Respiratory acidosis: Difference between revisions

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{{Infobox_Disease |
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| [[Respiratory acidosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
  DiseasesDB    = 95 |
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  ICD10          = {{ICD10|E|87|2|e|70}} |
{{Respiratory acidosis}}
  ICD9          = {{ICD9|276.2}} |
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{{CMG}}
{{CMG}}; {{AE}} {{VKG}}
==Overview==
'''Respiratory acidosis''' is [[acidosis]] (abnormal acidity of the blood) due to decreased [[Ventilation (physiology)|ventilation]] of the [[lung|pulmonary]] [[alveoli]], leading to elevated [[artery|arterial]] [[carbon dioxide]] concentration (''Pa''CO<sub>2</sub>).
==Pathophysiology==
Respiratory acidosis is a clinical disturbance that is due to alveolar hypoventilation. Production of carbon dioxide occurs rapidly, and failure of ventilation promptly increases the level of ''Pa''CO<sub>2</sub>. Alveolar hypoventilation leads to an increased ''Pa''CO<sub>2</sub> (ie, [[hypercapnia]]). The increase in ''Pa''CO<sub>2</sub> in turn decreases the HCO<sub>3</sub><sup>-</sup>/''Pa''CO<sub>2</sub> and decreases pH. [[Hypercapnia]] and respiratory acidosis occur when impairment in ventilation occurs and the removal of CO<sub>2</sub> by the lungs is less than the production of CO<sub>2</sub> in the tissues.


== Classification ==
{{SK}} Acidosis, respiratory; blood carbon dioxide raised; hypercapnia; hypercarbia
===Acute respiratory acidosis===
* The ''Pa''CO<sub>2</sub> is elevated above the upper limit of the reference range (over 6.3 kPa or 47 mm Hg)
* Accompanied with acidemia (pH <7.35)
===Chronic respiratory acidosis===
* The ''Pa''CO<sub>2</sub> is elevated above the upper limit of the reference range
* Accompanied with a normal blood pH (7.35 to 7.45) or near-normal pH secondary to [[renal compensation]] and an elevated serum bicarbonate (HCO<sub>3</sub><sup>-</sup> >30 mm Hg).


== Causes ==
==[[Respiratory acidosis overview|Overview]]==
===Acute===
==[[Respiratory acidosis classification|Classification]]==
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]] (eg, [[myasthenia gravis]], [[amyotrophic lateral sclerosis]], [[Guillain-Barré syndrome]], [[muscular dystrophy]]), or airway obstruction related to asthma or chronic obstructive pulmonary disease (COPD) exacerbation.
==[[Respiratory acidosis pathophysiology |Pathophysiology]]==
==[[Respiratory acidosis causes|Causes]]==
==[[Respiratory acidosis differential diagnosis|Differentiating Respiratory acidosis from other Diseases]]==
==[[Respiratory acidosis epidemiology and demographics|Epidemiology and Demographics]]==
==[[Respiratory acidosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==Diagnosis==
[[Respiratory acidosis history and symptoms|History and Symptoms]] | [[Respiratory acidosis physical examination|Physical Examination]] | [[Respiratory acidosis laboratory findings|Laboratory Findings]] | [[Respiratory acidosis chest x ray|Chest X Ray]] | [[Respiratory acidosis CT|CT]] | [[Respiratory acidosis other imaging findings|Other Imaging Findings]] | [[Respiratory acidosis other diagnostic studies|Other Diagnostic Studies]]


===Chronic===
==Treatment==
Chronic respiratory acidosis may be secondary to many disorders, including [[COPD]]. Hypoventilation in COPD involves multiple mechanisms, including decreased responsiveness to [[Hypoxia (medical)|hypoxia]] and [[hypercapnia]], increased [[ventilation-perfusion mismatch]] leading to increased [[dead space]] ventilation, and decreased [[diaphragm (anatomy)|diaphragm]] function secondary to fatigue and hyperinflation.
[[Respiratory acidosis medical therapy|Medical Therapy]] | [[Respiratory acidosis surgery|Surgery]] | [[Respiratory acidosis primary prevention|Primary Prevention]] | [[Respiratory acidosis secondary prevention|Secondary Prevention]] | [[Respiratory acidosis future or investigational therapies|Future or Investigational Therapies]]
 
==Case Studies==
Chronic respiratory acidosis also may be secondary to [[obesity hypoventilation syndrome]] (ie, [[Pickwickian syndrome]]), neuromuscular disorders such as [[amyotrophic lateral sclerosis]], and severe restrictive ventilatory defects as observed in interstitial fibrosis and [[thoracic]] deformities.
:[[Respiratory acidosis case study one|Case #1]]
 
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 occurs.
===Common Causes===
===Causes by Organ System===
 
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Agrocide]], [[Agronexit]], [[Aparasin]], [[Aphtiria]], [[Ben-Hex]], [[Benhexol]], [[Benzene hexachloride]], [[Bexol]], [[Chloresene]], [[Cone shell poisoning]], [[HCH-gamma]], [[Hexachlorocyclohexane (gamma)]], [[Lindane]], [[Poison hemlock]], [[Tetrodotoxin]], [[Tick paralysis]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Acetylcarbromal]], [[Alfentanil]], [[Alprazolam]], [[Amylobarbitone]], [[Barbitone]], [[Bromazepam]], [[Brotizolam]], [[Butabarbital]], [[Butalbital]], [[Butobarbitone]], [[Camazepam]], [[Chlordiazepoxide]], [[Cinolazepam]], [[Clobazam]], [[Clonazepam]], [[Clorazepate]], [[Clotiazepam]], [[Cloxazolam]], [[Cyclobarbital]], [[Demethyldiazepam]], [[Diazepam]], [[Doxefazepam]], [[Drug overdose]], [[Estazolam]], [[Ethyl loflazepate]], [[Etizolam]], [[Etomidate]], [[Fentanyl]], [[Flurazepam]], [[Fluridrazepam]], [[Fospropofol]], [[General anaesthesia]], [[Halazepam]], [[Haloxazolam]], [[Hexobarbital]], [[Ketazolam]], [[Loprazolam]], [[Lorazepam]], [[Lormetazepam]], [[Medazepam]], [[Mephobarbital]], [[Methohexital]], [[Mexazolam]], [[Midazolam]], [[Nitrazepam]], [[Oxazepam]], [[Oxazolam]], [[Pentobarbital]], [[Pethidine]], [[Phenobarbital]], [[Pinazepam]], [[Prazepam]], [[Primidone]], [[Promethazine]], [[Propofol]], [[Quazepam]], [[Remifentanil]], [[Secobarbital]], [[Sufentanil]], [[Tapentadol]], [[Temazepam]], [[Tetrazepam]], [[Thiamylal]], [[Thiopentone]], [[Tofisopam]], [[Triazolam]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Necrotizing enterocolitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Athabaskan brain stem dysgenesis]], [[Edstrom myopathy]], [[Jeune thoracic dystrophy syndrome]], [[Muscular dystrophy]], [[Nemaline myopathy]], [[Perry syndrome]], [[Pitt-Hopkins syndrome]], [[Ullrich congenital muscular dystrophy]], [[X-linked myotubular myopathy]], [[Stuve-Wiedemann syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Clostridium tetani]], [[Poliomyelitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Cervical spine injury]], [[Congenital diaphragmatic hernia]], [[Congenital fiber-type disproportion myopathy]], [[Diaphragm paralysis]], [[Idiopathic spinal scoliosis]], [[Rib fracture]], [[Severe kyphoscoliosis]], [[Stuve-Wiedemann syndrome]], [[Muscular dystrophy]], [[Nemaline myopathy]], [[Ullrich congenital muscular dystrophy]], [[X-linked myotubular myopathy]], [[Neuromuscular diseases]], [[Myasthenia gravis]], [[Polymyositis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Amyotrophic lateral sclerosis]], [[Brain death]], [[Brown-Vialetto-van Laere syndrome]], [[Central sleep apnea]], [[CNS depression]], [[Congenital failure of autonomic control]], [[Guillain-Barre syndrome]], [[Motor neuron disease]], [[Neuromuscular diseases]], [[Raised intracranial pressure]], [[Subacute necrotising encephalomyelopathy]], [[X-linked infantile spinal muscular atrophy]], [[Athabaskan brain stem dysgenesis]], [[Diaphragm paralysis]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Subacute necrotising encephalomyelopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Acetylcarbromal]], [[Alfentanil]], [[Alprazolam]], [[Amylobarbitone]], [[Barbitone]], [[Bromazepam]], [[Brotizolam]], [[Butabarbital]], [[Butalbital]], [[Butobarbitone]], [[Camazepam]], [[Chlordiazepoxide]], [[Cinolazepam]], [[Clobazam]], [[Clonazepam]], [[Clorazepate]], [[Clotiazepam]], [[Cloxazolam]], [[Cyclobarbital]], [[Demethyldiazepam]], [[Diazepam]], [[Doxefazepam]], [[Drug overdose]], [[Estazolam]], [[Ethyl loflazepate]], [[Etizolam]], [[Etomidate]], [[Fentanyl]], [[Flurazepam]], [[Fluridrazepam]], [[Fospropofol]], [[General anaesthesia]], [[Halazepam]], [[Haloxazolam]], [[Hexobarbital]], [[Ketazolam]], [[Loprazolam]], [[Lorazepam]], [[Lormetazepam]], [[Medazepam]], [[Mephobarbital]], [[Methohexital]], [[Mexazolam]], [[Midazolam]], [[Nitrazepam]], [[Oxazepam]], [[Oxazolam]], [[Pentobarbital]], [[Pethidine]], [[Phenobarbital]], [[Pinazepam]], [[Prazepam]], [[Primidone]], [[Promethazine]], [[Propofol]], [[Quazepam]], [[Remifentanil]], [[Secobarbital]], [[Sufentanil]], [[Tapentadol]], [[Temazepam]], [[Tetrazepam]], [[Thiamylal]], [[Thiopentone]], [[Tofisopam]], [[Triazolam]], [[Oxygen]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Chronic bronchitis]], [[Chronic obstructive pulmonary disease]], [[Emphysema]], [[Foreign body in respiratory tract]], [[Hyaline membrane disease]], [[Obesity hypoventilation syndrome]], [[Obstructive sleep apnea]], [[Pickwickian syndrome]], [[Pneumothorax]], [[Pulmonary hypoplasia]], [[Respiratory depression]], [[Respiratory distress syndrome]], [[Severe asthma]], [[Shallow Breathing ]], [[Snoring]], [[Stuve-Wiedemann syndrome]], [[Tracheal stenosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Myasthenia gravis]], [[Polymyositis]], [[Guillain-Barre syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Flail chest]], [[Cervical spine injury]], [[Pneumothorax]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Asphyxiation]], [[Reduced level of consciousness]], [[Congenital failure of autonomic control]], [[Shallow Breathing ]]
|-
|}
 
===Causes in Alphabetical Order===
 
{{MultiCol}}
*[[Acetylcarbromal]]
*[[Agrocide]]
*[[Agronexit]]
*[[Alfentanil]]
*[[Alprazolam]]
*[[Amylobarbitone]]
*[[Amyotrophic lateral sclerosis]]
*[[Aparasin]]
*[[Aphtiria]]
*[[Asphyxiation]]
*[[Athabaskan brain stem dysgenesis]]
*[[Barbitone]]
*[[Ben-Hex]]
*[[Benhexol]]
*[[Benzene hexachloride]]
*[[Bexol]]
*[[Brain death]]
*[[Bromazepam]]
*[[Brotizolam]]
*[[Brown-Vialetto-van Laere syndrome]]
*[[Butabarbital]]
*[[Butalbital]]
*[[Butobarbitone]]
*[[Camazepam]]
*[[Central sleep apnea]]
*[[Cervical spine injury]]
*[[Chlordiazepoxide]]
*[[Chloresene]]
*[[Chronic bronchitis]]
*[[Chronic obstructive pulmonary disease]]
*[[Cinolazepam]]
*[[Clobazam]]
*[[Clonazepam]]
*[[Clorazepate]]
*[[Clostridium tetani]]
*[[Clotiazepam]]
*[[Cloxazolam]]
*[[CNS depression]]
*[[Cone shell poisoning]]
*[[Congenital diaphragmatic hernia]]
*[[Congenital failure of autonomic control]]
*[[Congenital fiber-type disproportion myopathy]]
*[[Cyclobarbital]]
*[[Demethyldiazepam]]
*[[Diaphragm paralysis]]
*[[Diazepam]]
*[[Doxefazepam]]
*[[Drug overdose]]
*[[Edstrom myopathy]]
*[[Emphysema]]
*[[Estazolam]]
*[[Ethyl loflazepate]]
*[[Etizolam]]
*[[Etomidate]]
*[[Fentanyl]]
*[[Flail chest]]
*[[Flurazepam]]
*[[Fluridrazepam]]
*[[Foreign body in respiratory tract]]
*[[Fospropofol]]
*[[General anaesthesia]]
*[[Guillain-Barre syndrome]]
*[[Halazepam]]
*[[Haloxazolam]]
*[[HCH-gamma]]
*[[Hexachlorocyclohexane (gamma)]]
*[[Hexobarbital]]
*[[Hyaline membrane disease]]
{{ColBreak}}
*[[Idiopathic spinal scoliosis]]
*[[Jeune thoracic dystrophy syndrome]]
*[[Ketazolam]]
*[[Lindane]]
*[[Loprazolam]]
*[[Lorazepam]]
*[[Lormetazepam]]
*[[Medazepam]]
*[[Mephobarbital]]
*[[Methohexital]]
*[[Mexazolam]]
*[[Midazolam]]
*[[Motor neuron disease]]
*[[Muscular dystrophy]]
*[[Myasthenia gravis]]
*[[Necrotizing enterocolitis]]
*[[Nemaline myopathy]]
*[[Neuromuscular diseases]]
*[[Nitrazepam]]
*[[Obesity hypoventilation syndrome]]
*[[Obstructive sleep apnea]]
*[[Oxazepam]]
*[[Oxazolam]]
*[[Oxygen]]
*[[Pentobarbital]]
*[[Perry syndrome]]
*[[Pethidine]]
*[[Phenobarbital]]
*[[Pickwickian syndrome]]
*[[Pinazepam]]
*[[Pitt-Hopkins syndrome]]
*[[Pneumothorax]]
*[[Poison hemlock]]
*[[Poliomyelitis]]
*[[Polymyositis]]
*[[Prazepam]]
*[[Primidone]]
*[[Promethazine]]
*[[Propofol]]
*[[Pulmonary hypoplasia]]
*[[Quazepam]]
*[[Raised intracranial pressure]]
*[[Reduced level of consciousness]]
*[[Remifentanil]]
*[[Respiratory depression]]
*[[Respiratory distress syndrome]]
*[[Rib fracture]]
*[[Secobarbital]]
*[[Severe asthma]]
*[[Severe kyphoscoliosis]]
*[[Shallow Breathing ]]
*[[Snoring]]
*[[Stuve-Wiedemann syndrome]]
*[[Subacute necrotising encephalomyelopathy]]
*[[Sufentanil]]
*[[Tapentadol]]
*[[Temazepam]]
*[[Tetrazepam]]
*[[Tetrodotoxin]]
*[[Thiamylal]]
*[[Thiopentone]]
*[[Tick paralysis]]
*[[Tofisopam]]
*[[Tracheal stenosis]]
*[[Triazolam]]
*[[Ullrich congenital muscular dystrophy]]
*[[X-linked infantile spinal muscular atrophy]]
*[[X-linked myotubular myopathy]]
{{EndMultiCol}}
 
==Differential diagnosis of respiratory acidosis==
The differential diagnosis of respiratory acidosis is generated by considering three structures involved in ventilation: the chest cavity (which expands and contracts the lungs), central processes (i.e. those that affect the central respiratory drive center), and the lungs and airways themselves.
==References==
{{reflist|2}}


==Related Chapters==
* [[Metabolic alkalosis]]
* [[Acid-base imbalance]]
* [[Metabolic acidosis]]
* [[Respiratory alkalosis]]
* [[Anion gap]]
* [[Hypocalcemia]]
[[Category:Electrolyte disturbance]]
[[Category:Inborn errors of metabolism]]
[[Category:Inborn errors of metabolism]]
[[Category:Signs and symptoms]]
[[Category:Medical tests]]
[[Category:Pulmonology]]
[[Category:Laboratory Test]]
[[Category:Electrolyte disturbance]]
[[Category:Nephrology]]
 
[[fr:Acidose respiratoire]]
 


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Latest revision as of 19:38, 7 March 2018



Resident
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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]

Synonyms and keywords: Acidosis, respiratory; blood carbon dioxide raised; hypercapnia; hypercarbia

Overview

Classification

Pathophysiology

Causes

Differentiating Respiratory acidosis from other Diseases

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | Other Imaging Findings | Other Diagnostic Studies

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