1. Mechanical Airway Obstruction (ex: Tumor)
2. Airway Obstruction
2.1. Acute
2.1.1. Kidneys do not have enough time to compensate
2.1.1.1. Not a strong buffer
2.1.1.2. Acute uncompensated appearance
2.1.1.2.1. Decreased PH
2.1.1.2.2. Elevated PaC02
2.1.1.2.3. Normal/slightly elevated bicarb %
3. Acute Causes
3.1. Pleural effusion
3.2. Pneumothorax
3.3. CNS Depression
3.3.1. Drugs
3.3.2. CVA (ischemia)
3.4. Nervous System Disorders/diseases
3.4.1. MG
3.4.2. Guillian Barre
3.4.3. ALS
4. Symptoms
4.1. Rapid/shallow resperations/dyspnea
4.2. Pallor/cyanosis of skin
4.2.1. only if hypoxic
4.2.1.1. Skin may be pink secondary to vasodilation
4.3. Weakness/fatigue/malaise
4.4. Dizziness
4.5. Confusion/disorientation
4.6. Hypertension/tachycardia/arrythmias
4.7. Nausea/vomiting
4.8. Diarrhea
5. Chronic Causes
5.1. COPD
5.2. Asthma
5.3. Pleural Edema
5.4. Pleural Emboli
5.4.1. IV drug users
5.5. Pneumonia
5.6. ILD?
6. Definition: Retention of C02 (hypercapnia)
7. Pathophysiology
7.1. Decrease perfusion
7.1.1. Hypoxic injury
7.1.1.1. Anaerobic Metabolism
7.1.1.1.1. Lactic acid production
7.1.1.1.2. Decreased ATP
7.1.1.1.3. Impaired glucose delivery/use
7.1.1.2. Increase Blood Pa02
7.1.1.3. Decrease Serum pH
7.1.1.3.1. Decrease pH CSF
8. References
8.1. 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
8.2. 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
8.3. 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
8.4. 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.
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