University Of Guyana

Faculty Of Health Sciences

College Of Medical Sciences
Course: MED 1102- Biochemistry
Lecturer: Dr. Emanuel Cummings
Title: Respiratory Acidosis
 GROUP MEMBERS
• Ave Abraham 1028909
• Ajay kissoon 1048319
• Amelia Ram 1044040
• Chaill Godette 1036263
• Kahdija Higgins 1039608
• Kaileigh Burnette 1041128
• Latwana Victorine 1030053
• Marlina D’Aguiar 1039957
• Oumadavi Manoo 1031723
 GROUP MEMBERS
• Ramesh Bradrinauth 1048336
• Revon Lafleur 1047496
• Shereeza Lall 1032360
• Trishelle Ross 1031123
• Samuella Williams 1046071
• Shaquana October 1033280
• Tabia Jacobs 1033698
• Tashana Ramnarine 1048316
• Sharmella Solomon 1026902
• Joshua Singh 1048313
 Objectives

01 02 03 04
Define List the types of State the causes of
Discuss the
Respiratory Respiratory
Buffer System Respiratory Acidosis
Acidosis Acidosis

05 06 07
Identify the signs and Understand how RespiratoryOutline the prevention 08
symptoms of Respiratory of Respiratory Identify the correct
Acidosis is diagnosed
Acidosis Acidosis treatment for Respiratory
Acidosis
 What is Respiratory Acidosis?
• Respiratory acidosis is an acid-base balance disturbance due to alveolar hypoventilation.
• This occurs when the lungs cannot remove all the carbon dioxide produced by the body
which results in acidosis(MedlinePlus,2022).
• A disruption in the arterial carbon dioxide partial pressure (pCO2).
• pCO2 is increased and a lowered ratio of arterial bicarbonate (HCO3-) to arterial pCO2,
eventually causes the blood pH to fall from its normal range of 7.35 to 7.45(Patel &
Sharma, 2023).
• To compensate for this disturbance, the kidneys start to excrete more acid in the forms of
hydrogen(H+) and ammonium (NH4+) and reabsorb more base in the form of
bicarbonate(HCO3-).
 TYPES OF RESPIRATORY
ACIDOSIS
Acidic Respiratory Acidosis
• This occurs when there is a sudden spike in carbon dioxide levels in the
lungs(Healthline,2021) because of ventilation failure.
• Carbon(II) oxide remains in the body and mixes with the water in the body forming carbonic
acid.
• RA may occur because of cerebrovascular accidents, emphysema, obstructed airway, use of
central nervous system depressants, or inability to use respiratory muscles.
• It qualifies as a medical emergency when compensation has failed with symptoms including
muscle jerking, confusion, drowsiness, shortness of breath, lethargy, fatigue, warm and
flushed skin, and anxiety.
 TYPES OF RESPIRATORY
Chronic Respiratory Acidosis ACIDOSIS
• Unlike acute respiratory acidosis, chronic respiratory acidosis is asymptomatic, it takes longer to be
recognized and it also occurs gradually and over a long period.
• The kidneys increase the production of body chemicals such as bicarbonate which will help to restore
and maintain the body’s acid-base balance.
• It leads to a stable situation, because instead of fighting the increased acidity, the body will adapt to it
(MedlinePlus).
• Chronic respiratory acidosis may be caused by Chronic Obstructive Pulmonary Disease or COPD.
• Some other causes of chronic respiratory acidosis include asthma, acute pulmonary edema, scoliosis,
and obesity.
• Overtime, there may be coordination problems, memory loss, sleeplessness and headaches, or even
high blood pressure(Weatherspoon, 2021).
 BUFFER SYSTEM

• A solution that withstands the addition of acids or bases without changing its pH,
when those changes to PH are small (Solanki & Wyman, 2023).
 Bicarbonate-Carbonic Acid BUFFER
SYSTEM
• A buffer consisting of the bicarbonate ion (HCO3-) and carbonic acid (H2CO3- )
keeps the pH of human blood constant.
• The bicarbonate buffering mechanism is particularly important because carbon dioxide
(CO2) can be shifted through carbonic acid (H2CO3) to hydrogen ions and
bicarbonate (HCO3−):

• H2O+CO2⇋H2CO3⇋HCO3−+H+ (Libretexts, 2023).

• In this buffer system, a weak acid or weak base seizes the free ions, preventing a pH
shift.
• If the blood pH is within the normal range, the bicarbonate ions and carbonic acid in
the blood have a 20:1 ratio.
 PROTEIN BUFFER
SYSTEM
Blood Plasma and Cells
• The protein buffer system is primarily present inside cells and serves an important
function in maintaining acid-base balance.
• Proteins, which are composed of amino acids, include both positively and negatively
charged amino groups and carboxyl groups.
• These molecules' charged portions can bind hydrogen and hydroxyl ions and so act
as buffers.
• They are responsible for two-thirds of the blood's buffering capability and the
majority of the buffering within cells.
 PROTEIN BUFFER
Hemoglobin SYSTEM
• The primary protein contained in red blood cells, hemoglobin, accounts for one-third of
the cell's mass.
• Carbonic acid is formed when carbon dioxide diffuses rapidly across cellmembranes and
interacts with water in respiratory acidosis.
• Haemoglobin acts as a buffer by absorbing hydrogen ions liberated during the conversion
of carbon dioxide (CO2) into bicarbonate (HCO3-)2.
• In the pulmonary capillaries, this process is reversed to convert CO2,which can then
diffuse into the air sacs and be expelled into the atmosphere.
• Hydrogen ions are buffered by hemoglobin and other negatively charged intracellular
molecules, such as those possessing phosphate groups.
 PHOSPHATE BUFFER
SYSTEM
• It functions within each cell's internal fluid.
• Tries to maintain homeostatic pH within our bodies.
• Has dihydrogen phosphate ions ([H2PO4]−), which serve as the hydrogen ion donor
(acid), and the hydrogen phosphate ion ([HPO4]2-) is the acceptor (base).
• The dihydrogen phosphate ion neutralizes additional hydroxide ions that may enter
the cellular fluid.
• Hydrogen phosphate ion neutralizes additional hydrogen ions that may enter the
cellular fluid.
• Kidney excretion of phosphate controls phosphoric acids (phosphates) that may alter
pH.
 CAUSES OF RESPIRATORY
ACIDOSIS
Acute causes of Respiratory Acidosis: Chronic Causes of Respiratory Acidosis:
• Overuse of substances that affect your central • Asthma
nervous system, including alcohol, • Chronic obstructive pulmonary disease
amphetamines and opioids. (COPD)
• Emphysema. • Pulmonary fibrosis
• Pneumonia. • Acute Pulmonary Edema
• Sleep apnea. • (neuromuscular disorders), including
• Cardiac Arrest multiple sclerosis (MS) and muscular
dystrophy.
• Obesity
• Scoliosis
 CAUSES OF RESPIRATORY
ACIDOSIS
Other Common causes :
• Stabs
• Gunshot wound
• Accidents
• CoronaVirus Disease 2019 (COVID-19)
 SIGNS AND SYMPTOMS

The symptoms of respiratory acidosis arise from the

effects of elevated CO2 levels.
Symptoms include:
• Headaches
• Involuntary muscle movements
• Blurred vision
• Fatigue
• Memory loss
• High blood pressure (pulmonary hypertension)
(Weatherspoon, 2021)
Clinical Presentation
DIAGNOSIS
 prevention
• Avoid Smoking: to protect lung health and prevent various respiratory diseases,
including COPD (Hadjiliadis, 2021).

• Manage Long-Term Respiratory Illnesses: Regular monitoring and management of

conditions like asthma and COPD (Cleveland Clinic Medical Professionals, 2023).

• Weight Management: Maintaining a healthy weight through diet and exercise

(Bender, 2017).

• Sedatives: Use sedative medications with caution, follow prescribed dosages, and
avoid using them with alcohol (Australian Indigeneous HealthInfoNet, 2022).
 prevention
• CPAP Device: If prescribed a continuous positive airway pressure (CPAP) device
use it regularly to ensure proper airflow during sleep (Cleveland Clinic Medical
Professionals, 2023).

• Regular Exercise: Physical activity strengthens both the heart and lungs, contributing
to overall respiratory health (Bender, 2017).

• Manage Cholesterol and Blood Pressure: Controlling cholesterol and blood pressure
levels is essential for proper oxygen supply to the body (Beckerman, 2023).
 prevention
• Stress Management: High stress levels can lead to shallow breathing and other
respiratory issues, so stress management techniques are important (Amaiza, 2023).

• Avoid Close Contact with Respiratory Infections: Preventing the spread of

contagious respiratory infections by avoiding close interactions with infected
individuals can help reduce the risk of infection (Bender, 2017).

• Air Quality: Avoid exposure to air pollutants, allergens, and irritants (Australian
Indigeneous HealthInfoNet, 2022).
treatment
treatment
treatment
 treatment
• You do not need to treat acid-base disorders unless the compensatory mechanism is
failing.
• As per the previous table, you will notice that in acute respiratory acidosis if the
paCO2 rises by 10 mmHg then bicarbonate should be increased by 1 mEq/L.
• In the above case, the compensation is satisfactory to maintain homeostasis.
• The above information is assessed by looking at the serum chemistry and ABG
results.
• If the calculated values do not adhere to the compensatory mechanisms, then you
have to intervene and treat the underlying cause
• Advanced Organ Support (ADVOS) system (enhanced renal support therapy based
on albumin dialysis).
treatment
ABG
 treatment
Treatment for respiratory acidosis will depend on the cause, as you must first treat the
underlying condition, but the goal is likely to make breathing easier. Some treatment
methods include for example:
• Antibiotics
• Diuretics
• Bronchodilators
• Corticosteroids
• ADVanced Organ Support (ADVOS) system
 treatment
• Detoxification .
• Hemodialysis
• Inotropes and other medications
• In addition, mechanical ventilation -used only in severe cases (Loik, 2023)
 case study
Mr Afridi is a 67-year-old war veteran who consults you for the first time. He complains
of being short of breath on exertion. From his history and examination you suspect
chronic obstructive airway disease due to a long history of smoking (20+ per day for 50
years). While he is still well you send him off for some respiratory function tests. You
also order blood gas measurements and the laboratory returns the following results:
 case study
• The patient has chronic respiratory acidosis (elevated CO2 levels)
• Elevation in plasma bicarbonate indicates the production of bicarbonate by the
kidney as renal compensation for respiratory acidosis.
• Drug treatment is a program of appropriate inhaled bronchodilators and inhaled
steroids.
 case study
Mr. Thomas is a 61 year old man with chronic obstructive pulmonary disease (COPD)
patient. He did an ABG as part of his routine care and the results are as follows:
 case study
Acid/base status
• The patient has a normal pH (neither acidemic nor alkalotic)
• The patient has a low PO2 (normal for COPD patients)
• High PCO2 (Chronic Respiratory acidosis)
• HCO3 is high (metabolic compensation is occurring).
 rEFERENCES
• Amaiza. (2023). How does stress affect your respiratory system? Tips to overcome it!
NCBlpc. https://ncblpc.org/stress-affect-your-respiratory-system/
• Australian Indigeneous HealthInfoNet. (2022). Prevention and management - respiratory
health. Australian Indigenous HealthInfoNet.
https://healthinfonet.ecu.edu.au/learn/health-topics/respiratory-health/prevention-and-manage
ment/
• Beckerman, J. (2023). Understanding low blood pressure -- symptoms. WebMD.
https://www.webmd.com/heart/understanding-low-blood-pressure-symptoms
• Bender, K. (2017). What to know about respiratory acidosis. Medical News Today.
https://www.medicalnewstoday.com/articles/313110#prevention
• Biga, L. M. (2019b). 26.4 Acid-Base balance. Pressbooks.
https://open.oregonstate.education/aandp/chapter/26-4-acid-base-balance/
 REFERENCES
• Buffer systems. (2023). MedicTests . https://medictests.com/units/buffer-systems
• Cambridge Medical & Rehabilitation Center. (2022). Acute Respiratory Acidosis.
https://cmrc.com/acute-respiratory-acidosis/
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https://my.clevelandclinic.org/health/diseases/24834-respiratory-acidosis
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https://my.clevelandclinic.org/health/diseases/24834-respiratory-acidosis
• Hadjiliadis, D. (2021). Respiratory acidosis. MedlinePlus Medical Encyclopedia.
https://medlineplus.gov/ency/article/000092.htm
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 REFERENCES
• Libretexts. (2023e). 10.4: Biological buffers. Chemistry LibreTexts.
https://chem.libretexts.org/Courses/South_Puget_Sound_Community_College/Chem_121_OER_Textbo
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• Libretexts. (2023e). 25.4B: Chemical buffer systems. Medicine LibreTexts.

https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundles
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• Loik, M. (2023). RESPIRATORY ACIDOSIS – Symptoms, Causes, Risk Factors, Prevention and
Respiratory Acidosis Treatment.
https://ecosh.com/respiratory-acidosis-symptoms-causes-risk-factors-prevention-and-respiratory-acidosis
-treatment/
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https://emedicine.medscape.com/article/301574-workup?0=reg=1#c9
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 REFERENCES
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