Respiratory acidosis medical therapy

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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

The mainstay of treatment for respiratory acidosis is treating the underlying disorder which is responsible for the condition.While correcting hypercapnia extra care should be taken because rapid correction of the hypercapnia can result in metabolic alkalemia and can result in seizures especially when cerebrospinal fluid (CSF) becomes alkaline.Indications for admitting the patient in intensive care unit (ICU) when a patient presents with a low pH of (< 7.25), confusion, lethargy and respiratory muscle weakness.

Medical Therapy

• Pharmacologic medical therapy is recommended for patients who are taking sedatives.
• For patients who are suspected of drug overdose administration of antidote is considered when the physician think it safe.
  • Preferred regimen (1): Naloxone 0.05 mg intravenously (IV) as an initial
  • In apneic patients give Naloxone 0.2 to 1 mg as an initial dose.
  • In cardiorespiratory arrest give Naloxone  2 mg as an initial dose.
  • Preferred regimen (2): Flumazenil 0.2 mg given IV over 30 seconds as an initial dose.
  • 0.2 mg to a maximum dose of 1 mg of Flumazenil should be considered but not more than that for an initial dose in an adult.
  • Overall not more than 3 mg of flumazenil should be given.

Bag-valve mask ventilation

• Supportive therapy for respiratory acidosis includes bag-valve-mask ventilation.
• The major use of using bag-valve-mask ventilation maneuvers are to a reduction in the partial pressure of arterial carbon dioxide (PaCO2).
• Once bag-valve-mask ventilation fails to do the job patients with respiratory acidosis or hypercapnia should undergo endotracheal intubation.
• Patients who are suitable for NIV medical therapy:
  • Patients who are having moderate acute acidosis when pH <7.3.
  • Patients who are having a respiratory rate of more than 25 per min
• Patients who are not suitable for NIV medical therapy:
  • Patients who are hemodynamically unstable.
  • Patients who are in severe cardiorespiratory distress.
  • Patients who are having Impaired consciousness.
  • Patients who underwent esophageal surgery.
  • Patients who undergo gastric bypass surgery.

 Oxygen

• In patients with severe hypoxemia it is necessary to administer oxygen to avoid life threatening complications.
• Goals to administer oxygen:
  • 1)The primary goal is to treat hypoxemia.
  • 2) The second goal is to prevent worsening of hypercapnia.