[Acid-Base imbalances] Respiratory acidosis / 호흡성 산증

1. 

Mnemonic을 먼저 알아야 함. 

Respiratory involvement를 알아야 함.

" If there is any problem with the patient breating rate (too slow), alveolar sacs demaged, 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.

 

2. Lab values (Respiratory acidosis)

-Blood pH decreased <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 back to normal.... so HCO3 becomes >26.

ACID	Normal	Base
pH		HCO3-
PaCO2

PH (Blood) Acid vs Base

PaCO2(Respiratory) >45 is an Acid, <35 is a BASE

HCO3-(Metabloic) <22 is an Acid, >26 is a BASE

--> Respiratory Acidosis: HCO3-가 BASE에 있으므로 not yet fully compensate. 
(partial compensation)

 

3. Causes of Respiratory Acidosis : remember DEPRESS breathing (anything that causes you to breathe slowly, blocks the airway, or causes the diaphragm not to work properly will cause respiratory acidosis)

(D) Drugs

       opioids like fentanyl and morphine, sedation like versed

       can causes respiratory depression - hypoventilation - retain carbon dioxide

       increase PaCO2 and decreased pH

       Diseases of the neuromuscular system-Myasthenia gravis, Guillain-Barré syndrome (weakness of voluntary muscles affects the disphragm...can't expelled the carbon dioxide)

(E) Edema (pulmonary) extra fluid in the lung causes impaired gas exchange

(P) Pneumonia.. excessive mucous production affect gas exchange.. the alveoli are majorly affected because they are filled with pus and fluid

(R) Respiratory center of brain damaged (brain injury, stroke)

(E) Emphysema: overinflated alveoli

(S) Spasms of bronchial tubes (asthma) bronchioles constrict and you have decreased gas exchange

(S) Sac elasticity of alveolar sac are damaged and this restricts air flow in and out of the lungs and this increases carbon dioxide (COPD)

 

4. S+S

 i) Major neuro changes: Confused, very drowsy, and reports a headache(이건 뭐 맨날 나옴)

 ii) low oxygen level (hypoxia), respiration rate less than 12

 iii) increased heart rate

 iv) hypotension

 v) increase carbon dioxide levels

 

5. NRS Action

 i) Administer oxygen: careful with oxygen administration in patients who have  chronic acidosis because their body has compensated and is used to the elevated CO2 levels. A low oxygen level guides their respiratory function and if oxygen levels go too high their breathing can decrease.

 ii) assess respirations and neuro status

 iii) encourage coughing and deep breathing

 iv) provide suctioning and mouth care

 v) may need respiratory treatment like bronchodilators

 vi) hold respiratory depression drugs (know the category of drugs used opiods, sedatives etc)

 ***) watch potassium levels that are >5.1!  

 vii) administer antibiotics for infection

 viii) may need endotracheal intubtion if CO2 b/c severely elevated