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Respiratory acidosis is a condition of accumulation of carbon dioxide in the blood

Produces a shift in the body's pH balance

Causes the body's system to become more acidic

Respiratory acidosis is an acid-base balance disturbance due to alveolar hypoventilation Production of carbon dioxide occurs rapidly and failure of ventilation promptly increases the partial pressure of arterial carbon dioxide (PaCO2) The normal reference range for PaCO2 is 35-45 mm Hg
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Respiratory acidosis it is most often caused by pulmonary problems, although head injuries, drugs (especially anesthetics and sedatives), and brain tumors can cause this acidemia Pneumothorax, emphysema, chronic bronchitis, asthma, severe pneumonia, and aspiration are among the most frequent causes

The clinical manifestations are often those of the underlying disorder, but can include:

Confusion Easy fatigue Lethargy Shortness of breath Sleepiness

Poor organ function Respiratory failure Shock Carbon dioxide narcosis

Muscle dysfunction

Identifying the underlying cause is priority, a physical exam can be followed by:

Arterial blood gas, which measures oxygen and carbon dioxide levels in the blood Basic metabolic panel Chest x-ray Pulmonary function test
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Treatment should be directed at the underlying disorder Pharmacological Therapies

Bronchodilators Respiratory stimulants Drug antagonists Bicarbonate

Oxygen therapy
Ventilatory support Stop smoking

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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 (obesity-hypoventilation syndrome) Be careful about taking sedating medicines, and never combine these medicines with alcohol Take medication as ordered

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Monitor ABGs, to be redrawn every 2 hours Monitor vital signs and respiratory status (including oxygen saturation) every 15 minutes for the first hour then every hour Assess color of skin, nail beds, and oral mucous membranes every hour Assess mental status and orientation every hour Monitor anxiety level as evidenced by restlessness and agitation Maintain a calm, quiet environment Provide reorientation and explain all activities Keep side rails in place, and place call bell within reach
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Respiratory alkalosis is a condition where the amount of carbon dioxide found in the blood drops to a level below normal range
This condition produces a shift in the body's pH balance and causes the body's system to become more alkaline

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Respiratory alkalosis results from an elevation in alveolar ventilation that causes a fall in the partial pressure of dissolved carbon dioxide
Respiratory alkalosis can be acute or chronic

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Psychiatric causes: anxiety, hysteria and stress

CNS causes: stroke, subarachnoid hemorrhage, meningitis Drug use: doxapram, aspirin, caffeine and coffee Moving into high altitude areas, where the low atmospheric pressure of oxygen stimulates increased ventilation

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Lung disease such as pneumonia, where a hypoxic drive governs breathing more than CO2 levels (the normal determinant)
CO2 level, which stimulates the respiratory center in the brainstem

Pregnancy
High levels of NH4+ leading to brain swelling and decreased blood flow to the brain
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Dizziness Bloating Light-headedness Numbness and/or muscle spasms in the extremities Discomfort in the chest area Confusion Dry mouth Heart palpitations Feeling short of breath

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Arterial blood gas, which measures oxygen and carbon dioxide levels in the blood
Basic metabolic panel Chest x-ray

Pulmonary function test

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Treatment attempts to eradicate the underlying condition

Treating the condition is a matter of raising carbon dioxide levels in the blood Breathe into a paper bag

Get reassurance
Restrict oxygen intake into the lungs

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Sedatives and/or antidepressants should be reserved for patients who have not responded to conservative treatment
In mechanically ventilated patients who have respiratory alkalosis, the tidal volume and/or respiratory rate may need to be decreased

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Help patient identify factors that precipitate anxiety that leads to hyperventilation
Help patient find coping mechanisms and activities that promote relaxation Breathing exercises, meditation, and regular exercise can also be effective in prevention

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Watch for and report changes in neurologic, neuromuscular, and cardiovascular functioning
Monitor ABG serum and electrolyte levels closely Report any variations immediately

Explain all procedures to the patient and allow ample time to answer any questions

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pH

PaCO2

HCO3

Results
Respiratory Acidosis Respiratory Alkalosis

7.35 7.48 7.40

55 34 40

25 23 26

Normal

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