RESPIRATORY

ACIDOSIS
Physiology

 Acid base balance maintained by :

 Co2 excretion by lungs
 H+ ions combine with buffers and excreted via kidneys.
Normal values

 pH : 7.35– 7.45
 Bicarbonate : 21 – 27 mEq/l
 PCo2 : 35-45 mmHg
Respiratory acidosis

 Lowering of pH
 Elevation of arterial pCo2 level.
 Simple acid base disorder
 Mixed acid base disorder
Causes

 Factors increasing co2

 Reduction of minute ventilation
 Increase dead space
Increased co2

 Rare
 washed out due to increased minute ventilation
 COPD exacerbation
 Respiratory muscle weakness
 Fever
 Thyrotoxicosis
 Sepsis
 Steroids
 Exercise
Reduced minute ventilation

 RR X Vt
 Central respiratorycentre: Changes in H+ conc. , Paco2, pao2
 Accessory muscles of respiration : rate and depth
 Thoracic cage function : expansion
Increased dead space

 Non gas exchanging parts of the lung.

 Increased V/Q
 COPD
 VD/VT INCREASE
COMPENSATION

 10: 1 - PCO2:HCO3 IN an acute scenario

 10 : 4 in chronic settings.
Clinical features

 Mild to moderate hypercapnia : anxiety, sluggishness, headaches,

mild dyspnea
 Rapidly developing hypercapnia – altered sensorium, paranoia,
depression and confusion which can progress to coma.
 Severe cases : asterixis, myoclonus, seizures, papilledema, dilated
superficial veins.
Always rule out

 Sedative use
 History of COPD/ILD.
 Central and peripehral muscular causes
Treatment

 ABC : supplemental oxygen

 Mechanical ventilation
 Emergency cricothyrotomy in case of upper airway obstruction
 NIV
 IV ACCESS
 ABG
 ACUTE OR CHRONIC
Treat the underlying cause

 Antidotes for drug OD.

 Naloxone : opioids
 Flumazenil : BZD
 NIV/bag mask
 Follow up abg
Oxygen supplementation

 Can worsen hypercapnia

 Keep saturation between 89-91/93
 Only if hypoxia persists
 Repeat abgs
cases

24 year old found unconscious

Pinpoint pupils
Spo2: 88
ABG : pH : 7.25
pCo2: 60’po2: 65
Hco3 : 26
 60 y/o k/c/o ALS
 Increased somnolescence
 Headaches
 ABG :
 Ph : 7.37
 Pco2: 57
 Hco3 : 32
 P02 : 70
 Thank you.