]> 2026-07-31T07:53:11+00:00 WBR1082 0 en CO2 retention A failure to improve even after a repeat steroid and albuterol is typical for decreased hypoxic drive. A quick initial improvement followed by worsening of the dyspnea is specific for decreased hypoxic drive. Respiratory acidosis Acute respiratory acidosis occurs when an abrupt failure of ventilation occurs. This failure in ventilation may be caused by depression of the central respiratory center by cerebral disease or drugs, inability to ventilate adequately due to neuromuscular disease (e.g., myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, muscular dystrophy), or airway obstruction related to asthma or chronic obstructive pulmonary disease (COPD) exacerbation.Chronic respiratory acidosis may be secondary to many disorders, including COPD. Hypoventilation in COPD involves multiple mechanisms, including decreased responsiveness to hypoxia and hypercapnia, increased ventilation-perfusion mismatch leading to increased dead space ventilation, and decreased diaphragm function secondary to fatigue and hyperinflation. Chronic respiratory acidosis also may be secondary to obesity hypoventilation syndrome (i.e., Pickwickian syndrome), neuromuscular disorders such as amyotrophic lateral sclerosis, and severe restrictive ventilatory defects as observed in interstitial fibrosis and thoracic deformities. Lung diseases that primarily cause abnormality in alveolar gas exchange usually do not cause hypoventilation but tend to cause stimulation of ventilation and hypocapnia secondary to hypoxia. Hypercapnia only occurs if severe disease or respiratory muscle fatigue occu No response to treatment. This is the wrong answer as the quick initial improvement followed by worsening of the dyspnea is specific for decreased hypoxic drive. Decreased hypoxic drive Fatigue Fatigue will not cause an initial improvement and then worsening Internal medicine Chetan Lokhande A 65-year-old male who smokes 1 pack per day for 35 years was brought to the emergency oepartment for acute shortness of breath. The emergency room physician administers 5L of Oxygen, orders an arterial blood gas, CXR, start inhaled albuterol plus ipratropium bromide and a steroid bolus. Initially he responds well, but after 15 min he complains of increasing difficulty breathing . A repeat steroid bolus and inhaled albuterol fails to relieve the shortness of breath. Which of these is the most probable cause of his increasing breathing difficulty? D Respiratory 2020-10-28T02:33:41Z 2459150.6067245 WBR1082