic alkalosis)

Surgery

Indications

  • • If unable to intubate, cricothyroidotomy may be necessary

Medications

  • • Sodium bicarbonate (rarely)

    • Narcotic antagonists

    • Benzodiazepine antagonists

Treatment Monitoring

  • • Serial ABG measurements

Complications

  • • Coma

    • Death

Prognosis

  • • Excellent if reversed quickly

    • Varies with etiology

Prevention

  • • Avoid over sedation

References

Adrogue HJ et al. Management of life-threatening acid-base disorders. (Two parts.) N Engl J Med. 1998;338:26, 107.

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