Acidosis, Respiratory

• • 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