RESPIRATORY ACIDOSIS (CARBONIC ACID EXCESS)

• A clinical disorder in which the pH is less than 7.35 and the PaCO 2 is greater than
45 mm Hg

CAUSES

• Caused by failure of the respiratory system to remove CO2 from body fluids as fast
as it is produced in the tissues
• Is always due to inadequate excretion of CO2 with inadequate ventilation, resulting
in elevated plasma CO2 levels and thus elevated carbonic acid levels
• May be acute or chronic
 Acute respiratory acidosis occurs in emergency situation, such as acute
pulmonary edema, aspiration of foreign object, atelectasis, pneumothorax,
overdose of sedatives, sleep apnea syndrome, administration of oxygen to a
patient with chronic hypercapnia, severe pneumonia, and acute respiratory
distress syndrome
 Chronic respiratory acidosis occurs with pulmonary diseases such as chronic
emphysema and bronchitis, obstructive sleeping apnea, and obesity. If
PaCO2 rises rapidly cerebral vasodilation will 
ICP; cyanosis and tachypnea
will develop.

SIGNS AND SYMPTOMS

• Hypercapnea(elevated PaCO2) – can cause PR, RR, BP, mental

cloudiness, and feeling of fullness in head; causes cerebrovascular vasodilatation
and cerebral blood flow.
• Ventricular fibrillation
• ICP resulting in papilledema and dilated conjunctival blood vessels
• Hyperkalemia may result H concentration overwhelms the compensatory
mechanism and moves into cells causing a shift of K out of the cells

ASSESSMENT AND DIAGNOSTIC FINDINGS

• ABG evaluation reveals a pH less than 7.35, a PaCO2 greater than 45 mm Hg

• Monitoring of serum electrolyte levels
• Chest X-ray for determining respiratory disease
• Drug screen if an overdose is suspected
• ECG to identify the cardiac involvement
 NURSING DIAGNOSIS

• Impaired Gas Exchange related to ventilation perfusion imbalance (e.g., altered

oxygen carrying capacity of blood, altered oxygen supply, alveolar-capillary membrane
changes, or altered blood flow).

MEDICAL MANAGEMENT

• Treatment is directed at improving ventilation

• Bronchodilators help reduce bronchial spasm
• Antibiotics used for respiratory infections
• Thrombolytics or anticoagulants used for pulmonary emboli
• Pulmonary hygiene measures are initiated to clear the respiratory tract of mucus
and purulent drainage
• Adequate hydration of about 2-3L/day is indicated to keep mucous membranes
moist and thereby facilitating removal of secretions
• Supplemental O2 as necessary
• Mechanical ventilation may improve pulmonary ventilation. Place client in semi-
Fowler’s position to facilitate expansion of the chest wall

PATHOPHYSIOLOGY
 OBSTRUCTIVE/RESTRICTIVE LUNG DISEASES
IMPAIRED MOVEMENT OF THORACIC CAGE
DEPRESSED RESPIRATORY CENTERS
NEUROMUSCULAR DISEASE

HYPOVENTILATION ( PaCO2)

 BLOOD PH

HYPERVENTILATION RENAL BUFFERING 48-72HRS

BLOW OFF CO2 H EXCRETION HCO3 RETENTION

BLOOD pH RETURNS NH3 – NH4 PRODUCTION

TO NORMAL
 RESPIRATORY ALKALOSIS (CARBONIC ACID DEFICIT)

• A clinical condition in which the arterial pH is greater that 7.45 and the PaCO 2 is
less than 35 mm Hg.

CAUSES

• Due to hyperventilation which causes excessive “blowing off” of CO2 and, hence, a
decrease in the plasma carbonic acid concentration.
• Extreme anxiety, hypoxemia, the early phase of salicylate intoxication, gram-
negative bacteremia, and inappropriate ventilator settings
• Chronic respiratory alkalosis results from chronic hypocapnia, and decreased
serum bicarbonate levels are the consequence. Chronic hepatic insufficiency and
cerebral tumors are predisposing factors.

SIGNS AND SYMPTOMS

• Lightheadedness due to vasoconstriction and decreased cerebral blood flow

• Inability to concentrate
• Numbness and tingling from decreased calcium ionization
• Tinnitus
• Loss of consciousness
• Cardiac effects: tachycardia and ventricular and atrial dysrhythmias.

ASSESSMENT AND DIAGNOSTIC FINDINGS

• ABG analysis reveals elevated pH as a result of low PaCO2 and a normal

bicarbonate level
• Evaluation of serum electrolytes is indicated to identify any decrease in K as H is
pulled out of cells in exchange for K; decreased Calcium, as severe alkalosis inhibits
Calcium ionization, resulting in carpopedal spasm and tetany; or  Phosphate due to
alkalosis, causing an uptake of Phosphate by the cells.

NURSING DIAGNOSIS

• Impaired Gas Exchange related to ventilation imbalance (e.g., altered oxygen

supply, altered blood flow, altered oxygen-carrying capacity of blood, alveolar-capillary
membrane changes)
 MEDICAL MANAGEMENT

• Anxiety – the patient is instructed to breathe more slowly to allow CO2 to

accumulate or to breathe into a closed system such as a paper bag. Sedatives may be
used to relieve hyperventilation
• Treat underlying symptoms

PATHOPHYSIOLOGY

ANXIETY
FEVER
MENINGITIS
ASA POISONING
PNUEMONIA

HYPERVENTILATION

HYPOCAPNIA (PaCO2)

BLOOD VOLUME

HYPOVENTILATION RENAL BUFFERING 48-72HRS

RETENTION OF CO2 H RETENTION HCO3 EXCESS

BLOOD pH RETURNS
TO NORMAL