Respiratory acidosis differential diagnosis: Difference between revisions

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Created page with "__NOTOC__ {{Respiratory acidosis}} {{CMG}} ==Overview== ==Differentiating Respiratory acidosis from other Diseases== For differential diagnosis of respiratory acidosis is con..."
 
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__NOTOC__
__NOTOC__
{{Respiratory acidosis}}
[[Image:Home_logo1.png|right|250px|link=https://wikidoc.org/index.php/Respiratory_acidosis]]
{{CMG}}
{{CMG}}; {{AE}}{{EG}}


==Overview==
==Overview==
==Differentiating Respiratory acidosis from other Diseases==
==Differentiating Respiratory acidosis from other Diseases==
For differential diagnosis of respiratory acidosis is consideration of the three structures involved in ventilation should be made: the chest cavity, central respiratory drive, and the lungs and airways.
 
===Lung and airway===
<small>'''''Abbreviations:''''' '''ABG ('''[[arterial blood gas]]'''); ACE ('''[[Angiotensin-converting enzyme|angiotensin converting enzyme]]'''); BMI ('''[[body mass index]]'''); CBC ('''[[Complete blood counts|complete blood count]]'''); CSF ('''[[cerebrospinal fluid]]'''); CXR ('''[[chest X-ray]]'''); DOE ('''dyspnea on [[exercise]]'''); ECG ('''[[electrocardiogram]]'''); FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FVC ('''[[forced vital capacity]]'''); JVD ('''[[jugular vein distention]]''');''' '''MCV ('''[[mean corpuscular volume]]'''); Plt ('''[[platelet]]'''); RV ('''[[residual volume]]'''); SIADH ('''[[syndrome of inappropriate antidiuretic hormone]]'''); TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]''');'''</small>
* [[Pneumonia]]
<small>
* [[Pulmonary edema]]
{|
* [[COPD]]/[[Asthma]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
* [[Foreign body]]
! colspan="3" rowspan="3" |Organ system
* [[Tumor]]
! rowspan="3" |Diseases
===Chest cavity===
! colspan="13" |Clinical manifestations
* Neuromuscular disorder
! colspan="5" rowspan="2" |Diagnosis
* Muscular disorder
! rowspan="3" |Other features
* [[Kyphoscoliosis]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
* [[Pleural effusion]]
! colspan="8" |Symptoms
* [[Flail chest]]
! colspan="5" |Physical exam
* [[Pneumothorax]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
===Central respiratory drive===
!Loss of consciousness
* [[Obstructive sleep apnea]]
!Agitation
* [[Sedation]]
!Weight loss
* [[Narcotics]]
!Fever
* Respiratory drive hypofunction secondary to [[infection]], [[inflammation]] or [[infarction]]
!Chest pain
!Cough
!Orthopnea
!DOE
!Cyanosis
!Clubbing
!JVD
!Peripheral edema
!Auscultation
!CBC
!ABG
!Imaging
!Spirometry
!Gold standard
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! rowspan="7" |Acute Dyspnea
! rowspan="2" |[[Respiratory system]]
! rowspan="2" |[[Chest]] and [[Pleurae|Pleura]],
Lower [[airway]]
![[Bronchitis]]<ref name="CantinBankier2009">{{cite journal|last1=Cantin|first1=Luce|last2=Bankier|first2=Alexander A.|last3=Eisenberg|first3=Ronald L.|title=Bronchiectasis|journal=American Journal of Roentgenology|volume=193|issue=3|year=2009|pages=W158–W171|issn=0361-803X|doi=10.2214/AJR.09.3053}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Rhonchi]] 
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]]
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Physical examination|Physical exam]]
! style="background: #F5F5F5; padding: 5px;" |[[Rhonchi]] relieved by [[Dextromethorphan|cough]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Rib fractures]] ([[flail chest]])<ref name="pmid27984449">{{cite journal |vauthors=Swart E, Laratta J, Slobogean G, Mehta S |title=Operative Treatment of Rib Fractures in Flail Chest Injuries: A Meta-analysis and Cost-Effectiveness Analysis |journal=J Orthop Trauma |volume=31 |issue=2 |pages=64–70 |date=February 2017 |pmid=27984449 |doi=10.1097/BOT.0000000000000750 |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Fracture marks
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Chest X-ray]]
! style="background: #F5F5F5; padding: 5px;" |[[Pneumothorax]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! colspan="2" |[[Central nervous system]]
![[Traumatic brain injury]]<ref name="pmid22033563">{{cite journal| author=McAllister TW| title=Neurobiological consequences of traumatic brain injury. | journal=Dialogues Clin Neurosci | year= 2011 | volume= 13 | issue= 3 | pages= 287-300 | pmid=22033563 | doi= | pmc=3182015 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22033563  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |[[Intracerebral hemorrhage]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Ct scan|Brain CT scan]]
! style="background: #F5F5F5; padding: 5px;" |[[Lucid interval]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! colspan="2" rowspan="2" |[[Toxic]]/[[Metabolic]]
![[Organophosphate poisoning]]<ref name="pmid25425841">{{cite journal| author=Peter JV, Sudarsan TI, Moran JL| title=Clinical features of organophosphate poisoning: A review of different classification systems and approaches. | journal=Indian J Crit Care Med | year= 2014 | volume= 18 | issue= 11 | pages= 735-45 | pmid=25425841 | doi=10.4103/0972-5229.144017 | pmc=4238091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425841  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], ↑[[CO2]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Blood test]]
! style="background: #F5F5F5; padding: 5px;" |[[Salivation]], [[Lacrimation]],  [[Emesis]], [[Miosis]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Carbon monoxide poisoning]]<ref name="pmid18710551">{{cite journal| author=Lane TR, Williamson WJ, Brostoff JM| title=Carbon monoxide poisoning in a patient with carbon dioxide retention: a therapeutic challenge. | journal=Cases J | year= 2008 | volume= 1 | issue= 1 | pages= 102 | pmid=18710551 | doi=10.1186/1757-1626-1-102 | pmc=2533003 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18710551  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze]]
! style="background: #F5F5F5; padding: 5px;" |[[Carboxyhemoglobin]]
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |N/A
! style="background: #F5F5F5; padding: 5px;" |[[Carboxyhemoglobin|Carboxyhemoglobin (HbCO)]] level
! style="background: #F5F5F5; padding: 5px;" |[[Headache]], [[Dizziness]], [[Weakness]], [[Vomiting]], [[Confusion]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! colspan="2" rowspan="2" |[[Systemic]]
![[Pregnancy]]<ref name="pmid28805596">{{cite journal |vauthors=Lee SY, Chien DK, Huang CH, Shih SC, Lee WC, Chang WH |title=Dyspnea in pregnancy |journal=Taiwan J Obstet Gynecol |volume=56 |issue=4 |pages=432–436 |date=August 2017 |pmid=28805596 |doi=10.1016/j.tjog.2017.04.035 |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]], [[RBC]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], ↑[[CO2]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Human chorionic gonadotropin|βhCG]]
! style="background: #F5F5F5; padding: 5px;" |Missed period, Hyperemesis
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Sepsis]]<ref name="pmid27216810">{{cite journal| author=Askim Å, Mehl A, Paulsen J, DeWan AT, Vestrheim DF, Åsvold BO et al.| title=Epidemiology and outcome of sepsis in adult patients with Streptococcus pneumoniae infection in a Norwegian county 1993-2011: an observational study. | journal=BMC Infect Dis | year= 2016 | volume= 16 | issue=  | pages= 223 | pmid=27216810 | doi=10.1186/s12879-016-1553-8 | pmc=4877975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27216810  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]], [[neutrophilia]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], ↑[[CO2]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[SIRS|SIRS criteria]]
! style="background: #F5F5F5; padding: 5px;" |[[Chills]], [[Confusion]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="3" rowspan="3" |Organ system
! rowspan="3" |Diseases
! colspan="13" |Clinical manifestations
! colspan="5" rowspan="2" |Diagnosis
! rowspan="3" |Other features
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="8" |Symptoms
! colspan="5" |Physical exam
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Loss of consciousness
!Agitation
!Weight loss
!Fever
!Chest pain
!Cough
!Orthopnea
!DOE
!Cyanosis
!Clubbing
!JVD
!Peripheral edema
!Auscultation
!CBC
!ABG
!Imaging
!Spirometry
!Gold standard
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! rowspan="8" |Chronic Dyspnea
! rowspan="7" |[[Respiratory system]]
! rowspan="7" |[[Chest]] and [[Pleura]],
Lower [[airway]]
![[Bronchial asthma]]<ref name="pmid19858243">{{cite journal| author=Hodder R, Lougheed MD, Rowe BH, FitzGerald JM, Kaplan AG, McIvor RA| title=Management of acute asthma in adults in the emergency department: nonventilatory management. | journal=CMAJ | year= 2010 | volume= 182 | issue= 2 | pages= E55-67 | pmid=19858243 | doi=10.1503/cmaj.080072 | pmc=2817338 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19858243  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze]]
! style="background: #F5F5F5; padding: 5px;" |↑ [[Eosinophil]]
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |[[Pulmonary]] hyperinflation,
 
[[Bronchial]] wall thickening
! style="background: #F5F5F5; padding: 5px;" |↓ [[FEV1]]/[[FVC]]
! style="background: #F5F5F5; padding: 5px;" |[[Spirometry]] before and after [[bronchodilator]]
! style="background: #F5F5F5; padding: 5px;" |Paroxysmal [[respiratory distress]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[COPD]]<ref name="pmid25177479">{{cite journal| author=Qureshi H, Sharafkhaneh A, Hanania NA| title=Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. | journal=Ther Adv Chronic Dis | year= 2014 | volume= 5 | issue= 5 | pages= 212-27 | pmid=25177479 | doi=10.1177/2040622314532862 | pmc=4131503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25177479  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze|Expiratory wheeze]]
! style="background: #F5F5F5; padding: 5px;" |↑ [[RBC]]
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |↑ Bronchovascular markings, [[Cardiomegaly]]
! style="background: #F5F5F5; padding: 5px;" |↓ [[FEV1]]/[[FVC]]
! style="background: #F5F5F5; padding: 5px;" |[[Physical examination|Physical exam]] and
[[Spirometry]]
! style="background: #F5F5F5; padding: 5px;" |[[Heavy smoking]] history
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Emphysema]]<ref name="pmid18453358">{{cite journal| author=Sharafkhaneh A, Hanania NA, Kim V| title=Pathogenesis of emphysema: from the bench to the bedside. | journal=Proc Am Thorac Soc | year= 2008 | volume= 5 | issue= 4 | pages= 475-7 | pmid=18453358 | doi=10.1513/pats.200708-126ET | pmc=2645322 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18453358  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze|Expiratory wheeze]], Hyperinflation
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Flattening of [[diaphragm]], vertical [[heart]]
! style="background: #F5F5F5; padding: 5px;" |↓ [[FEV1]]/[[FVC]]
! style="background: #F5F5F5; padding: 5px;" |[[Physical examination|Physical exam]] and
[[Spirometry]]
! style="background: #F5F5F5; padding: 5px;" |[[Barrel chest]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pulmonary hypertension]]<ref name="pmid20407377">{{cite journal |vauthors=Sajkov D, Petrovsky N, Palange P |title=Management of dyspnea in advanced pulmonary arterial hypertension |journal=Curr Opin Support Palliat Care |volume=4 |issue=2 |pages=76–84 |date=June 2010 |pmid=20407377 |doi=10.1097/SPC.0b013e328338c1e0 |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |Accentuated [[S2]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Hypoxia]] and [[acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Enlarged [[Pulmonary arteries|'''pulmonary''' arteries]]
! style="background: #F5F5F5; padding: 5px;" |↑[[Physiologic]] [[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Cardiac catheterization]]
! style="background: #F5F5F5; padding: 5px;" |[[Syncope]],
 
[[Ascites]], [[Pleural effusion]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Interstitial lung disease]]<ref name="pmid2060395">{{cite journal |vauthors=Baughman RP, Shipley RT, Loudon RG, Lower EE |title=Crackles in interstitial lung disease. Comparison of sarcoidosis and fibrosing alveolitis |journal=Chest |volume=100 |issue=1 |pages=96–101 |year=1991 |pmid=2060395 |doi= |url=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Rhonchi]], [[Wheezing]], [[Crackles]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Peripheral [[pulmonary]] infiltrative opacification
! style="background: #F5F5F5; padding: 5px;" |↑ [[FEV1]]/[[FVC]]
! style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|High resolution computed tomography (HRCT)]]
! style="background: #F5F5F5; padding: 5px;" |[[Pneumoconiosis]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pulmonary shunt|Pulmonary right-to-left shunt]]<ref name="pmid19335916">{{cite journal| author=Vodoz JF, Cottin V, Glérant JC, Derumeaux G, Khouatra C, Blanchet AS et al.| title=Right-to-left shunt with hypoxemia in pulmonary hypertension. | journal=BMC Cardiovasc Disord | year= 2009 | volume= 9 | issue=  | pages= 15 | pmid=19335916 | doi=10.1186/1471-2261-9-15 | pmc=2671488 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19335916  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Diminished [[breath sounds]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], ↑[[CO2]], [[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
([[physiological]])
! style="background: #F5F5F5; padding: 5px;" |[[CT angiography|Pulmonary CT angiography]]
! style="background: #F5F5F5; padding: 5px;" |Chronic [[hypoxemia]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Diaphragmatic paralysis]]<ref name="pmid27929389">{{cite journal| author=Dubé BP, Dres M| title=Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies. | journal=J Clin Med | year= 2016 | volume= 5 | issue= 12 | pages=  | pmid=27929389 | doi=10.3390/jcm5120113 | pmc=5184786 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27929389  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Unilateral or bilateral [[Diaphragmatic dysfunction|diaphragmatic flattening]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
([[anatomical]])
! style="background: #F5F5F5; padding: 5px;" |[[CXR]] confirmed by [[fluoroscopic]] sniff test
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory insufficiency]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! colspan="2" |[[Systemic]]
![[Obesity]]<ref name="pmid12090884">{{cite journal |vauthors=Sin DD, Jones RL, Man SF |title=Obesity is a risk factor for dyspnea but not for airflow obstruction |journal=Arch. Intern. Med. |volume=162 |issue=13 |pages=1477–81 |date=July 2002 |pmid=12090884 |doi= |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
([[anatomical]])
! style="background: #F5F5F5; padding: 5px;" |[[Body mass index|BMI]]
! style="background: #F5F5F5; padding: 5px;" |Low [[stamina]],
[[Sweating]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
|}
</small>


==References==
==References==

Latest revision as of 22:49, 14 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Differentiating Respiratory acidosis from other Diseases

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); DOE (dyspnea on exercise); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Acute Dyspnea Respiratory system Chest and Pleura,

Lower airway

Bronchitis[1] - - - + + + - - - - - - Rhonchi  ↑WBC Respiratory acidosis Normal Normal Physical exam Rhonchi relieved by cough
Rib fractures (flail chest)[2] - + - - + - - - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax
Central nervous system Traumatic brain injury[3] + +/- - - - - - - - - - - Normal Normal Respiratory acidosis Intracerebral hemorrhage Normal Brain CT scan Lucid interval
Toxic/Metabolic Organophosphate poisoning[4] + - - + - - - - - - - - Wheeze Normal ↓O2, ↑CO2 Normal Normal Blood test Salivation, Lacrimation, Emesis, Miosis
Carbon monoxide poisoning[5] + - - - + + - - + - - - Wheeze Carboxyhemoglobin Respiratory acidosis Normal N/A Carboxyhemoglobin (HbCO) level Headache, Dizziness, Weakness, Vomiting, Confusion
Systemic Pregnancy[6] - - - - +/- - - - - - - + Normal ↑WBC, RBC ↓O2, ↑CO2 Normal ↓Vt, ↑RV βhCG Missed period, Hyperemesis
Sepsis[7] +/- - - + - - - - - - - - Normal ↑WBC, neutrophilia ↓O2, ↑CO2 Normal Normal SIRS criteria Chills, Confusion
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Chronic Dyspnea Respiratory system Chest and Pleura,

Lower airway

Bronchial asthma[8] - + +/- - +/- + - - + + - - Wheeze ↑ Eosinophil Respiratory acidosis Pulmonary hyperinflation,

Bronchial wall thickening

↓ FEV1/FVC Spirometry before and after bronchodilator Paroxysmal respiratory distress
COPD[9] - - +/- - - + + + + + + +/- Expiratory wheeze ↑ RBC Respiratory acidosis ↑ Bronchovascular markings, Cardiomegaly ↓ FEV1/FVC Physical exam and

Spirometry

Heavy smoking history
Emphysema[10] - - - - - +/- - - + + - - Expiratory wheeze, Hyperinflation Normal Respiratory acidosis Flattening of diaphragm, vertical heart ↓ FEV1/FVC Physical exam and

Spirometry

Barrel chest
Pulmonary hypertension[11] - - - - +/- +/- - - +/- +/- + + Accentuated S2 Normal Hypoxia and acidosis Enlarged pulmonary arteries ↑Physiologic RV Cardiac catheterization Syncope,

Ascites, Pleural effusion

Interstitial lung disease[12] - - - - + + - - + + - - Rhonchi, Wheezing, Crackles Normal Respiratory acidosis Peripheral pulmonary infiltrative opacification ↑ FEV1/FVC High resolution computed tomography (HRCT) Pneumoconiosis
Pulmonary right-to-left shunt[13] - - - - +/- + - - + + - - Diminished breath sounds Normal ↓O2, ↑CO2, Respiratory acidosis Normal ↓Vt, ↑RV

(physiological)

Pulmonary CT angiography Chronic hypoxemia
Diaphragmatic paralysis[14] - - - +/- +/- +/- - - - - - - Normal Normal Respiratory acidosis Unilateral or bilateral diaphragmatic flattening ↓Vt, ↑RV

(anatomical)

CXR confirmed by fluoroscopic sniff test Respiratory insufficiency
Systemic Obesity[15] - - - - - - - - - - - - Normal Normal Respiratory acidosis Normal ↓Vt, ↑RV

(anatomical)

BMI Low stamina,

Sweating

References

  1. ↑ Cantin, Luce; Bankier, Alexander A.; Eisenberg, Ronald L. (2009). "Bronchiectasis". American Journal of Roentgenology. 193 (3): W158–W171. doi:10.2214/AJR.09.3053. ISSN 0361-803X.
  2. ↑ Swart E, Laratta J, Slobogean G, Mehta S (February 2017). "Operative Treatment of Rib Fractures in Flail Chest Injuries: A Meta-analysis and Cost-Effectiveness Analysis". J Orthop Trauma. 31 (2): 64–70. doi:10.1097/BOT.0000000000000750. PMID 27984449.
  3. ↑ McAllister TW (2011). "Neurobiological consequences of traumatic brain injury". Dialogues Clin Neurosci. 13 (3): 287–300. PMC 3182015. PMID 22033563.
  4. ↑ Peter JV, Sudarsan TI, Moran JL (2014). "Clinical features of organophosphate poisoning: A review of different classification systems and approaches". Indian J Crit Care Med. 18 (11): 735–45. doi:10.4103/0972-5229.144017. PMC 4238091. PMID 25425841.
  5. ↑ Lane TR, Williamson WJ, Brostoff JM (2008). "Carbon monoxide poisoning in a patient with carbon dioxide retention: a therapeutic challenge". Cases J. 1 (1): 102. doi:10.1186/1757-1626-1-102. PMC 2533003. PMID 18710551.
  6. ↑ Lee SY, Chien DK, Huang CH, Shih SC, Lee WC, Chang WH (August 2017). "Dyspnea in pregnancy". Taiwan J Obstet Gynecol. 56 (4): 432–436. doi:10.1016/j.tjog.2017.04.035. PMID 28805596.
  7. ↑ Askim Å, Mehl A, Paulsen J, DeWan AT, Vestrheim DF, Åsvold BO; et al. (2016). "Epidemiology and outcome of sepsis in adult patients with Streptococcus pneumoniae infection in a Norwegian county 1993-2011: an observational study". BMC Infect Dis. 16: 223. doi:10.1186/s12879-016-1553-8. PMC 4877975. PMID 27216810.
  8. ↑ Hodder R, Lougheed MD, Rowe BH, FitzGerald JM, Kaplan AG, McIvor RA (2010). "Management of acute asthma in adults in the emergency department: nonventilatory management". CMAJ. 182 (2): E55–67. doi:10.1503/cmaj.080072. PMC 2817338. PMID 19858243.
  9. ↑ Qureshi H, Sharafkhaneh A, Hanania NA (2014). "Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications". Ther Adv Chronic Dis. 5 (5): 212–27. doi:10.1177/2040622314532862. PMC 4131503. PMID 25177479.
  10. ↑ Sharafkhaneh A, Hanania NA, Kim V (2008). "Pathogenesis of emphysema: from the bench to the bedside". Proc Am Thorac Soc. 5 (4): 475–7. doi:10.1513/pats.200708-126ET. PMC 2645322. PMID 18453358.
  11. ↑ Sajkov D, Petrovsky N, Palange P (June 2010). "Management of dyspnea in advanced pulmonary arterial hypertension". Curr Opin Support Palliat Care. 4 (2): 76–84. doi:10.1097/SPC.0b013e328338c1e0. PMID 20407377.
  12. ↑ Baughman RP, Shipley RT, Loudon RG, Lower EE (1991). "Crackles in interstitial lung disease. Comparison of sarcoidosis and fibrosing alveolitis". Chest. 100 (1): 96–101. PMID 2060395.
  13. ↑ Vodoz JF, Cottin V, Glérant JC, Derumeaux G, Khouatra C, Blanchet AS; et al. (2009). "Right-to-left shunt with hypoxemia in pulmonary hypertension". BMC Cardiovasc Disord. 9: 15. doi:10.1186/1471-2261-9-15. PMC 2671488. PMID 19335916.
  14. ↑ Dubé BP, Dres M (2016). "Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies". J Clin Med. 5 (12). doi:10.3390/jcm5120113. PMC 5184786. PMID 27929389.
  15. ↑ Sin DD, Jones RL, Man SF (July 2002). "Obesity is a risk factor for dyspnea but not for airflow obstruction". Arch. Intern. Med. 162 (13): 1477–81. PMID 12090884.

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