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| '''For patient information page, click [[{{PAGENAME}} (patient information)|here]]'''
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| | | {| class="infobox" style="float:right;" |
| {{Infobox_Disease | | |
| Name = {{PAGENAME}} |
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| Image = |
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| Caption = |
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| DiseasesDB = 95 |
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| ICD10 = {{ICD10|E|87|2|e|70}} |
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| ICD9 = {{ICD9|276.2}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| MeshID = D000142 |
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| }}
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| {{Search infobox}}
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| {{CMG}}
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| ==Overview==
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| '''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>).
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| 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.
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| == Classification ==
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| Respiratory acidosis can be acute or chronic.
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| * In ''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) with an accompanying acidemia (pH <7.35).
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| * In ''chronic respiratory acidosis'', the ''Pa''CO<sub>2</sub> is elevated above the upper limit of the reference range, 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).
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| == Causes ==
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| ===Acute===
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| 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.
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| ===Chronic===
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| 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.
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| 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.
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| 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.
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| ===Common Causes===
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| ===Causes by Organ System===
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |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]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |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]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Necrotizing enterocolitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |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]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Clostridium tetani]], [[Poliomyelitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| [[Cervical spine injury]], [[Congenital diaphragmatic hernia]], [[Congenital fiber-type disproportion myopathy]], [[Diaphragm paralysis]], [[Idiopathic spinal scoliosis]], [[Rib fracture]], [[Severe kyphoscoliosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |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]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |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]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |- | | |- |
| | | [[File:Siren.gif|30px|link=Respiratory acidosis resident survival guide]]|| <br> || <br> |
| | | [[Respiratory acidosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| |} | | |} |
| | {{Respiratory acidosis}} |
| | '''For patient information page, click [[{{PAGENAME}} (patient information)|here]]''' |
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| ===Causes in Alphabetical Order===
| | {{CMG}}; {{AE}} {{VKG}} |
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| {{MultiCol}} | | {{SK}} Acidosis, respiratory; blood carbon dioxide raised; hypercapnia; hypercarbia |
| *[[Acetylcarbromal]]
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| *[[Agrocide]]
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| *[[Agronexit]]
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| *[[Alfentanil]]
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| *[[Alprazolam]]
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| *[[Amylobarbitone]]
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| *[[Amyotrophic lateral sclerosis]]
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| *[[Aparasin]]
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| *[[Aphtiria]]
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| *[[Asphyxiation]]
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| *[[Athabaskan brain stem dysgenesis]]
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| *[[Barbitone]]
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| *[[Ben-Hex]]
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| *[[Benhexol]]
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| *[[Benzene hexachloride]]
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| *[[Bexol]]
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| *[[Brain death]]
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| *[[Bromazepam]]
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| *[[Brotizolam]]
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| *[[Brown-Vialetto-van Laere syndrome]]
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| *[[Butabarbital]]
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| *[[Butalbital]]
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| *[[Butobarbitone]]
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| *[[Camazepam]]
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| *[[Central sleep apnea]]
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| *[[Cervical spine injury]]
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| *[[Chlordiazepoxide]]
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| *[[Chloresene]]
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| *[[Chronic bronchitis]]
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| *[[Chronic obstructive pulmonary disease]]
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| *[[Cinolazepam]]
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| *[[Clobazam]]
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| *[[Clonazepam]]
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| *[[Clorazepate]]
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| *[[Clostridium tetani]]
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| *[[Clotiazepam]]
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| *[[Cloxazolam]]
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| *[[CNS depression]]
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| *[[Cone shell poisoning]]
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| *[[Congenital diaphragmatic hernia]]
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| *[[Congenital failure of autonomic control]]
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| *[[Congenital fiber-type disproportion myopathy]]
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| *[[Cyclobarbital]]
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| *[[Demethyldiazepam]]
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| *[[Diaphragm paralysis]]
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| *[[Diazepam]]
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| *[[Doxefazepam]]
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| *[[Drug overdose]]
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| *[[Edstrom myopathy]]
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| *[[Emphysema]]
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| *[[Estazolam]]
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| *[[Ethyl loflazepate]]
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| *[[Etizolam]]
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| *[[Etomidate]]
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| *[[Fentanyl]]
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| *[[Flail chest]]
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| *[[Flurazepam]]
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| *[[Fluridrazepam]]
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| *[[Foreign body in respiratory tract]]
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| *[[Fospropofol]]
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| *[[General anaesthesia]]
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| *[[Guillain-Barre syndrome]]
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| *[[Halazepam]]
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| *[[Haloxazolam]]
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| *[[HCH-gamma]]
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| *[[Hexachlorocyclohexane (gamma)]]
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| *[[Hexobarbital]]
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| *[[Hyaline membrane disease]]
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| {{ColBreak}}
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| *[[Idiopathic spinal scoliosis]]
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| *[[Jeune thoracic dystrophy syndrome]]
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| *[[Ketazolam]]
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| *[[Lindane]]
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| *[[Loprazolam]]
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| *[[Lorazepam]]
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| *[[Lormetazepam]]
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| *[[Medazepam]]
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| *[[Mephobarbital]]
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| *[[Methohexital]]
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| *[[Mexazolam]]
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| *[[Midazolam]]
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| *[[Motor neuron disease]]
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| *[[Muscular dystrophy]]
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| *[[Myasthenia gravis]]
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| *[[Necrotizing enterocolitis]]
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| *[[Nemaline myopathy]]
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| *[[Neuromuscular diseases]]
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| *[[Nitrazepam]]
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| *[[Obesity hypoventilation syndrome]]
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| *[[Obstructive sleep apnea]]
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| *[[Oxazepam]]
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| *[[Oxazolam]]
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| *[[Oxygen]]
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| *[[Pentobarbital]]
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| *[[Perry syndrome]]
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| *[[Pethidine]]
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| *[[Phenobarbital]]
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| *[[Pickwickian syndrome]]
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| *[[Pinazepam]]
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| *[[Pitt-Hopkins syndrome]]
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| *[[Pneumothorax]]
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| *[[Poison hemlock]]
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| *[[Poliomyelitis]]
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| *[[Polymyositis]]
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| *[[Prazepam]]
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| *[[Primidone]]
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| *[[Promethazine]]
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| *[[Propofol]]
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| *[[Pulmonary hypoplasia]]
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| *[[Quazepam]]
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| *[[Raised intracranial pressure]]
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| *[[Reduced level of consciousness]]
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| *[[Remifentanil]]
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| *[[Respiratory depression]]
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| *[[Respiratory distress syndrome]]
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| *[[Rib fracture]]
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| *[[Secobarbital]]
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| *[[Severe asthma]]
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| *[[Severe kyphoscoliosis]]
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| *[[Shallow Breathing ]]
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| *[[Snoring]]
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| *[[Stuve-Wiedemann syndrome]]
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| *[[Subacute necrotising encephalomyelopathy]]
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| *[[Sufentanil]]
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| *[[Tapentadol]]
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| *[[Temazepam]]
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| *[[Tetrazepam]]
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| *[[Tetrodotoxin]]
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| *[[Thiamylal]]
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| *[[Thiopentone]]
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| *[[Tick paralysis]]
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| *[[Tofisopam]]
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| *[[Tracheal stenosis]]
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| *[[Triazolam]]
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| *[[Ullrich congenital muscular dystrophy]]
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| *[[X-linked infantile spinal muscular atrophy]]
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| *[[X-linked myotubular myopathy]]
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| {{EndMultiCol}}
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| == Physiological response == | | ==[[Respiratory acidosis overview|Overview]]== |
| ===Mechanism=== | | ==[[Respiratory acidosis classification|Classification]]== |
| Metabolism rapidly generates a large quantity of volatile acid (CO<sub>2</sub>) and [[nonvolatile acid]]. The metabolism of fats and carbohydrates leads to the formation of a large amount of CO<sub>2</sub>. The CO<sub>2</sub> combines with H<sub>2</sub>O to form carbonic acid (H<sub>2</sub>CO<sub>3</sub>). The lungs excrete the volatile fraction through ventilation, and acid accumulation does not occur. A significant alteration in ventilation that affects elimination of CO<sub>2</sub> can cause a respiratory acid-base disorder. The ''Pa''CO<sub>2</sub> is maintained within a range of 39-41 mm Hg in normal states.
| | ==[[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]] |
|
| |
|
| Alveolar ventilation is under the control of the central respiratory centers, which are located in the [[pons]] and the [[medulla]]. Ventilation is influenced and regulated by [[chemoreceptors]] for ''Pa''CO<sub>2</sub>, PaO<sub>2</sub>, and pH located in the brainstem,and in the [[aortic and carotid bodies]] as well as by neural impulses from lung [[stretch receptors]] and impulses from the [[cerebral cortex]]. Failure of ventilation quickly increases the ''Pa''CO<sub>2</sub>.
| | ==Treatment== |
| | | [[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]] |
| In acute respiratory acidosis, compensation occurs in 2 steps.
| | ==Case Studies== |
| * The initial response is cellular buffering that occurs over minutes to hours. Cellular buffering elevates plasma bicarbonate (HCO<sub>3</sub><sup>-</sup>) only slightly, approximately 1 mEq/L for each 10-mm Hg increase in ''Pa''CO<sub>2</sub>.
| | :[[Respiratory acidosis case study one|Case #1]] |
| * The second step is renal compensation that occurs over 3-5 days. With renal compensation, renal excretion of carbonic acid is increased and bicarbonate reabsorption is increased.
| |
| | |
| ===Estimated changes===
| |
| In renal compensation, plasma bicarbonate rises 3.5 mEq/L for each increase of 10 mm Hg in ''Pa''CO<sub>2</sub>. The expected change in serum bicarbonate concentration in respiratory acidosis can be estimated as follows:
| |
| | |
| * Acute respiratory acidosis: HCO<sub>3</sub><sup>-</sup> increases 1 mEq/L for each 10-mm Hg rise in ''Pa''CO<sub>2</sub>.
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| | |
| * Chronic respiratory acidosis: HCO<sub>3</sub><sup>-</sup> rises 3.5 mEq/L for each 10-mm Hg rise in ''Pa''CO<sub>2</sub>.
| |
| | |
| The expected change in pH with respiratory acidosis can be estimated with the following equations:
| |
| | |
| * Acute respiratory acidosis: Change in pH = 0.008 X (40 - ''Pa''CO<sub>2</sub>)
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| | |
| * Chronic respiratory acidosis: Change in pH = 0.003 X (40 - ''Pa''CO<sub>2</sub>)
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| | |
| Respiratory acidosis does not have a great effect on [[electrolyte]] levels. Some small effects occur on calcium and potassium levels. Acidosis decreases binding of calcium to albumin and tends to increase serum ionized calcium levels. In addition, acidemia causes an extracellular shift of potassium, but respiratory acidosis rarely causes clinically significant [[hyperkalemia]].
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| | ==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]]
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| [[Category:Nephrology]]
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| [[fr:Acidose respiratoire]]
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