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What Causes Respiratory Acidosis And Alkalosis?

Causes Of Respiratory Acidosis And Alkalosis - Deranged Physiology

Causes Of Respiratory Acidosis And Alkalosis - Deranged Physiology

Causes of Respiratory Acidosis and Alkalosis Respiratory acidosis and alkalosis are featured in virtually every paper, and being able to identify a respiratory acid-base disturbance is a vital skill for the CICM fellowship candidate. The SAQs will frequently require the application of the usual rules of compensation to reveal a hidden acid-base disorder, eg. "this patient has a low CO2 but it is not low enough". Questions which involve respiratory acid-base disturbances are too numerous to list. Some representative examples include the following: Question 12.3 from the second paper of 2014 Question 3.4 from the first paper of 2013 Question 3.5 from the first paper of 2013 Question 8.3 from the first paper of 2012 Question 9.1 from the first paper of 2011 Question 7.2 from the first paper of 2009 Several CICM fellowship questions revolve around the core question, "what possible causes for this respiratory acid-base disturbance can you think of ?" The causes can be split into aetiological categories, as below: Causes of Respiratory Acidosis and Alkalosis Rebreathing of CO2-containing expired gas Insufflation of CO2 into body cavity (eg for laparoscopic surgery) CO2 increases by 3mmg for every minute of apnoea central respiratory depression eg. by drugs or post-ictally neuromuscular disorders resulting in weakness lung or chest wall defects resulting in restriction The pH change in response to a chronic respiratory acid-base disturbance 0: An acute change in PaCO2 will not change the Standard Base Excess. 4: In chronic disorders, the expected change in SBE will be 0.4 times the change in PaCO2 ... i.e. expected SBE = 0.4 (40 - PaCO2) 1: In compensation for metabolic acidosis, the compensatory change in PaCO2 will be proportional to the SBE. ..i.e. expected CO2 = 40 + (1.0 Continue reading >>

Respiratory Alkalosis: Causes And Regulation

Respiratory Alkalosis: Causes And Regulation

Respiratory Alkalosis: Causes and Regulation Watch short & fun videos Start Your Free Trial Today An error occurred trying to load this video. Try refreshing the page, or contact customer support. You must create an account to continue watching Start Your Free Trial To Continue Watching As a member, you'll also get unlimited access to over 70,000 lessons in math, English, science, history, and more. Plus, get practice tests, quizzes, and personalized coaching to help you succeed. Coming up next: The Causes of Chronic Obstructive Pulmonary Disease (COPD) Log in or sign up to add this lesson to a Custom Course. Custom Courses are courses that you create from Study.com lessons. Use them just like other courses to track progress, access quizzes and exams, and share content. Organize and share selected lessons with your class. Make planning easier by creating your own custom course. Create a new course from any lesson page or your dashboard. Click "Add to" located below the video player and follow the prompts to name your course and save your lesson. Click on the "Custom Courses" tab, then click "Create course". Next, go to any lesson page and begin adding lessons. Edit your Custom Course directly from your dashboard. Name your Custom Course and add an optional description or learning objective. Create chapters to group lesson within your course. Remove and reorder chapters and lessons at any time. Share your Custom Course or assign lessons and chapters. Share or assign lessons and chapters by clicking the "Teacher" tab on the lesson or chapter page you want to assign. Students' quiz scores and video views will be trackable in your "Teacher" tab. You can share your Custom Course by copying and pasting the course URL. Only Study.com members will be able to access the entire Continue reading >>

Respiratory Alkalosis

Respiratory Alkalosis

Respiratory alkalosis is a medical condition in which increased respiration elevates the blood pH beyond the normal range (7.35–7.45) with a concurrent reduction in arterial levels of carbon dioxide.[1][3] This condition is one of the four basic categories of disruption of acid–base homeostasis.[medical citation needed] Signs and symptoms[edit] Signs and symptoms of respiratory alkalosis are as follows:[4] Palpitation Tetany Convulsion Sweating Causes[edit] Respiratory alkalosis may be produced as a result of the following causes: Stress[1] Pulmonary disorder[2] Thermal insult[5] High altitude areas[6] Salicylate poisoning (aspirin overdose) [6] Fever[1] Hyperventilation (due to heart disorder or other, including improper mechanical ventilation)[1][7] Vocal cord paralysis (compensation for loss of vocal volume results in over-breathing/breathlessness).[8] Liver disease[6] Mechanism[edit] Carbonic-acid The mechanism of respiratory alkalosis generally occurs when some stimulus makes a person hyperventilate. The increased breathing produces increased alveolar respiration, expelling CO2 from the circulation. This alters the dynamic chemical equilibrium of carbon dioxide in the circulatory system. Circulating hydrogen ions and bicarbonate are shifted through the carbonic acid (H2CO3) intermediate to make more CO2 via the enzyme carbonic anhydrase according to the following reaction: This causes decreased circulating hydrogen ion concentration, and increased pH (alkalosis).[9][10] Diagnosis[edit] The diagnosis of respiratory alkalosis is done via test that measure the oxygen and carbon dioxide levels (in the blood), chest x-ray and a pulmonary function test of the individual.[1] The Davenport diagram allows clinicians or investigators to outline blood bicarbonate concentr Continue reading >>

Respiratory Acidosis

Respiratory Acidosis

By James L. Lewis, III, MD, Attending Physician, Brookwood Baptist Health and Saint Vincents Ascension Health, Birmingham Respiratory acidosis is primary increase in carbon dioxide partial pressure (Pco2) with or without compensatory increase in bicarbonate (HCO3); pH is usually low but may be near normal. Cause is a decrease in respiratory rate and/or volume (hypoventilation), typically due to CNS, pulmonary, or iatrogenic conditions. Respiratory acidosis can be acute or chronic; the chronic form is asymptomatic, but the acute, or worsening, form causes headache, confusion, and drowsiness. Signs include tremor, myoclonic jerks, and asterixis. Diagnosis is clinical and with ABG and serum electrolyte measurements. The cause is treated; oxygen (O2) and mechanical ventilation are often required. Respiratory acidosis is carbon dioxide (CO2) accumulation (hypercapnia) due to a decrease in respiratory rate and/or respiratory volume (hypoventilation). Causes of hypoventilation (discussed under Ventilatory Failure ) include Conditions that impair CNS respiratory drive Conditions that impair neuromuscular transmission and other conditions that cause muscular weakness Obstructive, restrictive, and parenchymal pulmonary disorders Hypoxia typically accompanies hypoventilation. Distinction is based on the degree of metabolic compensation; carbon dioxide is initially buffered inefficiently, but over 3 to 5 days the kidneys increase bicarbonate reabsorption significantly. Symptoms and signs depend on the rate and degree of Pco2 increase. CO2 rapidly diffuses across the blood-brain barrier. Symptoms and signs are a result of high CO2 concentrations and low pH in the CNS and any accompanying hypoxemia. Acute (or acutely worsening chronic) respiratory acidosis causes headache, confusion Continue reading >>

Respiratory Acidosis

Respiratory Acidosis

What is respiratory acidosis? Respiratory acidosis is a condition that occurs when the lungs can’t remove enough of the carbon dioxide (CO2) produced by the body. Excess CO2 causes the pH of blood and other bodily fluids to decrease, making them too acidic. Normally, the body is able to balance the ions that control acidity. This balance is measured on a pH scale from 0 to 14. Acidosis occurs when the pH of the blood falls below 7.35 (normal blood pH is between 7.35 and 7.45). Respiratory acidosis is typically caused by an underlying disease or condition. This is also called respiratory failure or ventilatory failure. Normally, the lungs take in oxygen and exhale CO2. Oxygen passes from the lungs into the blood. CO2 passes from the blood into the lungs. However, sometimes the lungs can’t remove enough CO2. This may be due to a decrease in respiratory rate or decrease in air movement due to an underlying condition such as: There are two forms of respiratory acidosis: acute and chronic. Acute respiratory acidosis occurs quickly. It’s a medical emergency. Left untreated, symptoms will get progressively worse. It can become life-threatening. Chronic respiratory acidosis develops over time. It doesn’t cause symptoms. Instead, the body adapts to the increased acidity. For example, the kidneys produce more bicarbonate to help maintain balance. Chronic respiratory acidosis may not cause symptoms. Developing another illness may cause chronic respiratory acidosis to worsen and become acute respiratory acidosis. Initial signs of acute respiratory acidosis include: headache anxiety blurred vision restlessness confusion Without treatment, other symptoms may occur. These include: sleepiness or fatigue lethargy delirium or confusion shortness of breath coma The chronic form of Continue reading >>

Respiratory Acidosis/ Alkalosis

Respiratory Acidosis/ Alkalosis

Don't miss your chance to win free admissions prep materials! Click here to see a list of raffles . So, I am reading up on acid-base disturbances, which have always given me a bit of trouble. I think I am understanding them a lot better now, but am still confused about how the different lung diseases in particular cause either resp. acidosis or alkalosis. Different resources say different things and the sources I've taken a look at don't really do a good job of explainingthe reason why a particular disease causes acidosis or alkalosis. Take for example, restrictive and obstructive lung diseases. I can understand that with an obstructive lung disease you have trouble getting air out of the lungs, so less CO2 is removed --> respiratory acidosis. But what about restrictive lung disease? Different books say different things - some say that they cause resp. acidosis, while others say they cause resp. alkalosis. Nobody seems to give a good explanation either way. I think I can reason out that restrictive lung disease, esp. interstitial lung disease, --> imparied diffusion of CO2 out of the lungs --> resp. acidosis). What about pulmonary edema and pneumonia? Some sources say resp acidosis and some say resp alkalosis? Finally, one of the major causes I've seen for resp. alkalosis is hypoxemia (due to stimulation of peripheral chemoreceptors). However, it seems that most pulmonary causes of hypercapnia would also cause hypoxemia. So why wouldn't all pulmonary causes of hypercapnia cause a respiratory alkalosis? Finally, I've noticed that severe anemia is listed as a cause of respiratory alkalosis, but can't find the mechanism for this. Since anemia only decreases O2 content and doesn't affect the PaO2, I'm guessing it has nothing to do with peripheral chemoreceptor stimulation. Continue reading >>

Respiratory Alkalosis

Respiratory Alkalosis

What is respiratory alkalosis? Respiratory alkalosis occurs when the levels of carbon dioxide and oxygen in the blood are not balanced. Your body needs oxygen to function properly. When you inhale, you introduce oxygen into the lungs. When you exhale, you release carbon dioxide, which is a waste product. Normally, the respiratory system keeps these two gases in balance. Respiratory alkalosis occurs when you breathe too fast or too deep and carbon dioxide levels drop too low. This causes the pH of the blood to rise and become too alkaline. When the blood becomes too acidic, respiratory acidosis occurs. Hyperventilation is typically the underlying cause of respiratory alkalosis. Hyperventilation is also known as overbreathing. Someone who is hyperventilating breathes very deeply or rapidly. Causes of hyperventilation Panic attacks and anxiety are the most common causes of hyperventilation. However, they’re not the only possible causes. Others include: pain drug use fever infection If you’re experiencing hyperventilation (especially for the first time), don’t assume you know the cause. Make an appointment with your doctor. Overbreathing is a sign that respiratory alkalosis is likely to develop. However, low carbon dioxide levels in the blood also have a number of physical effects, including: dizziness bloating feeling lightheaded numbness or muscle spasms in the hands and feet discomfort in the chest area confusion dry mouth tingling in the arms feeling short of breath The treatment for respiratory alkalosis depends on the underlying cause. Panic and anxiety-related causes Treating the condition is a matter of raising carbon dioxide levels in the blood. The following strategies and tips are useful for respiratory alkalosis caused by overbreathing due to panic and anx Continue reading >>

Respiratory Acidosis

Respiratory Acidosis

Respiratory acidosis can arise from a break in any one of these links. For example, it can be caused from depression of the respiratory center through drugs or metabolic disease, or from limitations in chest wall expansion due to neuromuscular disorders or trauma (Table 90-1). It can also arise from pulmonary disease, card iog en ic pu lmon a ryedema, a spira tion of a foreign body or vomitus, pneumothorax and pleural space disease, or through mechanical hypoventilation. Unless there is a superimposed or secondary metabolic acidosis, the plasma anion gap will usually be normal in respiratory acidosis. Introduction Respiratory acidosis is characterized by an increased arterial blood PCO2 and H+ ion concentration. The major cause of respiratory acidosis is alveolar hypoventilation. The expected physiologic response is an increased PHCO3. The increase in concentration of bicarbonate ions (HCO3) in plasma (PHCO3) is tiny in patients with acute respiratory acidosis, but is much larger in patients with chronic respiratory acidosis. Respiratory alkalosis is caused by hyperventilation and is characterized by a low arterial blood PCO2 and H+ ion concentration. The expected physiologic response is a decrease in PHCO3. As in respiratory acidosis, this response is modest in patients with acute respiratory alkalosis and much larger in patients with chronic respiratory alkalosis. Although respiratory acid-base disorders are detected by measurement of PCO2 and pH in arterial blood and may reveal the presence of a serious underlying disease process that affected ventilation, it is important to recognize the effect of changes in capillary blood PCO2 in the different organs on the binding of H+ ions to intracellular proteins, which may change their charge, shape, and possibly their funct Continue reading >>

Respiratory Acidosis

Respiratory Acidosis

Causes of respiratory acidosis include: Diseases of the lung tissue (such as pulmonary fibrosis, which causes scarring and thickening of the lungs) Diseases of the chest (such as scoliosis) 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), often when combined with alcohol Severe obesity, which restricts how much the lungs can expand Obstructive sleep apnea Chronic respiratory acidosis occurs over a long time. This leads to a stable situation, because the kidneys increase body chemicals, such as bicarbonate, that help restore the body's acid-base balance. Acute respiratory acidosis is a condition in which carbon dioxide builds up very quickly, before the kidneys can return the body to a state of balance. Some people with chronic respiratory acidosis get acute respiratory acidosis because an illness makes their condition worse. Continue reading >>

Respiratory Alkalosis

Respiratory Alkalosis

Background Respiratory alkalosis is a disturbance in acid and base balance due to alveolar hyperventilation. Alveolar hyperventilation leads to a decreased partial pressure of arterial carbon dioxide (PaCO2). In turn, the decrease in PaCO2 increases the ratio of bicarbonate concentration to PaCO2 and, thereby, increases the pH level, thus the descriptive term of respiratory alkalosis. The decrease in PaCO2 (hypocapnia) develops when a strong respiratory stimulus causes the respiratory system to remove more carbon dioxide than is produced metabolically in the tissues. Respiratory alkalosis can be acute or chronic. In acute respiratory alkalosis, the PaCO2 level is below the lower limit of normal and the serum pH is alkalemic. In chronic respiratory alkalosis, the PaCO2 level is below the lower limit of normal, but the pH level is relatively normal or near normal. Respiratory alkalosis is the most common acid-base abnormality observed in patients who are critically ill. It is associated with numerous illnesses and is a common finding in patients on mechanical ventilation. Many cardiac and pulmonary disorders can manifest with respiratory alkalosis as an early or intermediate finding. When respiratory alkalosis is present, the cause may be a minor, non–life-threatening disorder. However, more serious disease processes should also be considered in the differential diagnosis. Continue reading >>

Respiratory Acidosis/alkalosis

Respiratory Acidosis/alkalosis

Increased rate and depth of respirations to blow off CO2. Kidneys eliminate H+ ions and retain HCO3-(urine pH less than 6) HCO3- levels rise when the body is compensating for the acidosis In an attempt ot compensate, the kidneys retain bicarbonate and excrete excess H+ ions into the urine The total concentration of buffer base is lower than normal, with a relative increase in hydrogen ion concentration; thus a greater number of hydrogen ions is circulating in the blood than can be absorbed by the buffer system. 1.Monitor for signs of respiratory distress. 3.Place the client in a semi-Fowler's position, unless contraindicated. 4.Encourage and assist the client to turn, cough, and deep-breathe. 5.Prepare to administer respiratory treatments as prescribed. 6.Encourage hydration to thin secretions, unless excess fluid intake is contraindicated. 7.Suction the client's airway, if necessary and if not contraindicated. 8.Reduce restlessness by improving ventilation rather than by administering tranquilizers, sedatives, or opioids because these medications further depress respirations. Hyperventilation caused by hypoxia, fear, fever, pain, exercise, anxiety, pulmonary embolus, hysteria, overventilation/mechanical,Stimulated respiratory center caused by septiceemia, encephalities, brain injury, salicylate poisoning, hypokalemia, salicylate poisoning Lethargy, Light-headedness, Dizziness, Confusion, Tachycardia, Increase sinsitivity to digitalis preperations, Dysrhythmias(related to hypokalemia from compensaation), Nausea, Vomiting, Epigastric pain, Tetany, Panic, Anxiety, Numbness/tingling of extremities(hypocalcemia), Hyperreflexia, Sseizures, Blured vision, Rapid/shallow breath, Hyperventilation(lungs aare unable to compensate when there is a respiratory problem) Kidneys conse Continue reading >>

Respiratory Alkalosis

Respiratory Alkalosis

(Video) Overview of Acid-Base Maps and Compensatory Mechanisms By James L. Lewis, III, MD, Attending Physician, Brookwood Baptist Health and Saint Vincents Ascension Health, Birmingham Respiratory alkalosis is a primary decrease in carbon dioxide partial pressure (Pco2) with or without compensatory decrease in bicarbonate (HCO3); pH may be high or near normal. Cause is an increase in respiratory rate or volume (hyperventilation) or both. Respiratory alkalosis can be acute or chronic. The chronic form is asymptomatic, but the acute form causes light-headedness, confusion, paresthesias, cramps, and syncope. Signs include hyperpnea or tachypnea and carpopedal spasms. Diagnosis is clinical and with ABG and serum electrolyte measurements. Treatment is directed at the cause. (See also Acid-Base Regulation , Acid-Base Disorders , and Hyperventilation Syndrome .) Respiratory alkalosis is a primary decrease in Pco2 (hypocapnia) due to an increase in respiratory rate and/or volume (hyperventilation). Ventilation increase occurs most often as a physiologic response to hypoxia (eg, at high altitude), metabolic acidosis , and increased metabolic demands (eg, fever) and, as such, is present in many serious conditions. In addition, pain and anxiety and some CNS disorders (eg, stroke, seizure [post-ictal]) can increase respirations without a physiologic need. Distinction is based on the degree of metabolic compensation. Excess HCO3 is buffered by extracellular hydrogen ion (H+) within minutes, but more significant compensation occurs over 2 to 3 days as the kidneys decrease H+ excretion. Pseudorespiratory alkalosis is low arterial Pco2 and high pH in mechanically ventilated patients with severe metabolic acidosis due to poor systemic perfusion (eg, cardiogenic shock, during CPR). Pseu Continue reading >>

Respiratory Acidosis Nclex Review Notes

Respiratory Acidosis Nclex Review Notes

Are you studying respiratory acidosis and need to know a mnemonic on how to remember the causes? This article will give you a clever mnemonic and simplify the signs and symptoms and nursing interventions on how to remember respiratory acidosis for nursing lecture exams and NCLEX. In addition, you will learn how to differentiate respiratory acidosis from respiratory alkalosis. Don’t forget to take the respiratory acidosis and respiratory alkalosis quiz. This article will cover: Sequence of normal breathing Patho of respiratory acidosis Causes of respiratory acidosis Signs and symptoms of respiratory acidosis Nursing interventions for respiratory acidosis Lecture on Respiratory Acidosis Respiratory Acidosis What’s involved:…let’s look at normal breathing: Oxygen enters through the mouth or nose down through the Pharynx into the Larynx (the throat) then into the Trachea and the Bronchus (right and left) which branches into the bronchioles and ends in alveoli sac *The alveolar sacs are where gas exchange takes place (oxygen and carbon dioxide diffuse across the membrane). The oxygen enters into your blood stream and CARBON DIOXIDE CO2 is exhaled through your nose or mouth. The diaphragm also plays a role in allowing lungs into inflate and deflate. Note: if there is any problem with the patient breathing rate (too slow), alveolar sacs (damaged), or diaphragm (weak) the patient can experience respiratory acidosis. *Main cause of respiratory acidosis is bradypnea (slow respiratory rate <12 bpm which causes CO2 to build-up in the lungs) When this happens the following lab values are affected: Blood pH decreases (<7.35) Carbon dioxide levels increase (>45) **To compensate for this the Kidneys start to conserve bicarbonate (HCO3) to hopefully increase the blood’s pH bac Continue reading >>

Respiratory Acidosis

Respiratory Acidosis

Respiratory acidosis is a medical emergency in which decreased ventilation (hypoventilation) increases the concentration of carbon dioxide in the blood and decreases the blood's pH (a condition generally called acidosis). Carbon dioxide is produced continuously as the body's cells respire, and this CO2 will accumulate rapidly if the lungs do not adequately expel it through alveolar ventilation. Alveolar hypoventilation thus leads to an increased PaCO2 (a condition called hypercapnia). The increase in PaCO2 in turn decreases the HCO3−/PaCO2 ratio and decreases pH. Terminology[edit] Acidosis refers to disorders that lower cell/tissue pH to < 7.35. Acidemia refers to an arterial pH < 7.36.[1] Types of respiratory acidosis[edit] Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range (over 6.3 kPa or 45 mm Hg) with an accompanying acidemia (pH <7.36). In chronic respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range, with a normal blood pH (7.35 to 7.45) or near-normal pH secondary to renal compensation and an elevated serum bicarbonate (HCO3− >30 mm Hg). Causes[edit] Acute[edit] Acute respiratory acidosis occurs when an abrupt failure of ventilation occurs. This failure in ventilation may be caused by depression of the central respiratory center by cerebral disease or drugs, inability to ventilate adequately due to neuromuscular disease (e.g., myasthenia gravis, amyotrophic lateral sclerosis, Guillain–Barré syndrome, muscular dystrophy), or airway obstruction related to asthma or chronic obstructive pulmonary disease (COPD) exacerbation. Chronic[edit] Chronic respiratory acidosis may be secondary to many disorders, including COPD. Hypoventilation Continue reading >>

6.2 Respiratory Alkalosis - Causes

6.2 Respiratory Alkalosis - Causes

Hyperventilation is the mechanism in ALL cases Hyperventilation (ie increased alveolar ventilation) is the mechanism responsible for the lowered arterial pCO2 in ALL cases of respiratory alkalosis. This low arterial pCO2 will be sensed by the central and peripheral chemoreceptors and the hyperventilation will be inhibited unless the patients ventilation is controlled. 1. Central Causes (direct action via respiratory centre) Other 'supra-tentorial' causes (pain, fear, stress, voluntary) Various drugs (eg analeptics, propanidid, salicylate intoxication) Various endogenous compounds (eg progesterone during pregnancy, cytokines during sepsis, toxins in patients with chronic liver disease) 2. Hypoxaemia (act via peripheral chemoreceptors) Respiratory stimulation via peripheral chemoreceptors 3. Pulmonary Causes (act via intrapulmonary receptors) 4. Iatrogenic (act directly on ventilation) Can a decreased CO2 production cause respiratory alkalosis? Hyperventilation is the mechanism in all of the situations in the above list & indeed in all cases. Theoretically, a decreased carbon dioxide production could result in respiratory alkalosis if alveolar ventilation remained fixed. But this would not occur in a normal person because any drop in arterial pCO2 would reflexly cause a decreased ventilation (via chemoreceptor inhibitory input into the respiratory centre). About the only situation where maybe a decrease in CO2 production could be the mechanism of respiratory alkalosis would be in an intubated patient on fixed ventilation during Anaesthesia or in Intensive Care Unit and where the CO2 production was low due to hypothermia and decreased metabolic rate. However, even in such a circumstance, this mechanism is usually referred to as 'excessive controlled ventilation' (which it Continue reading >>

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