Respiratory failure laboratory findings

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

Overview

Laboratory findings consistent with the diagnosis of respiratory failure include abdnormal bicarbonate, oxygen, phosphate, and magnesium levels.

Laboratory Findings

• Laboratory findings consistent with the diagnosis of respiratory failure include:
  • Arterial blood gases
    • Bicarbonate may be elevated
  • [Abnormal tes
  • [Abnormal test 3]

• Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

Laboratory assessment — Common laboratory abnormalities that should be drawn that also provide clues to the presence of hypercapnia and/or identify a potential etiology of hypercapnic respiratory failure include:

●Serum chemistries, bicarbonate, and electrolytes – An elevated bicarbonate level may suggest underlying chronic hypercapnia at baseline, although this feature is nonspecific as other etiologies (eg, volume contraction, diuretics) can increase the bicarbonate concentration. Similarly, arterial blood gases drawn on previous admissions or in the chronic stable state may identify the presence of normocapnia or chronic hypercapnia at baseline.

Additional abnormalities that may suggest a contributing etiology for hypercapnia include electrolyte disturbances, especially low phosphate and magnesium levels. Rarely does hypermagnesemia, hypokalemia, or hypercalcemia cause respiratory muscle weakness that is severe enough to result in hypercapnia.

●Complete blood count – Chronic hypoxemia from underlying lung disease may be associated with polycythemia. Although rare, an elevated eosinophil fraction on a complete blood count may be consistent with eosinophilic myalgia.

Additional tests that may be considered on a case-by-case basis include:

●Toxicology screen – A toxicology screen (opiates, benzodiazepines, tricyclic antidepressants, barbiturates) should be drawn when an overdose is suspected and drug history unavailable.

●Thyroid function tests – Thyroid function tests may reveal an elevated thyroid stimulating hormone (TSH) and low thyroxine (T4) consistent with hypothyroidism.

●Creatine phosphokinase – An elevated creatine phosphokinase (CPK) may suggest infectious or autoimmune polymyositis, hypothyroidism, rhabdomyolysis secondary to colchicine or chloroquine toxicity, or procainamide myopathy.

●Other – Additional testing aimed at identifying other specific etiologies are discussed separately.