Acute and Chronic Respiratory Acidosis (Carbonic Acid Excess) Respiratory acidosis is a clinical disorder in which the pH is less

than 7.35 and the partial pressure of arterial carbon dioxide (PaCo) is greater than 42 mm Hg. It may be acute or chronic. The lungs cannot remove all of the carbon dioxide the body produces. This causes body fluids, especially the blood, to become too acidic. Factors

Diseases of the airways (such as asthma and chronic obstructive lung disease) Diseases of the chest (such as sarcoidosis) Diseases affecting the nerves and muscles that "signal" the lungs to inflate or deflate Drugs that suppress breathing (including powerful pain medicines, such as narcotics, and "downers," such as benzodiazepines), especially when combined with alcohol

Severe obesity, which restricts how much the lungs can expand Signs and Symptoms

Acute - carbon dioxide builds up very quickly and before the kidneys can return the body to a state of balance. Sudden Hypercapnia ( elevated PaCo)

Increased pulse and respiratory rate Increased blood pressure Mental cloudiness Feeling of fullness in the head Elevated PaCo, greater than 60 mm Hg

Cerebrovascular vasodilation Increased cerebral blood flow Ventricular fibrillation (1st sign in anesthezied patients) Severe Intracranial pressure may increase

Papilledema (swelling and protrusion of the blind spot of the eye)

Dilated conjuctival blood vessel Chronic - occurs over a long period of time. This leads to a stable situation, because the kidneys increase body chemicals, such as bicarbonate, that help restore the body's acidbase balance.

Chronic emphysema and bronchitis Obstructive sleep apnea Obesity Hyperkalemia

Assessment Arterial blood gas analysis ( measures oxygen and carbon dioxide levels in the blood) Monitoring of serum electrolyte levels Pulmonary function test Chest X-ray ( determine any respiratory disease) Drug screening (if an overdose is suspected) ECG (to identify any cardiac involvement)

Treatment Bronchodilators (reduce bronchial spasm) Antibiotics (respiratory infections) Thrombolytics Oxygen (if the blood oxygen is low) Non-invasive positive-pressure ventilation (sometimes called CPAP or BPAP) or a breathing machine, if needed Prevention Do not smoke. Smoking leads to the development of many severe lung diseases that can cause respiratory acidosis. Losing weight may help prevent respiratory acidosis due to obesity (obesityhypoventilation syndrome). Be careful about taking sedating medicines, and never combine these medicines with alcohol.

References: Brunner & Suddarths: Textbook of Medical-Surgical Nursing 12th Ed http://www.nlm.nih.gov/medlineplus/ency/article/000092.htm