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ACNP II - Exam 1 > 1.8 - Respiratory Acidosis & Alkalosis > Flashcards

1.8 - Respiratory Acidosis & Alkalosis Flashcards

1
Q

What is respiratory acidosis?

A
  • It is a ventilatory process that increases hydrogen; pH less than 7.35
  • It is identified by an increase in arterial pCO2 greater than 45 mmHg
  • Metabolic alkalosis seen as compensating process
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2
Q

What causes respiratory acidosis?

A

Respiratory academia occurs when a failure (either acute or chronic) in ventilation occurs. The manifestations of respiratory academia are often overshadowed by the symptoms of hypoxia the patient may be exhibiting.

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3
Q

What are the 5 causes for acute respiratory acidosis ?

A

1. CNS depression - can be caused by opiates (main cause), sedatives additive effect to opiates

2. CNS injury - brain stem injury, CVA

3. Neuromuscular disease

  • Myasthenia Gravis
  • Guillain-Barre’ syndrome
  • Poliomyelitis

4. Airway obstruction

  • Mucus/foreign body
  • Severe bronchospasm of status asthmaticus
  • Bronchitis
  • Emphysema

5. Disorders of the chest

  • Flair chest
  • Pneumothorax
  • Kyphoscoliosis
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4
Q

What are the 3 causes for chronic respiratory acidosis?

A
  1. COPD
  2. Obesity – Pickwickian hypoventilation syndrome
  3. Diaphragmatic weakness/paralysis
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5
Q

What are the subjective exam findings associated with respiratory acidosis (acute/chronic)?

A

Acute respiratory acidosis:

  • Decreased level of consciousness, drowsiness to coma
  • Mental changes
    • Headache
    • Anxiety
    • Confusion
    • Hallucinations
  • Dyspnea

Chronic respiratory acidosis:

  • CNS symptoms
    • Sleep disturbances
    • Memory loss

Neuromuscular changes:

  • Impaired coordination
  • Tremor
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6
Q

What causes the subjective symptoms associated with respiratory acidosis?

A
  • The symptoms of respiratory acidosis result from changes in the cerebrospinal fluid (CSF) pH.
  • A very severe hypercapnia may be well tolerated if it is accompanied by renal compensation and a relatively normal pH. Conversely, only a slight rise in pCO2 may cause extreme symptoms if it occurs acutely.
  • Signs and symptoms of respiratory acidosis are also directly attributed to CO2 retention and are: bradypnea, drowsiness, confusion, papilledema and asterix.
    • These are generally not seen until the CO2 is 70 mmHg or higher
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7
Q

What are the physical exam findings associated with respiratory acidosis (acute/chronic)?

A

Acute respiratory acidosis:

  • Blood pressure elevation
  • CNS signs
    • Altered mental status or level of consciousness
    • Papilledema

Chronic respiratory acidosis:

  • CNS signs: none or mild tremor
  • Cardiovascular: you may see signs of cor pulmonale
    • Right ventricular heave
    • Pulmonary diastolic murmur
    • Cyanosis
  • Pulmonary: signs of COPD
    • Increased anterior-posterior chest diameter
    • Expiratory wheeze
    • Accessory respiratory muscle use
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8
Q

What laboratory/diagnostic tests are done to diagnose respiratory acidosis?

A
  1. ABG: pH, pCO2, pO2 and calculated HCO3
  2. Pulmonary Function tests
    • Decreased forced expiratory volume in 1 second (FEV1)
    • Increased residual volume
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9
Q

What is the treatment of acute respiratory acidosis based on?

A
  • Treatment should be based on patient symptoms and degree of acidemia.
  • If a patient has mild respiratory acidemia (pH 7.30-7.35) they can be observed while the causes are explored and corrected.
  • A patient with moderate respiratory acidemia (7.20-7.29) is on the edge of life threatening ventricular arrhythmias.
  • Patients with severe respiratory acidemia (pH 7.19 or lower) is at high risk for cessation of spontaneous respirations and ventricular arrhythmias.
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10
Q

How do you treat a patient with acute respiratory acidosis?

A

1. Assist ventilation

  • Facemask for continuous positive airway pressure
  • Airway intubation with mechanical ventilation

2. Reverse CNS depression if appropriate

  • Naloxone (Narcan) 0.4-2 mg IV for opioid overdose
  • Flumazenil (Romazicon) 0.2 mg (2 ml) IV over 30 seconds for benzodiazepine overdose (observe for seizures)

3. Reverse Airway obstruction

  • Bronchodilator therapy for bronchospasm with Albuterol (Ventolin, Proventil) 180 mcg inhaled Q6H Ipratropium (Atrovent) 36 mc inhaled Q6H
  • Mechanical extraction of secretions or foreign bodies
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11
Q

How do you treat a patient with chronic respiratory acidosis?

A
  1. Avoid respiratory depression (sedatives, O2 therapy exceeding 3L/min)
  2. Nocturnal continuous positive airway pressure
  3. Vigorous treatment of the underlying disorder
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12
Q

What is respiratory alkalosis?

A
  • It is a ventilatory process that decreases hydrogen resulting in a pH greater than 7.45
  • Identified by a decrease in arterial pCO2 to below 35 mmHg
  • Metabolic acidosis (decreased HCO3) is the compensating process
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13
Q

What are the 5 causes of acute respiratory alkalosis?

A

1. CNS disorders:

  • Anxiety, pain
  • Fever
  • Head trauma

2. Pulmonary diseases; decreased lung compliance

  • Pulmonary edema/CHF
  • Pneumonia
  • Pulmonary embolism
  • Asthma
  • Sepsis
  • Acute salicylate toxicity

3. Physiological conditions

  • Pregnancy
  • High altitudes

4. Drugs:

  • Salicylates
  • Aspirin
  • Progesterone

Miscellaneous

  • Hepatic failure
  • Hyperthyroidism
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14
Q

What causes the subjective symptoms associated with respiratory alkalosis?

A

The rise in CSF pH that occurs with respiratory alkalosis is associated with a significant reduction in cerebral blood flow that leads to the CNS/neurological symptoms

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15
Q

What are the subjective signs associated with respiratory alkalosis (acute/chronic)?

A

Acute respiratory alkalosis:

  • CNS symptoms
    • Lightheadedness
    • Confusion
  • Neurological
    • Paresthesias, especially around the mouth
  • Muscular symptoms – caused by an abrupt fall in ionized calcium that can occur
    • Chest tightness
    • Muscle cramps

Chronic respiratory alkalosis

  • Usually none because of a normal pH due to compensatory mechanisms
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16
Q

What are the physical signs associated with respiratory alkalosis (acute/chronic)?

A

Acute respiratory alkalosis:

  • Hyperactive deep tendon reflexes
  • Carpopedal spasm (tetany): flexed wrist/ankle with hyperextended digits (in severe cases)

Chronic respiratory alkalosis:

  • Usually none
17
Q

What laboratory/diagnostic tests are used to diagnose respiratory alkalosis?

A
  1. ABG: ph, pCO2, pO2 and calculated HCO3
  2. Tachyarrhythmias: ischemic like ST wave to T wave changes
18
Q

How do you treat a patient with respiratory alkalosis (acute/chronic)?

A

Acute respiratory alkalosis:

  • Treatment of underlying cause
    • Ventilator patients may only need setting adjustments
  • Anxiety causing hyperventilation
    • Give assurance
    • Use rebreathing into paper bag

Chronic respiratory alkalosis:

  • Generally none is required

ACNP II - Exam 1 (12 decks)

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