It's very difficult to write a good chapter about respiratory alkalosis (hypocapnia) or respiratory acidosis (hypercapnia). These states remind me a bit of grand central station, because each encompasses such a broad range of patients with different conditions – who need enormously different treatments. So any discussion of these conditions is by definition a gross generalization. Furthermore, it's very difficult to tease out the effects of hyper/hypocapnia from the effects of the underlying disease state. And finally, it's often best to focus on the underlying disease states rather than the hyper/hypocapnia – so an over-emphasis on these topics might even be detrimental!
For the sake of completeness, I have included these chapters. But please be very careful when reading them and applying them to your patients. The key of both hypercapnia and hypercapnia is to diagnose and treat the underlying disease (not necessarily the CO2!). You need to figure out why someone is in Grand Central station and where they are trying to go – only then can you help them.
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The IBCC chapter on respiratory acidosis (HYPERcapnia) is located 👉 here.
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The IBCC chapter on respiratory alkalosis (HYPOcapnia) is located 👉 here.
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Hello Dr. Farkas, thank you for the great article! A colleague (way more experienced than i am) from the icu said the following about the correction of pCO2: You should reduce pCO2 as aggressively as possible so they will get alkalosis. In the alkalotic state their body will adapt to the low CO2 levels and he won’t tolerate such high pCO2 the next time, increasing his ventilation drive and preventing another CO2 narcosis. He told me that after we intubated a patient with pCO2 130 pH 7,25 HCO3 55 (Patient was in sopor but not coma) After intubation the pCO2… Read more »
Great Article Dr Farkas
Our respiratory physician here loves using Azetazolamide in patients with chronic cor pulmonale. However, I am a little uneasy with the drug as patients who are well and walking around with no symptoms are given the drug based on numbers on the ABG. Would like to know your opinion on using CA inhibitors please. Thanks
Hi there,
Would love some discussion on obesity hypoventilation specifically; I’ve had enough patients who were so severe they required intubation (often due to flareups of other chronic diseases); always curious for learning points.
Thank you for everything you’ve written already, it’s a core element of my practice and I could never thank you enough.