1. Mechanical Airway Obstruction (ex: Tumor)
2. Acute Causes
2.1. Pleural effusion
2.2. Pneumothorax
2.3. CNS Depression
2.3.1. Drugs
2.3.2. CVA (ischemia)
2.4. Nervous System Disorders/diseases
2.4.1. MG
2.4.2. Guillian Barre
2.4.3. ALS
3. Chronic Causes
3.1. COPD
3.2. Asthma
3.3. Pleural Edema
3.4. Pleural Emboli
3.4.1. IV drug users
3.5. Pneumonia
3.6. ILD?
4. Definition: Retention of C02 (hypercapnia)
5. References
5.1. Akner, G., & Larsson, K. (2016). Undernutrition state in patients with chronic obstructive pulmonary disease. A critical appraisal on diagnostics and treatment. Respiratory Medicine,117, 81-91. doi:10.1016/j.rmed.2016.05.023
5.2. Bruno, C. M., & Valenti, M. (2012). Acid-base disorders in patients with chronic obstructive pulmonary disease: A pathophysiological review. Journal of Biomedicine & Biotechnology,2012, 915150-8. doi:10.1155/2012/915150
5.3. McCance, K. L. & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in adults and children. (7th ed.). St. Louis: Mosby. ISBN 978-0-323-08854-1
5.4. Terzano, C., Di Stefano, F., Conti, V., Di Nicola, M., Paone, G., Petroianni, A., & Ricci, A. (2012). Mixed acid-base disorders, hydroelectrolyte imbalance and lactate production in hypercapnic respiratory failure: The role of noninvasive ventilation. PloS One, 7(4), e35245.
6. Airway Obstruction
6.1. Acute
6.1.1. Kidneys do not have enough time to compensate
6.1.1.1. Not a strong buffer
6.1.1.2. Acute uncompensated appearance
6.1.1.2.1. Decreased PH
6.1.1.2.2. Elevated PaC02
6.1.1.2.3. Normal/slightly elevated bicarb %
7. Symptoms
7.1. Rapid/shallow resperations/dyspnea
7.2. Pallor/cyanosis of skin
7.2.1. only if hypoxic
7.2.1.1. Skin may be pink secondary to vasodilation
7.3. Weakness/fatigue/malaise
7.4. Dizziness
7.5. Confusion/disorientation
7.6. Hypertension/tachycardia/arrythmias
7.7. Nausea/vomiting
7.8. Diarrhea
8. Pathophysiology
8.1. Decrease perfusion
8.1.1. Hypoxic injury
8.1.1.1. Anaerobic Metabolism
8.1.1.1.1. Lactic acid production
8.1.1.1.2. Decreased ATP
8.1.1.1.3. Impaired glucose delivery/use
8.1.1.2. Increase Blood Pa02
8.1.1.3. Decrease Serum pH
8.1.1.3.1. Decrease pH CSF
9. Chronic obstruction
9.1. Effective renal compensation
9.1.1. acidosis produced from C02
9.1.1.1. stimulates kidneys to make Bicard from H+
9.1.1.1.1. Bicarb % elevated in blood
9.1.1.1.2. PaC02 levels elevated
9.1.1.1.3. pH levels normal (compensated)
10. Outcome
10.1. If uncorrected
10.1.1. Shock
10.1.1.1. Death