Hypoventilation

Hypoventilation
ICD-10	R06.8
DiseasesDB	29214
MeSH	D007040

For patient information, click Hypoventilation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords:

Overview

In medicine, hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (hypo means "below") to perform needed gas exchange. It generally causes an increased concentration of carbon dioxide (hypercapnia) and respiratory acidosis. It can be caused by medical conditions, by holding one's breath, or by drugs, typically when taken in overdose. Hypoventilation may be dangerous for those with sleep apnea.

Pathophysiology

Hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (hypo meaning "below") to perform needed gas exchange. By definition it causes an increased concentration of carbon dioxide (hypercapnia) and respiratory acidosis.

Associated Conditions

• Disorders like (CCHS) and Rapid-Onset Obesity, Hypothalamic Dysfunction, Hypoventilation, with Autonomic Dysregulation are recognized as conditions that are associated with hypoventilation. CCHS may be a significant factor in some cases of (SIDS), often termed "cot death" or "crib death".
• The opposite condition is (too much ventilation), resulting in low carbon dioxide levels, rather than hypercapnia.

Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetaminophen/Codeine Phosphate, Acetaminophen/Oxycodone Hydrochloride, Alcuronium, Alfentanyl, Alfentanil Hydrochloride, Alprostadil, Apomorphine, Aspirin/Caffeine/Dihydrocodeine Bitartrate, Aspirin/Codeine Phosphate, Aspirin/Oxycodone Hydrochloride, Atropine Sulfate, Baclofen, Brimonidine, Bupivacaine, Buprenorphine, Buprenorphine Hydrochloride, Buprenorphine/Naloxone, Butalbital/Acetaminophen/Caffeine/Codeine Phosphate, Butalbital/Aspirin/Caffeine/Codeine Phosphate, Butorphanol, Butorphanol Tartrate, Carisoprodol/Aspirin/Codeine Phosphate, Cifenline, Clonazepam, Clonidine, Codeine, Codeine Phosphate/Guaifenesin, Codeine Sulfate, Dantrolene, Desflurane, Dexmedetomidine, Dexmedetomidine Hydrochloride, Diazepam, Diclofenac, Dihydrocodeine, Droperidol, Enflurane, Ethanol, Fentanyl, Fentanyl Citrate, Fentanyl/Droperidol, Halazepam, Homatropine Methylbromide/Hydrocodone Bitartrate, Hydrocodone, Hydrocodone Bitartrate, Hydrocodone Bitartrate/acetaminophen, Hydrocodone Bitartrate/Chlorpheniramine Maleate, Hydrocodone bitartrate/Guaifenesin, Hydrocodone Bitartrate/Ibuprofen, Hydrocodone bitartrate/Pseudoephedrine Hydrochloride, Hydrocodone Polistirex/Chlorpheniramine Polistirex, Hydrocodone/Chlorpheniramine/Pseudoephedrine, Hydromorphone, Hydromorphone hydrochloride, Ipratropium, Isoflurane, Ketamine, Ketamine Hydrochloride, Levorphanol, Levorphanol Tartrate, Lidocaine, Lopinavir/Ritonavir, Lorazepam, Magnesium, Meperidine, Meperidine Hydrochloride, Methadone, Methadone Hydrochloride, Methohexital, Methohexital Sodium, Midazolam, Midazolam Hydrochloride, Morphine, Morphine Sulfate, Morphine Sulfate Liposome, Morphine Sulfate/Naltrexone Hydrochloride, Nalbuphine, Nalbuphine Hydrochloride, Nefopam, Neostigmine, Nortriptyline, OnabotulinumtoxinA, Opium, Oxycodone, Oxycodone Hydrochloride, Oxycodone Hydrochloride/Naloxone Hydrochloride, Oxycodon, Oxycodone Hydrochloride, Oxycodone Hydrochloride/Naloxone Hydrochloride, Oxycodone/Ibuprofen, Oxymorphone, Oxymorphone Hydrochloride, Pancuronium, Pancuronium Bromide, Pentazocine, Pentazocine Hydrochloride/Acetaminophen, Pentazocine Hydrochloride/Naloxone Hydrochloride, Pentazocine Lactate, Phenelzine, PolymixinB, Prilocaine, Prilocaine Hydrochloride, Promethazine, Promethazine Hydrochloride, Promethazine Hydrochloride/Codeine Phosphate, Promethazine/Phenylephrine/Codeine Phosphate, Propoxyphene, Propoxyphene napsylate/Acetaminophen, Quinine, Remifentail, Remifentanil Hydrochloride, Riluzole, RimabotulinumtoxinB, Sevoflurane, Sodium Oxybate, Succinylcholine, Succinylcholine Chloride, Sufentanil, Sufentanil Citrate, Tapentadol, Tapentadol Hydrochloride, Thiopental Sodium, Tilidine, Tramadol, Tramadol Hydrochloride, Tromethamine, Zanamivir
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Treatment

Pharmacotherapy

• Respiratory stimulants such as nikethamide were traditionally used to counteract respiratory depression from CNS depressant overdose, but were of only limited effectiveness.
• A new respiratory stimulant drug called BIMU8 is being investigated which seems to be significantly more effective and may be useful for counteracting the respiratory depression produced by opiates and similar drugs without offsetting their therapeutic effects.
• If the respiratory depression is from opioid overdose, then the overdose itself is usually treated with an inverse agonist, most likely naloxone, which will itself almost instantaneously stop the respiratory depression if caused by an opioid (and also, depending on the dose, plunge the patient into precipitated withdrawal).

References

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