Respiratory acidosis classification

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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 that occurs when the lungs are not able to remove enough of the carbon dioxide (CO2) produced by the body.Respiratory acidosis may be classified into two groups: Acute respiratory acidosis and Chronic respiratory acidosis.

Classification

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, for patients who develop acute respiratory acidosis, the measured pH will be higher than predicted.
• Acute respiratory acidosis occurs due to abrupt failure of ventilation. This failure may occur
  • • Central nervous system disease or drug-induced respiratory depression
    • Inability to ventilate adequately, due to a neuromuscular disease or paralysis (eg, myasthenia gravis, amyotrophic lateral sclerosis [ALS], Guillain-Barré syndrome, muscular dystrophy)
    • Airway obstruction, usually related to asthma or chronic obstructive pulmonary disease (COPD)

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).