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What Is The Cause Of Respiratory Acidosis?

Ph Control: Respiratory Acidosis

Ph Control: Respiratory Acidosis

Normally, the kidneys and lungs maintain a pH between 7.35 - 7.45 in extracellular fluid. Respiratory acidosis occurs when the lungs cannot eliminate enough carbon dioxide from the body’s tissues. The typical reason is hypoventilation, or a low respiratory rate, causing the plasma pH to fall below 7.35 due to excessive carbon dioxide in the blood. When this occurs, certain chemoreceptors in the body are stimulated to increase the respiratory rate. The kidneys also help by secreting more hydrogen ions (acid) into the tubular fluid and generating more bicarbonate (base) to help stabilize the pH. Respiratory acidosis can cause many physiological problems, particularly in the nervous and cardiovascular systems which are sensitive to pH fluctuations. Continue reading >>

Free Nursing Flashcards About Acid Base Knowledge

Free Nursing Flashcards About Acid Base Knowledge

Choose the acid-base disorder pyloric stenosis with projectile vomiting commonly causes.A) Respiratory alkalosis B) Metabolic acidosis C) Metabolic alkalosis D) Respiratory acidosis Which of the following conditions may cause metabolic acidosis? Choose all that apply. A) Excessive intake of bicarbonate antacid B) Hyperthyroidism C) Loss of gastric acid D) Salicylate overdose E) Untreated diabetes mellitus Choose the acid-base imbalance that acute renal failure causes. A) Metabolic alkalosis B) Respiratory acidosis C) Metabolic acidosis D) Respiratory alkalosis Which of the following lab values may be seen in fully compensated respiratory acidosis? A) Dec PaCO2, dec HCO3-, normal pH B) Inc PaCO2, dec HCO3-, normal pH C) Inc PaCO2, normal HCO3-, de pH D) Inc PaCO2, inc HCO3-, normal pH What is the compensatory mechanism for metabolic acidosis? A) Increased rate and depth of respirations. B) Increased renal excretion of bicarbonate. C) Decreased rate and depth of respirations. D) Decreased renal excretion of bicarbonate. Choose the acid-base imbalance that pneumococcal pneumonia causes. A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis Choose the acid-base disorder that COPD type B commonly causes. A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory alkalosis D) Respiratory acidosis Choose the acid-base imbalance that severe lack of insulin causes. A) Respiratory acidosis B) Metabolic acidosis C) Respiratory alkalosis D) Metabolic alkalosis Which of the following lab values would be seen in a patient who has end-stage type B COPD (chronic bronchitis)? A) Inc PaCO2, dec HCO3-, dec pH. B) Decr PaCO2, decr HCO3-, incr pH. C) Decr PaCO2, incr HCO3-, decr pH. D) Incr PaCO2, incr HCO3-, decr pH. Choose the acid-base imbalance Continue reading >>

Acidosis Or Alkalosis

Acidosis Or Alkalosis

Sleuthing: Using Blood Values to determine the Cause of Acidosis or Alkalosis Note the pH. This tells you whether the person is in acidosis (pH < 7.35) or alkalosis (pH > 7.45); but it does not tell you the cause. Next, check the PCO2 to see if this is the cause of the acid-base imbalance. Because the respiratory system is a fast-acting system, an excessively high or low PCO2 may indicate either that the condition is respiratory system—caused or that the respiratory system is compensating. For example, if the pH indicates acidosis and: The PCO2 is over 45 mm Hg, the respiratory system is the cause of the problem and the condition is a respiratory acidosis. The PCO2 is below normal limits (below 35 mmHg), the respiratory system is not the cause but is compensating. The PCO2 is within normal limits; the condition is neither caused nor compensated by the respiratory system. Check the bicarbonate level. If step 2 proves that the respiratory system is not responsible for the imbalance, then the condition is metabolic and should be reflected in increased or decreased bicarbonate levels. Metabolic acidosis is indicated by HCO3– values below 22 mEq/L, and metabolic alkalosis by values over 26 mEq/L. Notice that whereas PCO2 vary inversely with blood pH (PCO2 rises as blood pH falls), HCO3– levels vary directly with blood pH (increased HCO3– results in increased pH). Beyond this bare-bones approach there is something else to consider when you are assessing acid-base problems. If an imbalance is fully compensated, the pH may be normal even when the pH is normal, carefully scrutinize the PCO2 or HCO3– values for clues to what imbalance may be occurring. Causes and Consequences of Acid-Base imbalances Metabolic acidosis: Uncompensated (uncorrected) HCO3– < 22 mEq/L; pH Continue reading >>

Respiratory Acidosis Encyclopedia Search - Medical Dictionary Search Engines

Respiratory Acidosis Encyclopedia Search - Medical Dictionary Search Engines

Chronic respiratory acidosis; Ventilatory failure; Respiratory failure; Acidosis - respiratory Respiratory acidosis occurs when the lungs cannot remove all of the carbon dioxide (a normal by-product of metabolism) produced by the body. Because of this disturbance of the acid-base balance, body fluids become excessively acidic. Respiratory acidosis can be a consequence of any lung disease that prevents removal of carbon dioxide. Common lung diseases that lead to respiratory acidosis include: chronic obstructive pulmonary disease (COPD), severe asthma , or airway obstruction . Other conditions that may lead to respiratory acidosis include: obesity hypoventilation syndrome , excessive fatigue of the diaphragm or muscles of the rib cage, or severe deformities of the spine and rib cage (for example, severe scoliosis). In chronic respiratory acidosis, mild impairment of the lungs' ability to remove carbon dioxide occurs over a long period of time, leading to a stable situation. This is because the kidneys increase their retention of bicarbonate to maintain an acid-base balance in the blood that is almost normal. In severe cases, the carbon dioxide builds up very quickly, leading to severe disturbances in the acid-base balance of the blood. Nearly any lung disease may lead to respiratory acidosis. Chronic obstructive pulmonary disease (COPD) is a major cause of respiratory acidosis. COPD is most often caused by cigarette smoking. Symptoms of the diseases that cause respiratory acidosis are usually noticeable, and may include shortness of breath, easy fatigue, chronic cough, or wheezing. When respiratory acidosis becomes severe, confusion, irritability, or lethargy may be apparent. A chest x-ray or CAT scan may be done to diagnose possible lung disease Pulmonary function tests Continue reading >>

Respiratory Acidosis: Causes, Symptoms, And Treatment

Respiratory Acidosis: Causes, Symptoms, And Treatment

Respiratory acidosis develops when air exhaled out of the lungs does not adequately exchange the carbon dioxide formed in the body for the inhaled oxygen in air. There are many conditions or situations that may lead to this. One of the conditions that can reduce the ability to adequately exhale carbon dioxide (CO2) is chronic obstructive pulmonary disease or COPD. CO2 that is not exhaled can shift the normal balance of acids and bases in the body toward acidic. The CO2 mixes with water in the body to form carbonic acid. With chronic respiratory acidosis, the body partially makes up for the retained CO2 and maintains acid-base balance near normal. The body's main response is an increase in excretion of carbonic acid and retention of bicarbonate base in the kidneys. Medical treatment for chronic respiratory acidosis is mainly treatment of the underlying illness which has hindered breathing. Treatment may also be applied to improve breathing directly. Respiratory acidosis can also be acute rather than chronic, developing suddenly from respiratory failure. Emergency medical treatment is required for acute respiratory acidosis to: Regain healthful respiration Restore acid-base balance Treat the causes of the respiratory failure Here are some key points about respiratory acidosis. More detail and supporting information is in the main article. Respiratory acidosis develops when decreased breathing fails to get rid of CO2 formed in the body adequately The pH of blood, as a measure of acid-base balance, is maintained near normal in chronic respiratory acidosis by compensating responses in the body mainly in the kidney Acute respiratory acidosis requires emergency treatment Tipping acid-base balance to acidosis When acid levels in the body are in balance with the base levels in t 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 In The Elderly

Respiratory Acidosis In The Elderly

Brief introduction of respiratory acidosis in the elderly Respiratory acidosis (respiratory acid) often due to CO2 retention, acute kidney compensatory effect is not, bicarbonate buffer system does not work, so acidosis progress quickly, more than ten minutes to reach the severity ; And retention of CO2 easily into the cell, leading to intracellular acidosis, if not promptly corrected, high mortality. Its main feature is the plasma PaCO2 increased, chronic phase HCO3-level compensatory increase. Complications: coma disc edema brain edema heart failure Departments: Department of Respiratory Medicine Internal Medicine Other departments Emergency department intensive care unit Treatment: symptomatic treatment of drug treatment supportive treatment of rehabilitation Commonly used drugs: Nicholasin injection of doxapril hydrochloride injection Food to be soft, easy to digest, color and smell, can cause appetite. Causes of Respiratory Acidosis in the Elderly 1. respiratory center inhibition: drugs (all kinds of sedatives or anesthetics), central disease, extreme obesity and so on. 2. Respiratory muscle or chest wall obstruction: such as respiratory muscle weakness, paralysis or restrictions, the use of ventilator when the lack of ventilation or ventilation failure. 3. Upper airway obstruction: acute tracheal foreign body, acute throat spasm and so on. 4. Pulmonary diseases: such as chronic obstructive pulmonary disease, pulmonary edema, atelectasis, ARDS and so on. 5. Other: such as high fever or hyperthyroidism and so on. CO2 drainage disorders, including CO2 diffusion disorders and hypoventilation is the main pathogenesis, if the lung function is normal, increased CO2 production (such as high fever or hyperthyroidism, etc.) often does not occur CO2 retention. Prevention of Continue reading >>

Respiratory Acidosis

Respiratory Acidosis

Respiratory acidosis can be defined as a medical condition in which hypoventilation or decreased ventilation leads to an increase in the concentration of blood carbon dioxide and decreased pH or acidosis. CO2 is constantly produced as the cells of the body respire. However, carbon dioxide can rapidly accumulate if the lungs are unable to expel it adequately through alveolar ventilation. Hence, alveolar hypoventilation leads to increased levels of PaCO2, a condition which is referred to as hypercapnia. Increased levels of PaCO2 reduce the HCO3/PaCO2 ratio as well as decrease the pH levels. The ICD-9 Code for this disorder is 276.2. The condition is subdivided into the following two types: In this form, the PaCO2 levels are elevated above 47 mm Hg or 6.3 kPa reference mark along with accompanying acidemia (pH levels less than 7.35). In this type, the PaCO2 levels are elevated above upper limit of reference range, with normal blood pH levels (between 7.35 and 7.45) or near normal pH that is secondary to the renal compensation and elevated levels of serum bicarbonate (HCO3 greater than 30 mm Hg). There are a number of factors which might be responsible for the development of this disorder. The causes responsible for both types of respiratory acidosis might differ from each other. These causes have been mentioned below: It occurs due to an abrupt or sudden failure of ventilation. This can occur due to the following factors: Exacerbation of chronic obstructive pulmonary disease or COPD Depression of central respiratory center caused by drugs or cerebral disease Airway obstruction caused by asthma, emphysema, bronchitis or pneumonia Inadequate ventilation caused by neuromuscular diseases, such as amyotrophic lateral sclerosis, myasthenia gravis, muscular dystrophy and Guillai Continue reading >>

Surgical Procedures/acid Base Disorder

Surgical Procedures/acid Base Disorder

(Usually in clinical practice, H+ concentration is expressed as pH.) PaCO2 (Arterial CO2 concentration normal = 3545 mm Hg). HCO3 (Serum electrolytes normal = 2231 mmol/liter). Acidosis is a process that causes the accumulation of acid. Alkalosis is a process that causes the accumulation of alkali. The most common causes in the surgical practice include: Diuretic therapy (e.g., contraction alkalosis). Acid loss through GI secretions (e.g., nasogastric suctioning, vomiting). Exogenous administration of HCO3 or HCO3 precursors (e.g., citrate in blood). Chloride-unresponsive metabolic alkalosis is comparatively less common and includes: Renal tubular Cl wasting (Bartters syndrome) Measurement of urinary chloride concentration. Suggestive causes of the metabolic alkalosis if Urine Cl concentration is <15 mmol/liter: Sughgestive causes of the metabolic alkalosis if Urine Cl concentration is > 20 mmol/liter: Treatment principles in metabolic alkalosis:[ edit ] Removing and identifying underlying causes, Discontinuing exogenous alkali, repairing Cl, K+, and volume deficits. Correction of volume deficits (can be used 0.9% NaCl) and hypokalemia. H2-receptor antagonists or other acid-suppressing medications can be used after vomiting or nasogastric suctioning. Acetazolamide (5 mg/kg/day IV or PO) can be used. Eases fluid mobilization while decreasing renal HCO3 reabsorption. Tolerance to this diuretic may develop after 23 days. Ammonium chloride (NH4Cl) can be used in severe alkalemia (HCO3 >40 mmol/liter; rate not exceeding 5 ml/minute). Approximately one-half of the calculated volume of NH4Cl is usually administered and the acid-base status and Cl concentration is usually rechecked to determine the need of further treatment. Hepatic failure is contraindication for NH4Cl. HCl m Continue reading >>

Evaluation Of Respiratory Acidosis

Evaluation Of Respiratory Acidosis

Respiratory acidosis occurs when acute or chronic derangements of the respiratory system lead to inefficient clearance of carbon dioxide. These derangements may involve: A disorder of central control of ventilation. When alveolar gas exchange units are unable to sufficiently excrete carbon dioxide, this leads to an increase in the arterial carbon dioxide levels above the normal range of 35 to 45 mmHg (4.7-6.0 kPa). With the increase in carbon dioxide, hydrogen ions accumulate, causing the arterial pH to fall below the normal range (i.e., <7.35). [1] O'Driscoll BR, Howard LS, Earis J, et al. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72(suppl 1):ii1-ii90. Respiratory acidosis may be acute or chronic. Acute respiratory acidosis is usually secondary to acute respiratory failure. In acute respiratory failure, there is insufficient buffering capacity to handle the dramatic increase in arterial and venous carbon dioxide. Over time, more and more carbon dioxide is processed by carbonic anhydrase to bicarbonate (the Hamburger shift). This leads to chloride excretion by the kidney with ammonium, and the pH gradually rises. [2] Alfaro V, Torras R, Ibez J, et al. A physical-chemical analysis of the acid-base response to chronic obstructive pulmonary disease. Can J Physiol Pharmacol. 1996;74:1229-1235. The consequences of failing to recognize acute respiratory failure include marked hypoxemia, hyperkalemia, cardiovascular instability, and cardiac arrest. Drug use (narcotics, alcohol, sedatives, anesthetics) Continue reading >>

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 >>

Disorders Of Acid-base Balance

Disorders Of Acid-base Balance

Learning Objectives By the end of this section, you will be able to: Identify the three blood variables considered when making a diagnosis of acidosis or alkalosis Identify the source of compensation for blood pH problems of a respiratory origin Identify the source of compensation for blood pH problems of a metabolic/renal origin Normal arterial blood pH is restricted to a very narrow range of 7.35 to 7.45. A person who has a blood pH below 7.35 is considered to be in acidosis (actually, “physiological acidosis,” because blood is not truly acidic until its pH drops below 7), and a continuous blood pH below 7.0 can be fatal. Acidosis has several symptoms, including headache and confusion, and the individual can become lethargic and easily fatigued. A person who has a blood pH above 7.45 is considered to be in alkalosis, and a pH above 7.8 is fatal. Some symptoms of alkalosis include cognitive impairment (which can progress to unconsciousness), tingling or numbness in the extremities, muscle twitching and spasm, and nausea and vomiting. Both acidosis and alkalosis can be caused by either metabolic or respiratory disorders. As discussed earlier in this chapter, the concentration of carbonic acid in the blood is dependent on the level of CO2 in the body and the amount of CO2 gas exhaled through the lungs. Thus, the respiratory contribution to acid-base balance is usually discussed in terms of CO2 (rather than of carbonic acid). Remember that a molecule of carbonic acid is lost for every molecule of CO2 exhaled, and a molecule of carbonic acid is formed for every molecule of CO2 retained. Metabolic Acidosis: Primary Bicarbonate Deficiency Metabolic acidosis occurs when the blood is too acidic (pH below 7.35) due to too little bicarbonate, a condition called primary bicar Continue reading >>

Acid-base Disorders In Patients With Chronic Obstructive Pulmonary Disease: A Pathophysiological Review

Acid-base Disorders In Patients With Chronic Obstructive Pulmonary Disease: A Pathophysiological Review

Acid-Base Disorders in Patients with Chronic Obstructive Pulmonary Disease: A Pathophysiological Review Department of Internal Medicine and Systemic Diseases, University of Catania, 95100 Catania, Italy Received 29 September 2011; Accepted 26 October 2011 Copyright 2012 Cosimo Marcello Bruno and Maria Valenti. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The authors describe the pathophysiological mechanisms leading to development of acidosis in patients with chronic obstructive pulmonary disease and its deleterious effects on outcome and mortality rate. Renal compensatory adjustments consequent to acidosis are also described in detail with emphasis on differences between acute and chronic respiratory acidosis. Mixed acid-base disturbances due to comorbidity and side effects of some drugs in these patients are also examined, and practical considerations for a correct diagnosis are provided. Chronic obstructive pulmonary disease (COPD) is a major public health problem. Its prevalence varies according to country, age, and sex. On the basis of epidemiologic data, the projection for 2020 indicates that COPD will be the third leading cause of death worldwide and the fifth leading cause of disability [ 1 ]. About 15% of COPD patients need admission to general hospital or intensive respiratory care unit for acute exacerbation, leading to greater use of medical resources and increased costs [ 2 5 ]. Even though the overall prognosis of COPD patients is lately improved, the mortality rate remains high, and, among others, acid-base disorders occurring in these subjects can affect the outcome. The aim of this pa 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 >>

Virtualmedstudent.com || Respiratory Acidosis

Virtualmedstudent.com || Respiratory Acidosis

A respiratory acidosis occurs when a person hypoventilates (ie: breathes too slow or too shallow). The result is an increase in PaCO2 (ie: the amount of CO2 dissolved in blood). The increase in plasma CO2 causes the blood to become acidic, which is manifest by a drop in the bodies' pH. The reason blood becomes more acidic under these conditions is based on Le Chatelier's principle. To understand this principle better let's look at the equation that governs CO2 and HCO3- formation: HCO3- + H+ <---> H2CO3 <---> CO2(g) + H2O You'll notice that CO2 (on the right most part of the equation) is what is exhaled via the lungs. When a patient is hypoventilating there is much more CO2 than normal in the blood stream. The body compensates by turning this CO2 into HCO3- and H+. The resulting increase in H+ (hydrogen ion) causes the acidosis (decrease in pH). So what could cause someone to hypoventilate? There are many causes! All of them relate to a decreased ability of the patient to breath at a rate sufficient to remove carbon dioxide from the blood stream. Medications that slow respiratory rate (ie: morphine and other pain medications) are notorious culprits. Poor pulmonary mechanics from obesity or neuromuscular disease (ie: amyotrophic lateral sclerosis ) can also cause decreased respiratory rates. Lung and chest wall diseases are also common causes of respiratory acidosis and include pneumonia, pneumothorax, and decreased respiratory rate secondary to pain from rib fractures (contrast this from hyperventilating from other painful stimuli). When assessing someone who has a respiratory acidosis first ask the question: what is causing the patient to have a decreased respiratory rate? Look for signs of external chest wall trauma, pneumonia, etc. Scour through the medication recor Continue reading >>

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