Respiratory acidosis: Difference between revisions
No edit summary |
No edit summary |
||
| Line 14: | Line 14: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[COPD]] | |||
*Drugs ([[Opioid Overdose]]) | |||
*Chest wall dz | |||
*Pleural dz | |||
*Trauma | |||
==Diagnosis== | ==Diagnosis== | ||
| Line 24: | Line 24: | ||
==Treatment== | ==Treatment== | ||
#Improve alveolar ventilation | #Improve alveolar ventilation | ||
#*Bronchodilators | #*[[Bronchodilators]] | ||
#*CPAP | #*[[CPAP]] | ||
#*[[Intubation]] (esp of pH < 7.25) | #*[[Intubation]] (esp of pH < 7.25) | ||
#**Do not reduce pH too quickly (>5Hg/h) | #**Do not reduce pH too quickly (>5Hg/h) | ||
Revision as of 10:38, 20 July 2015
Background
- acidemia = pH < 7.38
- respiratory acidosis = pCO2 > 42
- Acute respiratory acidosis: Change in pH = 0.008 X (40 - PaCO2)
vs. Chronic respiratory acidosis: Change in pH = 0.003 X (40 - PaCO2)
- determine if another primary acid/base disturbance is occurring
- calculate AG
- if HCO3 < 24 + (pCO2-40)/10 x 3(+/-1) then there is a superimposed primary metabolic acidosis
- for every 10mm increase in pCO2 >40, HCO3expected increases by 2-4mEq (2 if acute/limited time for metabolic compensation, 4 if chronic i.e. COPD)
- if HCO3 > 24 + (pCO2-40)/10 x 3(+/-1) then suspect primary metabolic alkalosis
Etiology
Hypoventilation - acute vs chronic
Differential Diagnosis
- COPD
- Drugs (Opioid Overdose)
- Chest wall dz
- Pleural dz
- Trauma
Diagnosis
Treatment
- Improve alveolar ventilation
- Bronchodilators
- CPAP
- Intubation (esp of pH < 7.25)
- Do not reduce pH too quickly (>5Hg/h)
- Can lead to abrupt Hypocalcemia/Hypokalemia
- Do not reduce pH too quickly (>5Hg/h)