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| __NOTOC__ | | __NOTOC__ |
| {{Infobox_Disease | | | {| class="infobox" style="float:right;" |
| Name = {{PAGENAME}} |
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| Image = |
| | | [[File:Siren.gif|30px|link=Respiratory acidosis resident survival guide]]|| <br> || <br> |
| Caption = |
| | | [[Respiratory acidosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| DiseasesDB = 95 |
| | |} |
| ICD10 = {{ICD10|E|87|2|e|70}} |
| | {{Respiratory acidosis}} |
| ICD9 = {{ICD9|276.2}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| MeshID = |
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| }}
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| {{Search infobox}} | |
| '''For patient information page, click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information page, click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}}; {{AE}} {{VKG}} |
| ==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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| ==Pathophysiology==
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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 ==
| | {{SK}} Acidosis, respiratory; blood carbon dioxide raised; hypercapnia; hypercarbia |
| ===Acute respiratory acidosis===
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| * The ''Pa''CO<sub>2</sub> is elevated above the upper limit of the reference range (over 6.3 kPa or 47 mm Hg)
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| * Accompanied with acidemia (pH <7.35)
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| ===Chronic respiratory acidosis===
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| * The ''Pa''CO<sub>2</sub> is elevated above the upper limit of the reference range
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| * 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).
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| == 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]] |
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| ===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]] |
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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''' | |
| |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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| |- | |
| |-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]], [[Stuve-Wiedemann syndrome]]
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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]], [[Stuve-Wiedemann syndrome]], [[Muscular dystrophy]], [[Nemaline myopathy]], [[Ullrich congenital muscular dystrophy]], [[X-linked myotubular myopathy]], [[Neuromuscular diseases]], [[Myasthenia gravis]], [[Polymyositis]]
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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]], [[Athabaskan brain stem dysgenesis]], [[Diaphragm paralysis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Subacute necrotising encephalomyelopathy]]
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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"| [[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]]
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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"| [[Myasthenia gravis]], [[Polymyositis]], [[Guillain-Barre syndrome]]
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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"| [[Flail chest]], [[Cervical spine injury]], [[Pneumothorax]]
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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"| [[Asphyxiation]], [[Reduced level of consciousness]], [[Congenital failure of autonomic control]], [[Shallow Breathing ]]
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| |-
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| |}
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| ===Causes in Alphabetical Order===
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| {{MultiCol}}
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| *[[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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| ==Differential diagnosis of respiratory acidosis==
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| 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.
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| ==References==
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| {{reflist|2}}
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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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