Respiratory acidosis classification: Difference between revisions
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==Overview== | ==Overview== | ||
[[Respiratory acidosis]] is a clinical [[condition]] | [[Respiratory acidosis]] is a clinical [[condition]] associated with [[Lung|lungs]] dysfunction in order to remove excess [[carbon dioxide]] (CO2) from the body. [[Respiratory acidosis]] may be classified into two groups: [[Acute]] [[respiratory acidosis]] and [[Chronic]] [[respiratory acidosis]]. | ||
== Classification == | == Classification == | ||
*[[Respiratory acidosis]] is classified into [[acute]] and [[chronic]] groups, depending on the duration. | |||
===Acute respiratory acidosis=== | ===Acute respiratory acidosis=== | ||
* [[Acute]] [[respiratory acidosis]] occurs when [[PaCO2]] is increased above the upper limit of the [[References|reference]] range >45 mmHg with an accompanying [[acidemia]] (ie, pH <7.35). | * [[Acute]] [[respiratory acidosis]] occurs when [[PaCO2]] is increased above the upper limit of the [[References|reference]] range >45 mmHg with an accompanying [[acidemia]] (ie, pH <7.35). | ||
* In patients with pure [[acute]] [[respiratory acidosis]], the levels of [[hypercapnia]] and [[bicarbonate]] correctly predicts the [[pH]]. | * In patients with pure [[acute]] [[respiratory acidosis]], the levels of [[hypercapnia]] and [[bicarbonate]] correctly predicts the [[pH]]. | ||
* In contrast, | * In contrast, in patients who develop acute [[respiratory acidosis]], the measured [[pH]] will be higher than predicted. | ||
* Acute [[respiratory acidosis]] occurs due to the result of sudden failure of [[Ventilation (physiology)|ventilation]]. This failure may be due to [[central nervous system]]([[CNS]]) disease or any drug-induced respiratory [[depression]]. | * [[Acute]] [[respiratory acidosis]] occurs due to the result of sudden failure of [[Ventilation (physiology)|ventilation]]. This failure may be due to [[central nervous system]]([[CNS]]) disease or any drug-induced [[respiratory]] [[depression]]. | ||
* Inability to ventilate sufficiently , due to [[paralysis]] | * Inability to ventilate sufficiently , due to [[respiratory]] [[muscle]] [[paralysis]] disorders including [[myasthenia gravis]], [[amyotrophic lateral sclerosis]] [[[Amyotrophic lateral sclerosis|ALS]]], [[guillain-Barré syndrome]], [[muscular dystrophy]]. | ||
* Airway obstruction, usually seen in | * [[Airway]] [[obstruction]], usually seen in patients with [[asthma]] or [[chronic obstructive pulmonary disease]] ([[COPD]]).<ref name="pmid11262556">{{cite journal |vauthors=Epstein SK, Singh N |title=Respiratory acidosis |journal=Respir Care |volume=46 |issue=4 |pages=366–83 |year=2001 |pmid=11262556 |doi= |url=}}</ref><ref name="pmid22500110">{{cite journal |vauthors=Bruno CM, Valenti M |title=Acid-base disorders in patients with chronic obstructive pulmonary disease: a pathophysiological review |journal=J. Biomed. Biotechnol. |volume=2012 |issue= |pages=915150 |year=2012 |pmid=22500110 |pmc=3303884 |doi=10.1155/2012/915150 |url=}}</ref> | ||
===Chronic respiratory acidosis=== | ===Chronic respiratory acidosis=== | ||
* Chronic respiratory acidosis occurs when ''Pa''CO<sub>2</sub> is elevated above the upper limit of the reference range ie >45 mmHg. | * Chronic [[respiratory acidosis]] occurs when [[PaCO2|''Pa''CO<sub>2</sub>]] is elevated above the upper limit of the reference range ie >45 mmHg. | ||
* But the pH is at the lower limit of normal or near-normal pH (eg, pH 7.33 to 7.35) secondary to renal compensation (secretion of acid from the distal tubule). | * But the [[pH]] is at the lower limit of normal or near-normal pH (eg, pH 7.33 to 7.35) secondary to [[renal]] [[Compensation (essay)|compensation]] (secretion of acid from the [[distal tubule]]). | ||
* | * [[Chronic]] [[respiratory acidosis]] may occur [[secondary]] to many diseases such as [[chronic obstructive pulmonary disease]](COPD) and [[Obesity hypoventilation syndrome]] ([[Obesity hypoventilation syndrome|OHS]]) that involve multiple mechanisms including<ref name="pmid112625562">{{cite journal |vauthors=Epstein SK, Singh N |title=Respiratory acidosis |journal=Respir Care |volume=46 |issue=4 |pages=366–83 |year=2001 |pmid=11262556 |doi= |url=}}</ref><ref name="pmid225001102">{{cite journal |vauthors=Bruno CM, Valenti M |title=Acid-base disorders in patients with chronic obstructive pulmonary disease: a pathophysiological review |journal=J. Biomed. Biotechnol. |volume=2012 |issue= |pages=915150 |year=2012 |pmid=22500110 |pmc=3303884 |doi=10.1155/2012/915150 |url=}}</ref><ref name="pmid20488285">{{cite journal |vauthors=Brown LK |title=Hypoventilation syndromes |journal=Clin. Chest Med. |volume=31 |issue=2 |pages=249–70 |year=2010 |pmid=20488285 |doi=10.1016/j.ccm.2010.03.002 |url=}}</ref><ref name="pmid19452386">{{cite journal |vauthors=Berger KI, Goldring RM, Rapoport DM |title=Obesity hypoventilation syndrome |journal=Semin Respir Crit Care Med |volume=30 |issue=3 |pages=253–61 |year=2009 |pmid=19452386 |doi=10.1055/s-0029-1222439 |url=}}</ref> | ||
** In conditions with [[hypoxia]] and [[hypercapnia]], the responsiveness is decreased . | |||
** Increased in [[dead space]] [[ventilation]] due to increased [[ventilation-perfusion mismatch]]. | |||
** Function of [[Diaphragm]] decreased due to [[hyperinflation]] and [[fatigue]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 20:57, 21 September 2020
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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]
Overview
Respiratory acidosis is a clinical condition associated with lungs dysfunction in order to remove excess carbon dioxide (CO2) from the body. Respiratory acidosis may be classified into two groups: Acute respiratory acidosis and Chronic respiratory acidosis.
Classification
- Respiratory acidosis is classified into acute and chronic groups, depending on the duration.
Acute respiratory acidosis
- Acute respiratory acidosis occurs when PaCO2 is increased above the upper limit of the reference range >45 mmHg with an accompanying acidemia (ie, pH <7.35).
- In patients with pure acute respiratory acidosis, the levels of hypercapnia and bicarbonate correctly predicts the pH.
- In contrast, in patients who develop acute respiratory acidosis, the measured pH will be higher than predicted.
- Acute respiratory acidosis occurs due to the result of sudden failure of ventilation. This failure may be due to central nervous system(CNS) disease or any drug-induced respiratory depression.
- Inability to ventilate sufficiently , due to respiratory muscle paralysis disorders including myasthenia gravis, amyotrophic lateral sclerosis [[[Amyotrophic lateral sclerosis|ALS]]], guillain-Barré syndrome, muscular dystrophy.
- Airway obstruction, usually seen in patients with asthma or chronic obstructive pulmonary disease (COPD).[1][2]
Chronic respiratory acidosis
- Chronic respiratory acidosis occurs when PaCO2 is elevated above the upper limit of the reference range ie >45 mmHg.
- But the pH is at the lower limit of normal or near-normal pH (eg, pH 7.33 to 7.35) secondary to renal compensation (secretion of acid from the distal tubule).
- Chronic respiratory acidosis may occur secondary to many diseases such as chronic obstructive pulmonary disease(COPD) and Obesity hypoventilation syndrome (OHS) that involve multiple mechanisms including[3][4][5][6]
- In conditions with hypoxia and hypercapnia, the responsiveness is decreased .
- Increased in dead space ventilation due to increased ventilation-perfusion mismatch.
- Function of Diaphragm decreased due to hyperinflation and fatigue.
References
- ↑ Epstein SK, Singh N (2001). "Respiratory acidosis". Respir Care. 46 (4): 366–83. PMID 11262556.
- ↑ Bruno CM, Valenti M (2012). "Acid-base disorders in patients with chronic obstructive pulmonary disease: a pathophysiological review". J. Biomed. Biotechnol. 2012: 915150. doi:10.1155/2012/915150. PMC 3303884. PMID 22500110.
- ↑ Epstein SK, Singh N (2001). "Respiratory acidosis". Respir Care. 46 (4): 366–83. PMID 11262556.
- ↑ Bruno CM, Valenti M (2012). "Acid-base disorders in patients with chronic obstructive pulmonary disease: a pathophysiological review". J. Biomed. Biotechnol. 2012: 915150. doi:10.1155/2012/915150. PMC 3303884. PMID 22500110.
- ↑ Brown LK (2010). "Hypoventilation syndromes". Clin. Chest Med. 31 (2): 249–70. doi:10.1016/j.ccm.2010.03.002. PMID 20488285.
- ↑ Berger KI, Goldring RM, Rapoport DM (2009). "Obesity hypoventilation syndrome". Semin Respir Crit Care Med. 30 (3): 253–61. doi:10.1055/s-0029-1222439. PMID 19452386.