Causes of acute and chronic respiratory acidosis

The causes of increased CO2 may be excessive CO2 load, hypermetabolism, HCO3- titration, or, more commonly, reduction of alveolar ventilation. An excessive CO2 load rarely causes increased PCO2 in spontaneously breathing subjects, as the CO2 is a strong stimulus to ventilation. However, an extra CO2 load may cause respiratory acidosis in mechanically ventilated patients.

The most common cause of increased PCO2 is CO2 retention which may be due to changes in any of the organs involved in normal ventilation: the central nervous system, the conductive system (airways), the lung parenchyma, the inspiratory muscles, and the chest wall.

The most common causes of CO2 retention, which may be acute or chronic, are summarized in JableJ?.

Table 2 The most common causes of ventilatory impairment

Chapter References

Brackett, N.C., Cohen, J.J., and Schwartz, W.B. (1965). Carbon dioxide titration curve of normal man: effect of increasing degrees of acute hypercapnia on acid-base equilibrium. New England

Journal of Medicine, 272, 6-10.

Covelli, H.D., Black, J.W., Olsen, M.S., and Beekman, J.F. (1981). Respiratory failure by high carbohydrate loads. Annals of Internal Medicine, 95, 569-81.

Cunningham, D.J.C., Robbins, P.A., and Wolff, C.B. (1986). Integration of respiratory responses to changes in alveolar partial pressures of CO 2 and O2 and in arterial pH. In Handbook of physiology (ed. A.P. Fishman, N.S. Cherniack, J.G. Widdicombe, and R.G. Stephen), pp. 475-528. American Physiological Society, Bethesda, MD.

Long, G.L., et al. (1979). Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. Journal of Parenteral and Enteral Nutrition, 3, 452-6.

Weil, M.H., Rackow, E.C., Trevino, R., Grundler, W., Falk, J.L., and Griffel, M.I. (1986). Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. New England Journal of Medicine, 315, 153-6.

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