Hypercapnia: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*[[Headache]], confusion, lethargy, [[seizure]], coma | *[[Headache]], [[confusion]], [[lethargy]], [[seizure]], [[coma]] | ||
*Extreme hypercapnia (acute elevation >100) can result in | *Extreme hypercapnia (acute elevation >100) can result in [[shock|cardiovascular collapse]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Depressed central respiratory drive | *Depressed central respiratory drive | ||
**Structural CNS disease: brainstem lesions | **Structural CNS disease: brainstem lesions | ||
**Drug depression of respiratory center: opioids, sedatives, anesthetics | **Drug depression of respiratory center: [[opioids]], [[sedatives]], anesthetics | ||
**Endogenous toxins: tetanus | **Endogenous toxins: [[tetanus]] | ||
*Thoracic cage disorders | *Thoracic cage disorders | ||
**Kyphoscoliosis | **Kyphoscoliosis | ||
**Morbid obesity | **Morbid [[the obese patient|obesity]] | ||
*Neuromuscular impairment | *Neuromuscular impairment | ||
**Neuromuscular disease: myasthenia gravis, Guillain- | **Neuromuscular disease: [[myasthenia gravis]], [[Guillain-Barre]] | ||
**Neuromuscular toxin: organophosphate | **Neuromuscular toxin: [[organophosphate toxicity]], [[botulism]] | ||
*Intrinsic lung disease associated with increased dead space | *Intrinsic lung disease associated with increased dead space | ||
**[[COPD]] | **[[COPD]] | ||
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*[[ABG]] | *[[ABG]] | ||
**HCO3 increases 1 mEq/L for each 10mmHg increase in PaCO2 (acute) | **HCO3 increases 1 mEq/L for each 10mmHg increase in PaCO2 (acute) | ||
**HCO3 | **HCO3 increases 3.5 mEq/L for each 10mmHg increase in PaCO2 (chronic) | ||
==Management== | ==Management== | ||
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*[[Hypoxemia]] | *[[Hypoxemia]] | ||
*[[Shortness of breath]] | *[[Shortness of breath]] | ||
*[[Respiratory acidosis]] | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Pulmonary]] | [[Category:Pulmonary]] | ||
[[category:critical Care]] | |||
Latest revision as of 16:04, 12 October 2019
Background
- PaCO2 >45
- Exclusively caused by alveolar hypoventilation
- Results from decrease in respiratory rate, tidal volume, or increase in dead space
Clinical Features
- Headache, confusion, lethargy, seizure, coma
- Extreme hypercapnia (acute elevation >100) can result in cardiovascular collapse
Differential Diagnosis
- Depressed central respiratory drive
- Thoracic cage disorders
- Kyphoscoliosis
- Morbid obesity
- Neuromuscular impairment
- Neuromuscular disease: myasthenia gravis, Guillain-Barre
- Neuromuscular toxin: organophosphate toxicity, botulism
- Intrinsic lung disease associated with increased dead space
- Upper airway obstruction
Evaluation
- ABG
- HCO3 increases 1 mEq/L for each 10mmHg increase in PaCO2 (acute)
- HCO3 increases 3.5 mEq/L for each 10mmHg increase in PaCO2 (chronic)
Management
- Increase minute ventilation (rate and/or tidal volume)